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Wednesday, 26 February 2014 00:00

Managing Your Enlarged Prostate

About the Prostate

The prostate is a walnut-sized reproductive gland in men. It produces a fluid that is a major part of the semen. It lies in front of the large intestine and below the urinary bladder (which stores urine). It surrounds the urethra, the tube that carries urine out of the body. The prostate often enlarges as a man ages.

What Is Benign Prostatic Hyperplasia (BPH)?

BPH is the common condition of enlargement of the prostate gland. Benign means that BPH is not cancer. It is also not contagious or sexually transmitted.

What Causes BPH?

The cause is unknown, but aging and male hormones are related to BPH.

What Are the Symptoms of BPH?

Symptoms are rare before age 40 but occur in more than half of men in their 60s and as many as 90% in their 70s and 80s. Symptoms are related to difficulty urinating, including weak urine stream, urgency (need to urinate quickly), leaking or dribbling urine, and more frequent urination, especially at night.

Severe BPH can cause serious problems, such as infections, bladder or kidney damage, and incontinence. If bladder damage is permanent, BPH treatment may not work. When BPH is found earlier, it is less likely to cause serious complications.

How Is BPH Diagnosed?

Diagnosis begins with a medical history and doctor’s examination of the prostate with the finger (digital rectal examination). Blood and urine tests and a sonogram (ultrasound) may be done to evaluate for incomplete bladder emptying due to obstruction from an enlarged prostate and to exclude other causes of the symptoms. A blood test called prostate-specific antigen (PSA) may be used to rule out prostate cancer. The doctor should review risks and benefits of this controversial test.

How Is BPH Treated?

Most people with symptoms require treatment at some point. Effective treatments range from conservative, which means simply drinking less fluid at night, to taking medicines or having surgery.
Medicines include alpha-blockers such as tamsulosin to help urine flow and reduce blockage in the bladder. Other medications, such as Finasteride inhibit production of the hormone testosterone, so the prostate shrinks or stops growing. Over- the-counter drugs include saw palmetto, but their effectiveness has not been proven.

If drugs don’t work, surgery can be tried. These operations range from slightly invasive to very invasive. The operation called TURP (transurethral resection of the prostate) is used for 90% of all surgeries for BPH. Other operations include transurethral microwave therapy (uses microwave heat), transurethral needle ablation (radiofrequency therapy, uses radio waves), and laser surgery.

DOs and DON’Ts in Managing BPH:

  • DO understand that common drug side effects include light-headedness and dry mouth.
  • DO tell your doctor about any over-the-counter medicines, herbs, or supplements you take. These may cause symptoms.
  • DO realize that surgical complications may include urinary incontinence, erection problems, and bleeding.
  • DO understand that 10% to 30% of men with BPH also have prostate cancer.
  • DO call your doctor if you cannot urinate or have blood in your urine.
  • DON’T forget that caffeine and certain prescription drugs (e.g., for colds and allergy) may cause irritating prostate symptoms.
  • DON’T forget to discuss with your doctor the risks and benefits of operations and use of the PSA blood test for diagnosing prostate cancer.

For more information, see the attachments below.

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