September is Prostate Cancer Awareness Month, and our maturing population means more men are encountering age-related prostate issues than ever before. Reports from the National Institutes of Health show benign prostatic hyperplasia (BPH) affects 70% of U.S. men 60-69 years of age and 80% of those over age 70. Men falling into these age groups should be aware of BPH symptoms.
BPH is a non-cancerous enlargement of the prostate which is common for men as they age. The condition is hereditary and, because it is associated with aging, unpreventable, but it can be treated successfully.
“There is a wide constellation of symptoms associated with BPH,” explained Eric Espinosa, MD, a urologist with Kettering Health Network. “These may include feeling of incomplete emptying, increased urinary frequency, intermittency (starting and stopping of the urine flow), urgency to urinate, weakened urinary stream, needing to strain or push to empty the bladder, and causing one to awaken at night.”
In addition to these, other BPH symptoms can include trouble starting urination and a feeling of a full bladder, even right after urinating. If the prostate enlargement is severe enough, urination may stop entirely. This is an emergency for which you should seek immediate treatment.
The symptoms can occur insidiously and can become more problematic over time. Frequently, the patient's significant other will be more alert of the problem. Most people will tolerate getting up once at night, but more frequent episodes can interrupt the sleep cycle, causing fatigue and irritability during the day.
All men over the age of 40 are at risk, and the causes of BPH are not well understood. Aging is a common factor, and it may also be related to testicular issues. Some studies suggest greater levels of the female hormone estrogen or the male hormone dihydrotestosterone (DHT) may push prostate cells to continue to grow as testosterone levels decrease.
Family history is another risk factor. If a father or brother has experienced prostate problems, it’s likely you will, as well. Diabetes and heart disease might increase the risk of BPH, particularly when the patient is being treated with beta blockers used to control heart rhythm and treat high blood pressure.
Diagnosis and treatment
Diagnosis of BPH generally consists of a combination of tests. A digital rectal exam and blood test are the most common methods. A blood test is used to check for any sort of kidney problem, as well as checking for an elevated prostate-specific antigen (PSA). A urine test is also used to rule out any infection or other conditions with similar symptoms. The doctor might recommend additional testing to exclude other issues and confirm the enlarged prostate. If your condition is more complex, advanced testing such as ultrasound or biopsy might be recommended.
While BPH has not been identified as a direct risk factor for prostate cancer, the two can coexist. In fact, some studies indicate a presence of BPH in 83% of prostate cancer cases. Prostate cancer is the second most-prevalent cancer in men globally. If left untreated, BPH symptoms will worsen, and due to the prevalence of prostate cancer among BPH patients, men exhibiting the symptoms are encouraged to see their physician.
As noted earlier, the condition cannot be definitively prevented, but a healthy weight and diet including plenty of fruits and vegetables may help. The Urology Care Foundation reports links between BPH and a higher level of body fat, which increases hormone levels and other factors in the blood that stimulate prostate cell growth. Regular exercise and an active lifestyle will help to control weight and hormone levels, thus reducing BPH risks.
Many new non-invasive treatments can resolve the symptoms of BPH. The most common treatment for mild-to-moderate BPH symptoms is medication. Alpha blockers, Cialis (normally prescribed for erectile dysfunction), 5-alpha-reductase inhibitors, and sometimes combination drug therapy, can all be very effective. Minimally invasive surgical procedures, such as UroLift, are also available for more serious conditions.
“Recent studies are showing long-term medications for BPH can cause weakening of the bladder,” Dr. Espinosa said. “We suggest seeking medical treatment to see if you are a candidate for one of these procedures, instead of staying on long-term medications.”
To learn more about the treatment options available for BPH through Kettering Health Network, visit ketteringhealth.org/urology