The prostate gland is a very small organ that is approximately the size of a walnut. Structurally it lies below the bladder and surrounds a man’s urethra (the tube that connects the bladder to the outside of the body). This particular gland is consists two regions. Although researchers know that one of the primary functions of the prostate glands is to make fluid that helps to feed the sperm as part of the semen, they do not know all of the functions.
As a man matures the prostate gland goes through two periods of growth. The first happens during puberty when the gland actually doubles in size. The second is growth period actually happens years later as a man ages and results in benign prostatic hypertrophy or hyperplasia. This condition rarely causes symptoms in a man before the age of 40, but some statistics list more than half of the men in their 60s and as many as 90% in their 80s, as having some form of benign prostatic hypertrophy.
Although the prostate continues to enlarge as a man ages, a layer tissue around it stops it from expanding and causes the gland to press downward against the urethra like clamp. The bladder wall then becomes thicker and begins to contract when it contains even a small amount of urine. Eventually, the bladder itself becomes weaker and loses the ability to completely empty. This combination of a narrow urethra and partially full bladder is the root of many of the problems associated with benign prostatic hypertrophy.
The cause of the overgrowth of the prostate gland is not well understood and researchers are unable to document a definitive cause. For centuries doctors have known that BPH occurs mainly in older men and does not develop in a man whose testicles were removed before puberty. Some researchers believe that the factors which are related to aging and the testicles are what trigger the growth in the prostate glands.
One theory identifies the falling levels of testosterone in an aging man’s body and rising levels of estrogen which suggest that the gland growth is triggered by the estrogen in the bloodstream. Another theory focuses on dihydrotestosterone which is a substance that is derived from testosterone. The human male apparently continues to produce and accumulate the substance which may eventually encourage the growth of the prostate cells.
Men experience symptoms which include a hesitant or interrupted weak stream of urine, urgency and leaking during the day, as well as more frequent urination, especially at night. BPH is also one of the causes behind urinary incontinence in men. In some cases, the gentleman may not even know he has prostatic hypertrophy until he faces acute urinary retention. This is a condition in which he suddenly finds himself unable to urinate at all and is often triggered by taking over-the-counter cold or allergy medications which contain a decongestant. If there is a slight obstruction present this retention can also be triggered by alcohol, cold temperatures or a long period of immobility.
In eight out of 10 cases the symptoms described above were a result of benign prostatic hypertrophy and not prostatic cancer. It is very important to have these symptoms evaluated by your primary care physician in order to rule out the more serious conditions that require immediate treatment.
Do not overlook the symptoms of BPH because they themselves can cause serious problems over time. As the bladder weakens and the individual retains more urine, it can lead to urinary tract infections, kidney damage, bladder stones and incontinence. If the condition is overlooked for a long period of time the bladder damage can be permanent and any treatment for BPH will be ineffective.
Some men notice symptoms of BPH initially while others are diagnosed during a routine prostate examination. If BPH is suspected, the man may be referred to a urologist, or physician who specializes in the urinary tract. Several different tests may be done in order to decide whether surgery is required in order to treat the condition.
The phyician will usually do a complete examination in the office and a digital rectal examination. This gives the doctor a general idea of the size and condition of the prostate gland. The doctor may also recommend a PSA blood test which measures are protein produced by the prostate cells. Researchers are continuing to evaluate the effectiveness and methods of the interpreting these levels in order to discriminate between cancer and benign prostatic hypertrophy.
Other tests which may be ordered include rectal ultrasound, prostate biopsy, urine flow study or cystoscopy. These tests are all done on an outpatient basis and give the physician a better idea of the type of problem being faced by the man.
Men who have BPH usually need some kind of treatment but there continues to be a debate about when treatment should be started. The results of early studies indicate that early treatment may not be needed because symptoms clear up without treatment in as many as one third of all cases that are mild. Instead, researchers suggest that regular checkups in order to follow the condition and treatment should begin when the condition poses a danger to the health of the man or a major inconvenience.
The first line of treatment are usually medications which help to shrink the size of the prostate glands and alleviate the symptoms. Drug treatment is not effective in all cases and so minimally invasive therapies have also been developed which includes a transurethral microwave procedure. In this procedure a device is used to send computer regulated microwaves through a catheter to selectively kill some of the prostate gland.
Transurethral needle ablation has also been approved by the FDA and delivers low level of radiofrequency energy to burn away a defined region of the enlarged prostate. This procedure improves urine flow and relieves symptoms with very few side effects when compared to the old surgical transurethral resection of the prostate that often left a man either incontinent, impotent or both.
Another minimally invasive procedure is the water induced thermotherapy in which he did water it is used to destroy the excessive tissue. Physicians also have the opportunity to recommend patients for clinical trials using high-intensity focused ultrasound; the FDA has not yet approved it.
When medication and minimally invasive treatment protocols are not successful physicians will turn to surgical options that include a transurethral surgery, open surgery and laser surgery all of which are all performed with the expressed goal of relieving symptoms of BPH. In some instances the surgical procedures will also leave a man incontinent or impotent.
Thankfully the majority of men do not have to reach the level of surgical treatment in order to relieve the symptoms of their BPH. If you or someone you love is suffering from these symptoms seek the advice of your primary care physician in order to determine your best course of action before the problem gets too big.
FamilyDoctor.org: Benign Prostatic Hypertrophy
National Kidney and urologic Diseases Infomration Clearinghouse: Prostate Enlargement: Benign Prostatic Hypertrophy
MedlinePlus: Enlarged Prostate
University of Maryland Medical Center: Benign Prostatic Hyperplasia