Prostate Issues

Benign prostatic hyperplasia (BPH) results in the enlargement of the prostate gland, a prevalent issue among men and individuals assigned male at birth, particularly with advancing age. Symptoms often entail urinary difficulties and urgent or frequent urination. Treatment options encompass medications, surgical interventions, and minimally invasive procedures.

What is Benign Prostatic Hyperplasia?

Benign prostatic hyperplasia (BPH) refers to the enlargement of the prostate gland, a walnut-sized organ located below the bladder and in front of the rectum. This growth can constrict the urethra, the tube responsible for passing urine and ejaculate out of the body, leading to difficulties in urination and ejaculation.

While BPH itself is not cancerous, its symptoms may mirror those of more severe conditions such as prostate cancer, warranting timely medical attention and evaluation.

Does Having BPH Raise Prostate Cancer Risk?

Studies indicate that having BPH does not heighten the risk of developing prostate cancer. Nonetheless, both conditions share similar symptoms, and it's possible to have prostate cancer alongside BPH without detection.

To facilitate early detection of prostate cancer, individuals with a prostate should undergo annual prostate screenings between the ages of 55 and 69. Those with a family history of prostate cancer, should commence screenings at age 40 to mitigate potential risks.

How Common is Benign Prostatic Hyperplasia?

Benign prostatic hyperplasia (BPH) is prevalent.

By the age of 60, approximately 50% of individuals with a prostate will exhibit some indications of BPH. By age 85, this proportion rises to about 90%.

Around half of those affected by BPH will experience symptoms necessitating treatment.

Symptoms and Causes

Identifying Benign Prostatic Hyperplasia Warning Signs:

Benign prostatic hyperplasia (BPH) can lead to the enlargement of your prostate, which surrounds your urethra. Recognizing warning signs of BPH is crucial, as it may cause blockage in your urethra. Common early symptoms of BPH encompass:

Difficulty initiating urination or experiencing a slow flow.
Urinary dribbling.
Incontinence or leakage.
Urgent need to urinate.
Frequent nighttime urination.
Feeling of incomplete bladder emptying.
Discomfort during urination or ejaculation.
Alteration in urine color or odor.

Left untreated, an enlarged prostate can lead to exacerbated symptoms and potentially serious complications, including:

Urinary tract infections (UTIs).
Formation of bladder stones.
Presence of blood in urine (hematuria).
Kidney damage resulting from urine backflow from the bladder to the kidney, which increases pressure on the kidney.

Causes of Benign Prostatic Hyperplasia

The exact cause of benign prostatic hyperplasia (BPH) remains unclear to healthcare providers and medical researchers.

One theory suggests that with aging, there is a decline in testosterone levels (low testosterone), while estrogen levels remain constant. This hormonal shift may trigger the growth of prostate cells. However, it's worth noting that individuals who use supplemental testosterone may experience the development or exacerbation of BPH.

Moreover, individuals assigned male at birth (AMAB) typically have elevated levels of dihydrotestosterone (DHT) as they age. DHT, a more potent form of testosterone, is known to contribute to prostate enlargement.

Which type of specialist treats benign prostatic hyperplasia?

If you're showing signs of BPH, our urologists specialize in treating conditions that impact the urinary system, including BPH.

Medical & Surgical Management

Prostate issues, such as benign prostatic hyperplasia (BPH), prostatitis, and prostate cancer, require different management strategies depending on the condition's severity and type. Here’s an overview of medical and surgical management for these common prostate problems:

Benign Prostatic Hyperplasia (BPH)

Medical Management
1. Alpha-Blockers: These medications, such as tamsulosin, alfuzosin, and doxazosin, relax the muscles of the prostate and bladder neck to improve urine flow and reduce symptoms.
2. 5-Alpha-Reductase Inhibitors: Finasteride and dutasteride shrink the prostate by preventing hormonal changes that cause prostate growth.
3. Combination Therapy: Sometimes, a combination of alpha-blockers and 5-alpha-reductase inhibitors is more effective than either drug alone.
4. Phosphodiesterase-5 Inhibitors: Tadalafil, a medication often used for erectile dysfunction, can also relieve BPH symptoms.
5. Anticholinergics: Used cautiously, these can help manage bladder symptoms such as urgency and frequency.

