Download Enlarged Prostate - Patient Education Center

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Harvard Medical School
Enlarged
Prostate
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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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3
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.
4
7) Plan Ahead
When you are in new places, learn the location
of the bathroom before you really need it.
5
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.
6
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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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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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