Enlarged Prostate (Benign Prostatic Hyperplasia)
It is normal for a man’s prostate gland to enlarge from age 40 years. This enlargement is known as benign prostatic hyperplasia and may affect a man’s ability to urinate and lead to bladder and kidney problems.
Various treatment options exist to address enlarged prostate, including both medical and surgical options. The most common prostate surgery is transurethral resection of the prostate (TURP).
The prostate is a walnut-shaped gland located below the outlet of the bladder. Its main function is to produce a fluid which protects and enriches sperm.
As men age, it is normal for the prostate gland to gradually enlarge. This usually begins about the age of 40 years and is thought to be caused by hormonal changes. This enlargement -benign prostatic hyperplasia (BPH) - can cause difficulties with urinating and can lead to problems with the bladder and kidneys. Hyperplasia is a term that describes an increase in the number of cells in an organ.
An enlarged prostate does not cause prostate cancer. However, prostate cancer can occur in men with an enlarged prostate. Read more about prostate cancer here.
As the prostate gland enlarges it narrows the urethra (the tube which drains urine from the bladder) and can obstruct the flow of urine. This can lead to difficulties with urinating such as:
- Increased frequency – having to urinate more often
- Urinary urgency – having a sudden need to urinate
- Nocturia – having to get up frequently in the night to urinate
- Difficulty with getting the urine stream started (hesitancy)
- Poor flow of urine
- Dribbling of urine – particularly at the end of urination
- Incomplete emptying of the bladder.
Symptoms can fluctuate in nature and severity. Some men may have no symptoms at all, while for others, symptoms may be very problematic.
Enlarged prostate, if severe, can also lead to:
- Back up of urine into the kidneys
- Enlargement and thickening of the bladder
- Bladder stones
- Urinary tract infections (UTIs)
- Bleeding from the urethra
- An inability to urinate at all.
Any of these situations can cause damage to the bladder, urethra and kidneys. If there is burning, bleeding or pain while urinating, medical attention should be sought promptly. Being unable to urinate at all is a medical emergency and requires immediate medical attention.
If symptoms of enlarged prostate are present a doctor should be consulted so an accurate diagnosis can be made and treatment recommended. It is important to rule out other possible causes for the symptoms such as prostatitis (inflammation of the prostate) or prostate cancer.
In order to diagnose the condition the doctor will undertake the following:
Medical history
Including the nature, duration and severity of the current symptoms, the presence of any other medical conditions, and family history of prostate problems.
Physical examination
During a physical examination the doctor will feel the abdomen for signs of an enlarged bladder and they will perform a digital rectal examination (DRE) to check for enlargement or irregularity of the prostate gland.
Blood tests
These will be performed to check kidney function and to check the PSA (prostate specific antigen). PSA is a protein released into the blood by the prostate gland. Higher than normal levels can indicate enlarged prostate, prostate inflammation (prostatitis) or prostate cancer. The PSA level tends to be significantly elevated in prostate cancer, but not always.
Urine test
This can show infection or the presence of blood in the urine.
If blood tests indicate an elevated PSA and the digital rectal examination indicates irregularities of the prostate, a biopsy of the prostate gland may be advised in order to rule out prostate cancer.
An ultrasound scan of the prostate and urinary tract may also be recommended in some cases.
Treatment is only required if enlarged prostate is causing symptoms. Three main treatment approaches are taken - “wait and watch”, medical treatment, and surgical treatment.
“Wait and watch”
This approach may be advised if the symptoms are mild. The condition is regularly monitored and treatment will be advised if symptoms worsen.
Medical treatment
There are a number of medications that can be used to treat enlarged prostate. The medications work by relaxing the muscle inside the prostate, making it easier for the urethra to open, and some block the action of testosterone, causing the prostate to shrink.
Medications commonly used in New Zealand to treat enlarged prostate include Terazosin (Hytrin), Doxazasin (Cardoxan) and Finastaride (Proscar).
Surgical treatment
Up to 25% of men with enlarged prostate will require surgical treatment. The most commonly performed procedure is transurethral resection of the prostate (TURP). In some cases open surgery may be recommended.
Transurethral Resection of the Prostate (TURP)
A TURP is performed by a specialist urologist (urinary system specialist) and is usually performed under a general anaesthetic.
The specialist inserts a resectoscope (a thin tube-like telescope with a light at its tip) through the urethra and up into the prostate gland. The specialist can view the prostate gland and bladder, either through the resectoscope or on a television monitor.
Diagram courtesy of www.urolog.nl
A special heated wire loop is inserted through the resectoscope and is used to cut away excess prostate tissue a sliver at a time. The wire also seals blood vessels to help minimise bleeding.
A hospital stay of between one and five days may be required after a TURP. Prior to going home the specialist will recommend recovery and activity guidelines and it is important to follow these carefully.
A variation on the TURP technique is laser resection of the prostate. This is performed in a similar way to a TURP, however a laser beam is used to cut away the prostate tissue rather than a heated wire loop. This technique tends to produce less bleeding than a TURP and recovery time tends to be quicker.
Open prostatectomy
This surgery involves removing part, or all of the prostate gland via an incision in the lower abdomen or the perineum (the area between the scrotum and anus). It is also performed by a specialist urologist and it may be recommended in cases where the prostate gland is significantly enlarged. It is usually performed under a general anaesthetic.
A hospital stay of up to five days is common after open prostatectomy. Again, the specialist will recommend recovery and activity guidelines.
Further Information and Support
For further information contact your doctor of practice nurse or contact:
The Prostate Cancer Foundation of New Zealand
Freephone: 0800 62 72 77
Website: www.prostate.org.nz
The PCF offers information and support about all prostate problems.
Healthline
Freephone: 0800 611 116
Healthline is a free, 24 hour a day health advice service.
Anderson, K.N., Anderson, L.E. & Glanze, W.D. (eds.) (2006) Mosby’s medical, nursing, & allied health dictionary (6th ed.) St. Louis: Mosby-Year Book, Inc.
Cramer, D. A. and Frey, R. J. (2006) Prostatectomy. The Gale Encyclopedia of Medicine. Third Edition. Jacqueline L. Longe, Editor. Farmington Hills, MI. Thompson Gale.
Everybody (2005) Bladder problems and the prostate. Auckland. CMPMedica (NZ) Ltd. http://www.everybody.co.nz/page-3000e3f8-dfa2-44d9-80fc-0b183255874a.aspx
Hewitt, A (2001) Transurethral Resection of the Prostate (TURP). Booklet. Promed Urology Ltd. Tauranga.
The Prostate Cancer Foundation of New Zealand (2007) Benign Prostatic Hyperplasia. The Prostate Cancer Foundation of New Zealand. http://www.prostate.org.nz/4Ci.html#BPH
Last reviewed – 14/11/07
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