Surgical Management
1. Transurethral Resection of the Prostate (TURP): A common procedure where part of the prostate is removed to relieve obstruction.
2. Laser Surgery: Techniques like Holmium laser enucleation (HoLEP) or photoselective vaporization of the prostate (PVP) use lasers to remove prostate tissue.
3. Prostatic Urethral Lift (Urolift): This minimally invasive procedure uses implants to hold the prostate tissue away from the urethra.
4. Transurethral Incision of the Prostate (TUIP): Involves making small incisions in the prostate to reduce pressure on the urethra.
5. Open or Robot-Assisted Prostatectomy: Used for very large prostates, this involves removing part or all of the prostate through an abdominal incision.

Prostatitis

Medical Management
1. Antibiotics: The primary treatment for bacterial prostatitis. Common choices include ciprofloxacin, levofloxacin, and trimethoprim-sulfamethoxazole.
2. Alpha-Blockers: Can help relieve symptoms of chronic prostatitis/chronic pelvic pain syndrome by relaxing bladder neck muscles.
3. Anti-Inflammatory Medications: NSAIDs like ibuprofen can help reduce pain and inflammation.
4. Pain Management: Other pain management strategies might include muscle relaxants, antidepressants, or analgesics.

Surgical Management
Surgery is rarely required for prostatitis unless there are complications such as abscess formation. In such cases, drainage may be necessary.

Prostate Cancer

Medical Management
1. Active Surveillance: Monitoring the cancer closely with regular tests and only treating if it shows signs of getting worse.
2. Hormone Therapy: Medications to reduce or block testosterone, such as leuprolide or goserelin, which prostate cancer cells need to grow.
3.Chemotherapy: Drugs like docetaxel and cabazitaxel are used, especially in advanced cancer.
4. Targeted Therapy: Drugs that target specific pathways involved in cancer growth, such as PARP inhibitors.
5. Immunotherapy: Treatments like sipuleucel-T that help the immune system attack cancer cells.

Surgical Management
1. Radical Prostatectomy: Removal of the prostate gland, seminal vesicles, and surrounding tissues. This can be done via open surgery or minimally invasive techniques like laparoscopic or robot-assisted surgery.
2. Transurethral Resection of the Prostate (TURP): Sometimes used to relieve symptoms in men with advanced prostate cancer.

Other Interventions
1. Radiation Therapy: External beam radiation or brachytherapy (internal radiation) to kill cancer cells.
2. Cryotherapy: Freezing and killing prostate tissue.
3. High-Intensity Focused Ultrasound (HIFU): Uses focused ultrasound waves to heat and destroy prostate tissue.

The choice of treatment depends on various factors including the specific condition, its severity, patient health status, and personal preferences. Each approach has its benefits and risks, and a thorough discussion with a healthcare provider is crucial for optimal management.

Investigations

Investigations for prostate issues are essential for diagnosing conditions such as benign prostatic hyperplasia (BPH), prostatitis, and prostate cancer. The specific tests and investigations include:

1. Digital Rectal Examination (DRE)
- Purpose: To assess the size, shape, and texture of the prostate.
- Procedure: A doctor inserts a gloved, lubricated finger into the rectum to feel the prostate gland.

2. Prostate-Specific Antigen (PSA) Test
- Purpose: Measures the level of PSA in the blood, which can be elevated in prostate cancer and other prostate conditions.
- Procedure: A blood sample is taken and analyzed for PSA levels.

3. Urinalysis
- Purpose: To check for signs of infection, blood, or other abnormalities in the urine.
- Procedure: A urine sample is analyzed in a lab.

4. Ultrasound
- Transrectal Ultrasound (TRUS)
- Purpose: Provides detailed images of the prostate and helps guide biopsies.
- Procedure: An ultrasound probe is inserted into the rectum to create images of the prostate.
- Abdominal Ultrasound
- Purpose: Used to examine the bladder and kidneys, and to check for urinary retention.
- Procedure: An ultrasound probe is moved over the abdomen.

5. Prostate Biopsy
- Purpose: To obtain tissue samples from the prostate for histological examination.
- Procedure: Performed usually with the guidance of TRUS. Multiple small samples are taken from different areas of the prostate.

