BPH stands for benign prostatic hyperplasia (pronounced be-NINE prah-STAT-ik-HY-per-PLAY-zha). Benign means "not cancer" and hyperplasia means too much growth. The result is that the prostate becomes enlarged. BPH is not linked to cancer and does not raise your chances of getting prostate cancer—yet the symptoms for BPH and prostate cancer can be similar.
BPH Symptoms
BPH Symptoms usually start after the age of 50. They can include:
- Trouble starting a urine stream or making more than a dribble.
- Passing urine often, especially at night.
- Feeling that the bladder has not fully emptied.
- A strong or sudden urge to pass urine.
- Weak or slow urine stream.
- Stopping and starting again several times while passing urine.
- Pushing or straining to begin passing urine.
At its worst, BPH can lead to:
- A weak bladder
- Backflow of urine causing bladder or kidney infections
- Complete block in the flow of urine
- Kidney failure
How can BPH be treated?
About half of the men with BPH eventually have symptoms that are bothersome enough to need treatment. BPH cannot be cured, but drugs or surgery can often relieve its symptoms. BPH symptoms do not always grow worse.
Here are three ways to manage BPH:
- Surgery
- Active surveillance (regular follow-up with your doctor)
- Drug therapy
BPH Surgery
The number of prostate surgeries has gone down over the years. But operations for BPH are still one of the most common surgeries for American men. Surgery is used when symptoms are severe or drug therapy has not worked.
Types of Surgery:
- TURP (transurethral resection of the prostate) is the most common surgery for BPH. It accounts for 90 percent of all BPH surgeries. It takes about 90 minutes. The doctor passes an instrument through the urethra and trims away extra prostate tissue. A spinal block is used to numb the area. Tissue is sent to the laboratory to check for prostate cancer.
TURP generally avoids the two main dangers linked to other prostate surgeries:
- Incontinence (not being able to hold in urine)
- Impotence (not being able to have an erection)
The recovery period for TURP is much shorter as well.
- TUIP (transurethral incision of the prostate) is similar to TURP. It is used on slightly enlarged prostate glands. The surgeon places one or two small cuts in the prostate. This relieves pressure without trimming away tissue. It has a low risk of side effects. Like TURP, this treatment helps with urine flow by widening the urethra.
- TUNA (transurethral needle ablation) burns away excess prostate tissue using radio waves. It helps with urine flow, relieves symptoms, and may have fewer side effects that TURP. Most men need a catheter to drain urine for a period of time after the procedure.
- TUMT (transurethral microwave thermotherapy) uses microwaves sent through a catheter to destroy excess prostate tissue. This can be an option for men who should not have major surgery because they have other medical problems.
- TUVP (transurethral electroevaporation of the prostate) uses electrical current to vaporize prostate tissue.
- Open prostatectomy means the surgeon removes the prostate through a cut in the lower abdomen. This is done only in very rare cases when obstruction is severe, the prostate is very large, or other procedures can't be done. General or spinal anesthesia is used and a catheter remains for 3 to 7 days after the surgery. The prostate is sent to the laboratory to check for prostate cancer.
Active Surveillance
Men with mild symptoms of BPH who do not find them bothersome often choose this approach. Active surveillance means getting annual checkups. The checkups can include DREs and other tests. Treatment is started only if symptoms become too much of a problem.
If you choose to live with symptoms, three simple steps can help:
- Limit drinking in the evening, especially drinks with alcohol or caffeine.
- Empty the bladder all the way when you pass urine.
- Use the restroom often. Don't wait for long periods without passing urine.
- Some medications can make BPH symptoms worse, so talk with your doctor or pharmacist about any medicines you are taking such as:
- Over-the-counter cold and cough medicines (especially antihistamines)
- Tranquilizers
- Antidepressants
- Blood pressure medicine
Drug Therapy
Millions of American men with mild-to-moderate BPH symptoms have chosen prescription drugs over surgery since the early 1990s.
There are two types of drugs used. One type relaxes muscles near the prostate while the other type shrinks the prostate gland. Evidence shows that taking both drugs together may work best to keep BPH symptoms from getting worse.
Alpha-blockers help relax muscles near the prostate to relieve pressure and let urine flow more freely, but they don't shrink the size of the prostate. For many men, the drug can improve urine flow and reduce symptoms within days. Possible side effects include dizziness, headache, and fatigue.
5-Alpha-reductase inhibitors (finasteride and dutasteride) relieve symptoms by blocking an enzyme that acts on the male hormone, testosterone, to boost organ growth. When the enzyme is blocked, growth slows down. This helps shrink the prostate, reduces blockage, and limits the need for surgery.
Taking this drug for at least 6 months to 1 year can increase urine flow and reduce your symptoms. It seems to work best for men with very large prostates. You must continue to take the drug to prevent symptoms from coming back.
The drug is also used to treat baldness in men. It can cause these side effects in a small percentage of men:
- Decreased interest in sex.
- Trouble getting or keeping an erection.
- Smaller amount of semen with ejaculation.
It's important to note that taking this drug can lower your PSA test levels. There is also evidence that these drugs lower the risk of getting prostate cancer, but whether they reduce the risk of dying from prostate cancer is still unclear.
Talk to your doctor about the best choice for you. Your symptoms may change over time, so be sure to tell your doctor about any changes.
