written by

Harvard Medical School

Enlarged Prostate

www.patientedu.org www.patientedu.org/prostate

T

he prostate is a walnut-shaped gland that produces the milky-white fluid that is part of semen. It is located in front of the rectum and right below the bladder. It is not known exactly why, but the prostate grows larger as a man grows older. This condition is called benign prostatic hyperplasia (BPH), or more simply, an enlarged prostate. The urethra, the tube that carries urine out from the bladder, runs through the prostate (see figure). As the gland enlarges, it can pinch or close off the urethra, making urination difficult or impossible. Even a slightly enlarged prostate can cause trouble.

Bladder

Prostate

Pelvic Bone

Urethra

Penis

What Causes BPH? The cause of BPH is one of the great mysteries of modern medicine. Doctors know that two factors appear to play critical roles: 1) age and 2) changing hormones. Certain health habits can also increase the chances of getting BPH. These include, for example, the following:

• Abdominal obesity. • Cigarette smoking. •L  ack of exercise. • Poor diet. •E  xcessive alcohol intake.

Anus

Symptoms The symptoms of BPH vary. One group of problems is caused by urethra narrowing. To get an idea of this, picture the way you can slow the flow of liquid through a straw by pinching it between your thumb and index finger. Urethra narrowing can cause the following types

of problems:

• Having to strain and wait to start urinating. • Having a weak, slow urine stream. • Taking a long time to urinate and dribbling at the end. • Not emptying the bladder completely. Sometimes this means a man cannot urinate at all, an urgent problem called acute urinary retention. The other group of symptoms is due to irritation of the bladder. Some common examples include: • An urgent, sometimes uncontrollable need to urinate, often passing only small amounts of urine. • Frequent nighttime urination.

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Watchful Waiting For many men, simple lifestyle adjustments can take bothersome BPH out of daily life. Here are a few tips: 1) R  educe your intake of fluids, especially after dinner. 2) Limit your intake of alcohol and caffeine.

3) Avoid drugs that stimulate muscles in the bladder neck and prostate, such as pseudoephedrine and other decongestants.

Diagnosis Your physician may recognize BPH simply by your symptoms, medical history, and answers to the American Urological Association index. They will also want to rule out other causes of urinary symptoms, including diabetes or neurological disorders. A digital rectal exam can help evaluate the size of the prostate and check for signs of infection or possible cancer. Doctors often suggest prostate specific antigen (PSA) testing for men with BPH. When the PSA is high or rising, a biopsy may be needed to check for possible prostate cancer.

4) A  void medications that weaken bladder contrac-

tions, such as antihistamines or antidepressants.

5) A  sk your doctor to lower your dosage or substitute

another drug for diuretics, which increase the need to urinate.

6) N  ever pass up a chance to use the bathroom,

even if your bladder does not feel full. Take your time and empty your bladder as much as possible.

Although 50% to 60% of men with BPH may never have symptoms, the effects can range from annoying to disruptive for those who do.

Treatment BPH progresses slowly, and men who are not bothered by symptoms may choose lifestyle approaches as the first treatment step. If your symptoms interfere with your quality of life, you and your doctor have a number of treatment options to consider. BPH can make you more likely to develop blood in the urine or a prostate infection, so talk with your doctor about what to watch for.

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7) Plan Ahead When you are in new places, learn the location of the bathroom before you really need it.

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Surgery Although many men with BPH do well with drugs, others will need surgery to get relief. The most common surgery is transurethral resection of the prostate (TURP). Although results vary, TURP reduces BPH symptoms in 80% to 90% of patients. Complications may include infection or bleeding, dry ejaculation, ED, and incontinence. Because the prostate can grow back, up to 20% of men who have TURP require more treatment within 10 years.

Medications When symptoms are more troubling, doctors usually suggest a combination of lifestyle changes and prescription medication. Alpha-blockers, such as terazosin, doxazosin, tamsu-

losin, and alfuzosin, relax smooth muscle cells in the prostate and bladder. These drugs typically act within weeks, and about 70% of men with BPH see improvements after taking these medications. Hormone blockers, such as finasteride and dutasteride,

actually shrink the gland. These drugs work slowly— taking 6 months or longer to have an effect—and are more helpful for men with large prostates. Research suggests that these drugs may slightly increase the risk of developing aggressive prostate cancer. Talk with your doctor about all your risk factors when considering this type of medication.

Draining the Bladder (Catheterization) In some cases, BPH can make it impossible to urinate at all. This is called acute urinary retention, or AUR. When BPH is severe and doesn’t improve with drugs or surgery, men can learn to insert a thin tube (catheter) to drain the bladder as needed. The stress on the bladder will hopefully resolve, and the catheter can then be removed.

New Choices for an Old Problem Medical and surgical treatment options for BPH continue to expand and improve. And many men are learning to manage minor symptoms without treatment by making a few lifestyle changes. It’s a new era that will allow well-informed men to take control of an old problem.

BPH drugs, such as alpha blockers and 5-alpha reduc-

tase inhibitors, may cause sexual side effects. If you experience erectile dysfunction (ED) after starting medication for BPH, ask your doctor how you can treat this problem. The ED drug tadalafil was recently approved by the FDA for both the relief of BPH symptoms as well as ED. For men taking one or more medications for BPH, a PSA test may be needed before starting these medications and intermittently thereafter.

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To learn more about an enlarged prostate, visit the Patient Education Center at www.patientedu.org/prostate.

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Patient Education Center 2127 Second Avenue North Fort Dodge, IA 50501 [email protected]

About This Brochure: This brochure was written by practicing physicians from Harvard Medical School. It is part of a series developed and distributed by the Patient Education Center. All the information in this brochure and on the associated Web site (www.patientedu.org) is intended for educational use only; it is not intended to provide, or be a substitute for, professional medical advice, diagnosis, or treatment. Only a physician or other qualified health care professional can provide medical advice, diagnosis, or treatment. Always consult your physician on all matters of your personal health. Harvard Medical School, the Patient Education Center, and its affiliates do not endorse any products. Consulting Physician: Anthony L. Komaroff, MD Editorial Director: Keith D’Oria Creative Director: Jon Nichol © Copyright Harvard Medical School.

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