6. Magnetic Resonance Imaging (MRI)
- Purpose: Provides detailed images of the prostate and surrounding tissues, particularly useful in detecting and staging prostate cancer.
- Procedure: The patient lies in an MRI machine while it takes detailed images.

7. Urodynamic Tests
- Purpose: To assess how well the bladder and urethra store and release urine.
- Procedure: Includes a variety of tests that measure bladder pressure and urine flow.

8. Cystoscopy
- Purpose: To visually inspect the bladder and urethra for any abnormalities.
- Procedure: A thin, flexible tube with a camera (cystoscope) is inserted through the urethra into the bladder.

9. CT Scan or Bone Scan
- Purpose: Used to determine if prostate cancer has spread (metastasized) to other parts of the body.
- Procedure: Imaging tests that provide detailed cross-sectional images (CT scan) or detect areas of increased bone activity (bone scan).

10. Uroflowmetry
- Purpose: Measures the flow rate of urine to help identify blockage or weak bladder.
- Procedure: The patient urinates into a special device that measures the speed and volume of urine flow.

11. Post-Void Residual (PVR) Measurement
- Purpose: Measures the amount of urine left in the bladder after urination.
- Procedure: Can be measured using ultrasound or catheterization.

Diagnosis

Diagnosing Prostatic Hyperplasia

Diagnosing benign prostatic hyperplasia (BPH) typically involves a thorough assessment by our healthcare professional. This process includes reviewing your medical history, conducting a series of inquiries, and performing a physical examination, which often includes a digital rectal exam (DRE).

During the digital rectal exam, our healthcare professional will gently insert a gloved finger into your rectum to assess the size, texture, and any irregularities in your prostate gland. This examination helps to detect any abnormalities or signs of cancer.

In addition to the physical exam, our healthcare professional may recommend further tests, including:

A symptom severity survey to assess the impact of your symptoms.
A urine flow test to measure the rate of urine flow.
Post-void residual measurement to determine how much urine remains in your bladder after urination.
Cystoscopy, a procedure to visually examine the inside of your bladder for any abnormalities.

These diagnostic procedures collectively provide valuable insights into your prostate health and aid in developing an appropriate treatment plan tailored to your needs.

Benign prostatic hyperplasia (BPH) is a common condition in older men characterized by the non-cancerous enlargement of the prostate gland. Diagnosis of BPH involves several steps, including medical history, physical examination, and various tests. Here is a detailed approach to diagnosing BPH:

1. Medical History
A thorough medical history is essential to understand the symptoms and their impact on the patient's quality of life. The history includes:
- Detailed description of urinary symptoms (e.g., frequency, urgency, nocturia, weak stream, incomplete emptying)
- Duration and progression of symptoms
- Presence of any pain or discomfort
- Impact on daily activities and quality of life
- Previous medical history, including urinary tract infections, surgeries, or neurological disorders
- Medications being taken, especially those affecting urinary function (e.g., diuretics, antihistamines, antidepressants)
- Family history of prostate disease

2. Symptom Assessment
The International Prostate Symptom Score (IPSS) questionnaire is often used to quantify the severity of symptoms. It includes questions about:
- Frequency
- Nocturia
- Weak stream
- Hesitancy
- Intermittency
- Incomplete emptying
- Urgency

3. Physical Examination
A digital rectal examination (DRE) is performed to assess the size, shape, and consistency of the prostate. During this examination:
- The physician inserts a lubricated, gloved finger into the rectum to palpate the prostate gland.
- The size, symmetry, and texture of the prostate are evaluated. A large, smooth, and firm prostate is typical of BPH.

4. Urinalysis
A urine sample is tested to check for signs of infection, blood, or other abnormalities that might indicate conditions other than BPH.

5. Prostate-Specific Antigen (PSA) Test
A blood test measures the level of PSA, a protein produced by the prostate. Elevated PSA levels can indicate BPH, prostate cancer, or prostatitis. However, PSA alone cannot diagnose BPH, as levels can be influenced by various factors.

6. Uroflowmetry
This test measures the rate of urine flow. A reduced flow rate may suggest bladder outlet obstruction due to BPH.

7. Postvoid Residual Volume (PVR) Test
Using ultrasound, the amount of urine left in the bladder after urination is measured. A high residual volume may indicate incomplete bladder emptying due to BPH.

