ENLARGED PROSTATE

Fortunately, most prostate diseases are noncancerous. They can be uncomfortable and inconvenient but are not life-threatening. The two main benign prostate diseases are prostatitis and benign prostatic hyperplasia (BPH), or an enlarged prostate. These are also among the most common male urologic problems as men age. Benign means that the enlargement is not caused by cancer or infection, or is unnatural; prostatic refers to the area affected (the prostate gland); and hyperplasia means enlargement. As many as 50% of men experience symptoms of an enlarged prostate by age 60, and 90% of men will report symptoms by age 85.

Physicians are not certain exactly why prostate enlargement occurs, but it is believed that it may be due to an excess of certain hormones in the body. One theory regarding the origin of an enlarged prostate involves the presence of a hormone called dihydrotestosterone (DHT) in the blood. DHT is a natural hormone that is responsible for the initial stages of prostate growth. As men age, DHT may cause the prostate to continue growing after it has reached full size. Studies have shown a high positive correlation between DHT levels and enlarged prostate. Physicians have noted that men who do not produce DHT do not experience an enlarged prostate. Research has also shown evidence that estrogen and genetics may play roles in BPH as well.

The role of estrogen can be explained by changing levels of testosterone. It is known that men produce testosterone and a small amount of estrogen throughout their lives; with aging, the amount of testosterone in the blood decreases, which leaves a larger proportion of estrogen. Studies have shown that higher levels of estrogen have been found in men who have enlarged prostate glands. Many physicians believe that genetics play a role as well. Men with a family history of enlarged prostate may be at greater risk than others.

It is important to note that the actual size of the prostate does not necessarily denote the severity of the symptoms. Constriction of the urethra by the prostate may occur in small as well as large glands. It is important to establish the presence of obstruction by clinical testing when considering treatments for symptoms.

What are some of the symptoms associated with BPH?

Since the prostate surrounds the urethra just below the bladder, its enlargement can result in symptoms that irritate or obstruct the bladder. A common symptom is the need to frequently empty the bladder, sometimes as often as every one to two hours, especially at night. Other symptoms include the sensation that the bladder is not empty, even after a man is done urinating, or that a man cannot postpone urination once the urge to urinate arises. BPH can cause a weak urinary stream, dribbling of urine, or the need to stop and start urinating several times when the bladder is emptied. BPH can cause trouble in starting to urinate, often requiring a man to push or strain in order to urinate. In extreme cases, a man might not be able to urinate at all, which is an emergency that requires prompt attention.

For addition information, visit The American Urological Association Foundation at www.urologyhealth.org