Prostate Enlargement: Symptoms, Causes, Diagnosis and Treatment

Prostate enlargement, also known as Benign Prostatic Hyperplasia (BPH), is a common condition that affects men, particularly as they age. This condition can significantly impact daily life, causing discomfort and frequent urination. It's estimated that about half of men in their 60s, and up to 90% in their 70s and 80s, have some symptoms of BPH.

Benign Prostatic Hyperplasia is a non-cancerous enlargement of the prostate gland. The prostate is a small gland that produces seminal fluid in men. An enlarged prostate can press against the urethra, causing a variety of urinary symptoms.

Symptoms

The symptoms of BPH can vary, but often include:
- Frequent or urgent need to urinate
- Difficulty starting urination
- Weak urine stream or a stream that stops and starts
- Dribbling at the end of urination
- Inability to completely empty the bladder

"BPH is a common part of ageing for men and understanding the condition is key to managing symptoms effectively." - Mayo Clinic#

Causes

The exact cause of BPH is not entirely understood. However, it appears to be related to changes in male sex hormones as men age. Factors such as genetics and environmental influences may also play a role.

Impact and Complications

If left untreated, BPH can lead to complications such as urinary tract infections, bladder stones, and kidney damage. It can also significantly impact a man's quality of life, causing discomfort and frequent interruptions to sleep due to the need to urinate.

At risk groups

• Men over the age of 50
• Men with a family history of BPH
• Men with medical conditions such as obesity, heart and circulatory disease, and type 2 diabetes
• Men of African descent are at higher risk than men of Asian descent

Diagnosis

The most important investigations for a patient with a suspected enlarged prostate, also known as benign prostatic hyperplasia (BPH), typically include:
1. Medical history and physical examination, including a digital rectal exam (DRE) to assess the size, shape, and consistency of the prostate.
2. Urinalysis to check for signs of infection or other urinary problems.
3. Serum prostate-specific antigen (PSA) test to measure the level of PSA in the blood, which can be elevated in men with BPH as well as prostate cancer.
4. Kidney function tests to assess the impact of the enlarged prostate on the kidneys.
5. Post-void residual volume test, which measures how much urine remains in the bladder after urination.
6. Uroflowmetry, a test that measures the speed of urine flow.
7. Cystoscopy, a procedure that allows the doctor to view the inside of the bladder and urethra.
8. Transrectal ultrasound to visualize the prostate and measure its size.

Treatment Options

The recommended treatments for an enlarged prostate may include:
1. Watchful waiting or active surveillance for men with mild symptoms.
2. Medications such as alpha-blockers (eg. tamsulosin) that relax the muscles of the prostate and bladder neck, making it easier to pass urine.
3. 5-alpha reductase inhibitors (eg. finasteride or dutasteride) to shrink the enlarged prostate.
4. Combination therapy using both alpha-blockers and 5-alpha reductase inhibitors for more effective symptom relief.
5. Minimally invasive therapies such as transurethral microwave thermotherapy (TUMT) or transurethral needle ablation (TUNA).
6. Surgical options, such as transurethral resection of the prostate (TURP), if symptoms are severe or other treatments are not effective.

Doctors and Specialists Likely To Be Involved In The Patient’s Care

• Primary care physician (PCP) or an adult general practitioner (GP) for initial evaluation and referral for further treatment where necessary.
• Urologist for specialised assessment, diagnosis, and management of prostate enlargement.
• Radiologist for imaging studies if needed.
• Anaesthesiologist for any procedures requiring anaesthesia.
• Oncologist may be consulted if there is a concern for prostate cancer.
• Pharmacist for medication management and counselling on the medications frequently used to manage an enlarged prostate.

Importance of Treatment

Treatment for BPH is important to alleviate symptoms, improve quality of life, and prevent complications.

Early detection and treatment of BPH can significantly improve quality of life. - National Institute of Diabetes and Digestive and Kidney Diseases

Related Conditions or Complications

Men with BPH may also have other conditions such as erectile dysfunction, bladder stones, and chronic kidney disease.

Outlook and Prognosis

With appropriate treatment, most men with BPH can manage their symptoms and live a comfortable life. The prognosis is generally very good, but it can depend on factors such as the severity of symptoms and any underlying conditions.

Lifestyle changes can be a simple yet effective part of managing BPH symptoms. - NHS

Practical Tips & Coping Strategies

• Follow your doctor's treatment plan
• Limit fluid intake in the evening
• Limit caffeine and alcohol
• Exercise regularly
• Maintain a healthy weight