8. Imaging Studies
- **Transrectal Ultrasound (TRUS):** Provides detailed images of the prostate and can help assess its size and shape.
- **Bladder Ultrasound:** Assesses bladder wall thickness and any residual urine volume.
- **Cystoscopy:** A thin, flexible tube with a camera (cystoscope) is inserted through the urethra to visualize the bladder and urethra, helping to identify blockages or other abnormalities.

9. Urodynamic Studies
These tests assess bladder function and pressure during filling and emptying. They are more commonly used if the diagnosis is unclear or if surgery is being considered.

10. Biopsy
Although not routinely used for diagnosing BPH, a prostate biopsy might be performed if there is suspicion of prostate cancer.

Differential Diagnosis
It’s important to rule out other conditions that can mimic BPH symptoms, such as:
- Prostate cancer
- Prostatitis
- Urethral stricture
- Bladder stones
- Neurogenic bladder

Accurate diagnosis of BPH involves a combination of these assessments and tests, tailored to the individual patient's symptoms and medical history. Early and precise diagnosis is crucial for effective management and treatment of BPH.

Tests

Benign prostatic hyperplasia (BPH) is a common condition in older men where the prostate gland is enlarged, leading to urinary symptoms. Diagnosing BPH involves a combination of symptom assessment, physical examinations, and various tests. Here are the primary tests and evaluations used to diagnose BPH:

1. Medical History and Symptom Assessment:
- International Prostate Symptom Score (IPSS): This questionnaire helps assess the severity of symptoms and their impact on quality of life.
- AUA Symptom Index: Another questionnaire used to evaluate the severity of urinary symptoms.

2. Physical Examination:
- Digital Rectal Exam (DRE): The doctor inserts a finger into the rectum to feel the prostate and check for enlargement, tenderness, or abnormalities.

3. Urine Tests:
- Urinalysis: Tests the urine for signs of infection, blood, or other abnormalities.
- Urine Flow Study (Uroflowmetry): Measures the speed and volume of urine flow to determine how much urine the bladder can hold and how well it empties.

4. Blood Tests:
- Prostate-Specific Antigen (PSA) Test: Measures the level of PSA in the blood. Elevated levels can indicate prostate enlargement, infection, inflammation, or prostate cancer.

5. Postvoid Residual Volume Test:
- Uses ultrasound or a catheter to measure the amount of urine left in the bladder after urination. A high residual volume can indicate an obstruction.

6. Imaging Tests:
- Transrectal Ultrasound (TRUS): Provides images of the prostate using sound waves, helping assess its size and shape.
- Cystoscopy: Involves inserting a scope through the urethra to view the bladder and urethra, helping to rule out other conditions.

7. Urodynamic and Pressure Flow Studies:
- These tests measure bladder pressure and urine flow to evaluate the function of the bladder and urethra and determine if BPH is causing blockage.

8. Prostate Biopsy:
- In some cases, a biopsy might be performed if there are concerns about prostate cancer, based on PSA levels or findings from other tests.

9. Additional Tests:
- Electromyography (EMG): Measures the electrical activity of the muscles and nerves in and around the bladder and sphincters.
- Pelvic MRI or CT Scan: Sometimes used to get a detailed image of the prostate and surrounding tissues if more information is needed.

These tests help differentiate BPH from other conditions that can cause similar symptoms, such as urinary tract infections, bladder or prostate cancer, or prostatitis. The combination of these assessments provides a comprehensive view of the prostate health and guides the appropriate management and treatment of BPH.

Management and Treatment

How is benign prostatic hyperplasia managed?

If your symptoms are mild, you may not need immediate treatment. Our healthcare professional might suggest a 'watchful waiting' approach, where you have regular check-ups to monitor the condition's progression.

Treatment options may include:

Utilizing commonly prescribed medications to relax the muscles in the prostate, thereby alleviating tension on the urethra.
Administering medications aimed at reducing the production of the hormone DHT, effectively slowing the enlargement of the prostate gland. These medications are particularly advantageous for individuals with larger prostates.

Our healthcare professional may recommend a combination of medications to address your symptoms comprehensively while enhancing urine flow.

