Prostate Health Report
The Power of Prevention
By Jason Forsythe

Does your enlarged prostate have you running to the bathroom at all hours?
If so, rest assured — you have a prostate condition that can be treated.

It’s a fact of life that more than half of all men between the ages of 51 and 60, and almost all men over age 80, suffer from symptoms of an enlarged prostate. It is equally true that benign prostatic hyperplasia (BPH) is a treatable condition.

The Basics
The prostate is a small gland the size of a walnut that wraps around the urethra, located just below the bladder. By age 40, the prostate naturally grows to the size of an apricot, and to the size of a lemon by age 60. As it grows, the prostate can press against the bladder and squeeze the urethra, affecting bladder control and impeding the flow of urine through the urethra. If left untreated, a host of serious problems could emerge, ranging from urinary tract infections to urine retention to kidney damage. An estimated two-thirds of the male population over age 65 require some sort of intervention.

BPH stands for benign prostatic hyperplasia—themedical termfor an enlarged prostate. The term hyperplasia means excessive growth of either tissue or normal cells. The direct cause of BPH remains unknown, although age is clearly a factor. Genetics may also play a role. African-American men have a higher rate of BPH than the general population. Also, obesemen are twice as likely to suffer from BPH.

“Unfortunately, there isn’t a preventative strategy yet, although researchers are looking at dietary factors,” says Kevin T. McVary, M.D., a professor of urology at Northwestern Memorial Hospital in Chicago and a spokesman for the American Urological Association (AUA). “My advice to anyone wishing to avoid BPH is exercise and staying trim — but that is based on a hunch, not on overwhelming medical evidence.”

“If you live long enough, you will likely have some symptoms of BPH.”

- Dr. Kevin T. McVary

The key notion here is that BPH is non-cancerous (hence the term benign) and does not cause prostate cancer, nor does it increase your chances of developing prostate cancer. However, the symptoms for both BPH and prostate cancer—as well as for kidney stones, bladder cancer and urinary tract infections—are often similar, and need to be assessed by a doctor if they persist.
The good news is that BPH is an eminently treatable and manageable condition. The best place to start is by expanding your knowledge of the disease and, if conditions persist, making an appointment with a urologist. Fortunately, several options are available to physicians to treat BPH.

Typical BPH Symptoms Include:

• A need to urinate as often as every two hours (especially at night)

• A weak or interrupted urinary stream

• A sensation that you cannot empty your bladder completely

• A delay or hesitation when you start to urinate

• A feeling that you must urinate right away

Watchful Waiting
For the majority of men with BPH who do not suffer chronic symptoms, watchful waiting may be the best option. This means having a yearly or bi-yearly physical exam to spot more serious complications early on. Your doctor may suggest a digital rectal exam to manually assess the size of your prostate. Typically, if you are over 50, this is a part of your regular physical check-up.

A urinalysis can also check for infection or bleeding and measure kidney function. Some physicians may also order a blood test to detect elevated levels of an enzyme called prostate-specific antigen, or PSA, which the prostate produces. This test is also used to screen for prostate cancer, but BPH alone can also cause elevated PSA levels.

“If you live long enough, you will likely have some symptoms of BPH,” says Dr. McVary. “The question I am often asked is, ‘What if you have symptoms, and you don’t do anything?’ In studies of men who did watchful waiting or active surveillance over a five-year period of time, about half of the patients eventually opted for some type of therapy. About one-third of all men with BPH symptoms have spontaneous improvement to the level where they don’t need intervention or care. So watchful waiting pays off for that group.”

A physician may also suggest minor lifestyle changes for minor symptoms, such as drinking less during the evening.

Medications

If watchful waiting proves to be ineffective, there are several drugs that can reduce urinary symptoms and lessen the risk of BPH-related surgery. Alpha-blockers are a class of drugs that were originally used to lower high blood pressure by relaxing smooth muscle tissue in blood vessel walls. For BPH, alpha-blockers relax the muscular portion of the prostate and bladder neck, which allows urine to flow more freely.

Typically, alpha-blockers work within one week. Another group of drugs, called 5-alpha-reductase inhibitors, shrink the enlarged prostate by lowering hormone levels, and it can take six months or more to achieve the desired results.

Surgery
When all other medical therapies have failed, or if other serious problems occur—such as urethral bleeding, frequent urinary tract infections, kidney damage or bladder stones—minimally invasive treatments can be performed as outpatient procedures. These include transurethral microwave heat thermotherapy (TUMT), which uses microwaves to destroy excess prostate tissues, and transurethral needle ablation (TUNA), which uses carefully directed heat for the same purpose.

The most common surgery to treat BPH is transurethral resection of the prostate, known as TURP. By inserting a scope through the urethra, a physician can remove the prostate’s inner portion with the help of a laser and clear out any urethral blockages. Removal of the prostate (prostatectomy) and laser ablation are other options.

Looking Ahead
Several promising developments in BPH treatment are now under investigation. Sildenafil citrate and other high-profile medications designed to improve sexual performance have been shown in clinical trials to relax the bladder and, at the same time, relieve some of the symptoms of BPH.

Another astonishing new development is BOTOX® injections. Remarkably, the same chemical used to smooth facial wrinkles is now in clinical trials to shrink the prostate and reverse the effects of BPH. The hope is that one day a single, one-minute procedure, in which BOTOX® is injected directly into the prostate, will provide a year or more of relief from the symptoms of BPH.

More information about these and other treatments can be found by visiting www.UrologyHealth.org, a Web site sponsored by the AUA Foundation. To ensure your best prostate health, log on to learn about specific adult urologic conditions and diseases, and search for a local urologist to make your next appointment.