BPH is so common that all men will have an enlarged prostate if they live long enough. A small amount of prostate enlargement is present in many men over age 40 -- half of them by age 75. Some studies show 90% of men with BPH after age 80.
What are the Causes of BPH?
It is an unknown. Many researchers believe it is linked to aging and it may be linked to the growth of the testicles. Men who have had their testicles removed at a young age – because of cancer, for instance -- do not develop BPH. Similarly, if the testicles are removed after a man develops BPH, the prostate begins to shrink in size. No risk factors have been identified other than having normally functioning testicles.
Symptoms
Interestingly, less than half of all men with BPH have symptoms of the disease. The most common symptoms include:
- Slowed or delayed start of the urinary stream
- Weak urine stream
- Dribbling after urinating
- Straining to urinate
- Sudden urge to urinate
- Incomplete emptying of your bladder
- Needing to urinate two or more times per night
- Urinary retention (complete inability to urinate)
- Incontinence
- Pain with urination or bloody urine, both could indicate infection
Some men avoid the DRE (digital rectal exam) because they are uncomfortable with the procedure – but it is an essential screening tool for prostate cancer and can determine the extent of BPH. It is not painful and lasts less than a minute.
During a DRE, the patient either bends forward over the examination table, lies on his side, or kneels on the table. The doctor then inserts a gloved, lubricated finger a few inches into the rectum and gently palpates the prostate gland to feel for a nodule or lump, change in size, hard tissue, or any other abnormality that might indicate a tumor is present.
The American Cancer Society and American Urology Association recommend that all men over age 50 have a DRE, along with a PSA (prostate-specific antigen) test, once a year—and earlier if they are at high risk for prostate cancer.
Other tests may include urine flow rate, urinalysis to check for blood or infection, urine culture to check for infection, and a PSA blood test to screen for prostate cancer.
Treatments -- Self Care and Surgical
Doctors cannot accurately predict how quickly an enlarged prostate will require treatment. Symptoms from obstruction of the urethra can remain stable for years and may even improve over time in as many as one-third of men.
For mild symptoms:
- Urinate when you first get the urge. Also, go to the bathroom when you have the chance, even if you don't feel a need to urinate.
- Avoid excess alcohol, caffeine or fluid intake, especially at night.
- Try NOT to take over-the-counter cold and sinus medications that contain decongestants or antihistamines. These medications can increase BPH symptoms.
- Keep warm and exercise regularly. Cold weather and lack of physical activity may worsen symptoms.
- Ask your doctor about heat treatments, including minimally invasive microwave or radio-frequency energy, which are available on an outpatient basis
In more severe cases:
- The most common surgical treatment is the removal of excess tissue from an enlarged prostate via transurethral resection of the prostate (TURP). Surgeons pass a thin, lighted viewing tube through the penis into the urethra. A minuscule cutting tool at the end of the tube is used to excise prostate tissue that is pressing upon the urethra.
- If the prostate is unusually large, surgical removal of obstructing prostate tissue via an abdominal incision may be necessary.
Now a study shows a diet low in fat and red meat but high in vegetables and lean protein is as good for the heart as it is for the prostate. Researchers found that a “high-fat diet increased the risk of prostate enlargement by 31 percent, and that daily consumption of red meat increased the risk by 38 percent,” according to an article in ScienceDaily (February 15, 2008). Funded by the National Institute of Health, the study was conducted by researchers from the Hutchinson Center, the Keck School of Medicine at the University of Southern California and the University of Texas Health Sciences Center at San Antonio.
Other Key Findings
In assessing the diet, supplement use and alcohol consumption in 4,770 men for seven years (876 of whom developed symptomatic BPH), the study also revealed:
- Eating four or more servings of vegetables daily reduced BPH risk by 32 percent
- Consuming high amounts of lean protein (about 15 percent of caloric intake) reduced risk by 15 percent
- Regular, moderate alcohol consumption of no more than two drinks per day showed a 38 percent decline in BPH risk
- Incremental increases in BPH risk by men who got 40 percent of their calories from fat.
"It is known that obesity increases the risk of BPH. The dietary pattern that is associated with obesity among men in the United States is high fat consumption. The results of this study clearly show a link between a high-fat diet and increased risk of BPH," said Alan Kristal, a lead author on the study and associate head of the Cancer Prevention Program in the Public Health Sciences Division at the Hutchinson Center.
The Growing Prostate
From the size of an almond in puberty, the prostate grows in size to the shape of a walnut and weighs about 20 grams. Almost all of this mass develops during puberty in response to hormonal changes associated with maturation.
As men age and the prostate inevitably enlarges, especially from age 50 onward, the bigger prostate puts pressure on the urethra, the tube which passes urine from the bladder. That pressure makes it difficult to empty the bladder completely, which in turn results in the frequent urge to urinate.
Anything that happens to swell or inflame the prostate can obstruct the flow of urine, causing a wide spectrum of misery and discomfort. The mechanisms of excess fat intake and alcohol are considered likely factors that cause chronic inflammation and changes in steroid hormones, leading to BPH.
Common Prostate Disorder
Unfortunately for men between the age of 40 and 59, nearly 60 percent can be shown to already be suffering from BPH. This usually does not present a noticeable problem until after the age of 50. By the age of 80, however, some 85 percent of all men suffer from one or more symptoms of BPH.
Contributing background information for this article: John Hopkins Medical white papers 2007 and 2008, the New York Times online, and the American Cancer Society website