Surgical Interventions

Various surgical procedures are available to alleviate prostate-related urinary obstruction. These include:

Transurethral resection of the prostate (TURP): A specialized instrument (resectoscope) is inserted through the urethra to visualize and remove excess prostate tissue.
Transurethral incision of the prostate (TUIP): Small incisions are made in the prostate and the bladder neck to widen the urethra and enhance urine flow.
Transurethral electrovaporization: An electrode is used to heat prostate tissue, converting enlarged tissue cells into steam.

Following surgery, most individuals can typically resume their normal activities within several days to a week.

Advanced Minimally Invasive Treatments

Emerging BPH treatments offer less invasive alternatives to surgery, minimizing damage to healthy tissue. Typically outpatient procedures, these treatments enable same-day discharge, providing cost-effective solutions with reduced side effects and quicker recovery times. Despite these benefits, limited long-term data is available regarding their efficacy and potential complications due to their novelty.

Following a minimally invasive procedure, you can expect to resume your regular activities within a few days. Noticeable improvements in your symptoms should be observed within three to six weeks.

What Treatment is Most Effective for Benign Prostatic Hyperplasia?

For most cases of BPH, Transurethral Resection of the Prostate (TURP) stands as the most efficacious treatment.

Nevertheless, in individuals aged 65 and above, medications and minimally invasive procedures are favored. This preference is due to potential complications and extended recovery periods post-surgery, particularly in older patients.

What Dietary Restrictions Should I Follow with Benign Prostatic Hyperplasia?

Here are some dietary guidelines for managing benign prostatic hyperplasia (BPH):

Beneficial Foods:

Berries
Broccoli
Citrus fruits
Nuts
Tomatoes
Turmeric

Consider adopting a Mediterranean diet, which emphasizes fruits, vegetables, and healthy fats, to support prostate health.

Foods to Limit or Avoid:

Processed foods
Sugars
Large amounts of carbohydrates
Alcohol
Caffeine
Dairy products
Red meat
High sodium (salt) foods

These dietary adjustments may help alleviate symptoms and improve overall prostate health.

Prevention

What steps can I take to lower my chances of developing benign prostatic hyperplasia?

Curious about reducing your risk of benign prostatic hyperplasia (BPH)? Implementing lifestyle adjustments to enhance both prostate and heart health, alongside incorporating supplements, can significantly aid in this endeavor.

Regular physical activity, with at least 30 minutes dedicated each day, serves as a cornerstone in BPH prevention or mitigating prostate growth. Equally crucial is the maintenance of optimal cholesterol, blood pressure, and blood sugar levels.

Consider incorporating the following herbal supplements into your regimen to potentially diminish the likelihood of developing BPH:

Beta-sitosterol: A plant-derived micronutrient renowned for its potential in promoting heart health.
Pygeum africanum: Extracted from the bark of the African cherry tree, this herbal remedy may assist in prostate size reduction.
Flaxseed: Rich in dietary fiber and omega-3 fatty acids, flax exhibits cholesterol-lowering properties.
Pumpkin seed oil: Extracted from pumpkin seeds, this oil is believed to aid in prostate shrinkage.

Before introducing any new supplements, it's imperative to consult our healthcare professional. We can offer insights into potential interactions with your existing supplement or medication regimen, ensuring your well-being remains safeguarded.

Getting Ready for Your Appointment

When to Consult Our Healthcare Professional?

Contact your healthcare provider promptly if you experience any of the following symptoms:

Lower abdominal or genital pain during urination.
Difficulty urinating or inability to urinate.
Fever or chills during urination.
Presence of blood in urine.

Essential Questions to Discuss with Our Doctor

How can BPH be diagnosed?
If BPH is ruled out, what alternative conditions could be causing my symptoms?
What measures can be taken to alleviate prostate enlargement?
Is treatment necessary for my condition?
What treatment options are most suitable for my specific situation?
Are there any supplements you suggest?
Will these supplements interact with my current medications or supplements?

A Note from Kamakhya Andro-Uro Care & Fertility Clinic:

Benign prostatic hyperplasia (BPH) is a prevalent condition primarily affecting individuals assigned male at birth (AMAB), typically manifesting around the age of 55. For those with mild BPH, a monitoring approach through routine check-ups with your healthcare provider may be appropriate. However, if BPH symptoms significantly impact your daily life, various treatments are available to reduce prostate enlargement.

If you experience symptoms of BPH, it's essential to consult our healthcare professionals. Together, we can explore tailored solutions to address your specific needs and improve your quality of life.