BPH: Medical Management (Benign Prostatic Hyperplasia /Enlarged Prostate)
Throughout a man's life, the prostate may grow and start to cause problems as a man gets older. For many years, surgery was the only relief for this very common problem. Today, medications are the most common method for controlling urinating symptoms of BPH. What are the causes of these symptoms and what are some of the new treatments? The following should help answer that question as well as others.
What is the prostate?
The prostate, part of the male reproductive system, is about the same size and shape as a walnut and weighs about an ounce. It is located below the bladder and in front of the rectum and surrounds the urethra, the tube-like structure that carries urine from the bladder out through the penis. The main function of the prostate is to produce ejaculatory fluid.
What is BPH?
Benign prostatic hyperplasia (BPH) is a common urological condition caused by the non-cancerous enlargement of the prostate gland in aging men. Urinating symptoms can occur as the prostate enlarges.
What are some of the risk factors for BPH?
Risk factors for developing BPH include increasing age and a family history of this condition.
What are some of the symptoms associated with BPH?
Since the prostate surrounds the urethra just below the bladder, its enlargement can result in symptoms that irritate or obstruct the bladder. A common symptom is the need to frequently empty the bladder, especially at night. Other symptoms include difficulty in starting the urine flow or dribbling after urination ends. Also, size and strength of the urine stream may decrease.
How are the urinating symptoms secondary to BPH diagnosed?
In order to help assess the severity of such symptoms, the American Urological Association (AUA) BPH Symptom Score Index was developed. This diagnostic system includes a series of questions that target the frequency of the urinary systems identified above, and as a result, helps identify the severity of the BPH — ranging from mild to severe.
There are a number of diagnostic test procedures that can be used to confirm BPH. The tests vary from patient to patient, but the following are the most common: digital rectal examination (DRE), PSA test, transrectal ultrasound (this measures the size of the prostate), urine flow study (this measures the speed and strength of the urinary stream), measurement of how much urine is left after urinating (post-void residual urine) and cystoscopy (a fiber-optic instrument inserted into the urethra to examine both the prostate and the urinary bladder).
What are some of the medical treatments available for BPH?
Alpha blockers: These drugs, originally used to treat high blood pressure, work by relaxing the smooth muscle of the prostate and bladder neck to improve urine flow and reduce bladder outlet obstruction. Although alpha blockers may relieve the symptoms of BPH, they usually do not reduce the size of the prostate. They are usually taken orally, once or twice a day and they work almost immediately. Commonly prescribed alpha blockers include: alfuzosin, terazosin, doxazosin and tamsulosin. Side effects can include headaches, dizziness, lightheadedness, fatigue and ejaculatory dysfunction.
5-alpha-reductase inhibitors: Finasteride and dutasteride are oral medications that work completely different then alpha blockers. In select men, finasteride and dutasteride can relieve BPH symptoms, increase urinary flow rate and actually shrink the prostate though it must be used indefinitely to prevent recurrence of symptoms. Studies suggest that these medications may be best suited for men with relatively large prostate glands. It may take as long as six months to a year, however, to achieve maximum benefits from this drug. . These drugs reduce the risk of BPH complications such as acute urinary retention (suddenly being unable to urinate) and the eventual need for BPH surgery. Side effects can include impotence, decreased libido and reduced semen release during ejaculation.
Combination Therapy: The use of both alpha blockers and 5-alpha-reductase inhibitors result in better amelioration of symptoms and long term benefits than using only one type of drug. However, this improved benefit may be associated with more side effects (possible side effects from both medications).
Phytotherapies: These compounds, also known as herbal therapies, are very popular self treatment remedies. However their effectiveness is not really known but if they provide benefit, it is much less than other medical therapies.
Frequently asked questions:
Is BPH a rare condition?
No, it is very common. It will affect approximately 50 percent of men between the ages of 51 and 60 and up to 90 percent of men over the age of 80.
Does BPH lead to prostate cancer?
No, BPH is not cancer and cannot lead to cancer, although both conditions can exist together. There are usually no symptoms during the early stages of prostate cancer, so yearly physical examinations and PSA tests are highly recommended.
Which type of drugs are the best?
Alpha blockers work in most patients and provide early relief of symptoms. But alpha blockers may not protect against progression of BPH over time and symptoms or BPH related complications may re-occur. 5-alpha-reductase inhibitors appear to work best in men with large prostates and do reduce the risk of BPH progression over time. The combination of both of these drugs provide the best benefit but also the highest risk of potential side effects.
How do I know if oral medications are the best treatment for me?
If you are diagnosed with BPH, you should discuss all treatment options with your urologist. Together, you can decide whether medication or surgical treatment is best for you.
Where can I get more information?
Hormone Health Network's Enlarged Prostate Fact Sheet
Common terms for BPH: enlarged prostate big prostate
Reviewed: January 2011
Last updated: April 2013
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