What is benign prostatic hyperplasia (BPH)?
BPH (also referred to as benign prostatic hypertrophy) is a condition in which the prostate gland becomes very enlarged and may cause problems associated with urination. BPH can raise PSA (prostate-specific antigen) levels two to three times higher than the normal level. An increased PSA level does not indicate cancer, but the higher the PSA level, the higher the chance of having cancer.
Some of the signs of BPH and prostate cancer are the same; however, having BPH does not seem to increase the chances of developing prostate cancer. A man who has BPH may also have undetected prostate cancer at the same time or may develop prostate cancer in the future. Therefore, the National Cancer Institute (NCI) and the American Cancer Society (ACS) recommend that all men over 50 consult their physicians about having a digital rectal and PSA examination once a year to screen for prostate cancer.
How does BPH occur?
The prostate goes through two main periods of growth. In early puberty, the prostate doubles in size. Then, around age 25, the prostate begins to grow again and continues to grow throughout most of a man's life.
The continuing enlargement of the prostate does not usually cause problems until later in life. However, the second period of growth may, many years later, result in BPH. According to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK):
BPH rarely causes symptoms before age 40.
More than half of men in their 60s have some symptoms of BPH.
As many as 90 percent of men in their 70s and 80s have some symptoms of BPH.
What happens when the prostate enlarges?
As the prostate enlarges, it presses against the urethra and interferes with urination. At the same time, the bladder wall becomes thicker and irritated, and begins to contract -- even when it contains only small amounts of urine -- which causes more frequent urination. And, as the bladder continues to weaken, it may not empty completely and leave some urine behind, leading to a frequent sensation of having to void, having a slow urinary flow, and waking up at night to urinate.
Blocking or narrowing of the urethra by the prostate and partial emptying of the bladder cause many of the problems associated with BPH.
What are symptoms of BPH?
The following are the most common symptoms of benign prostatic hyperplasia. However, each individual may experience symptoms differently. Symptoms may include:
Leaking or dribbling of urine
More frequent urination, especially at night
Urgency to urinate
Urine retention (inability to urinate)
A hesitant, interrupted, weak stream of urine
These problems may lead to one or more of the following:
Urinary tract infections
Inability to pass urine at all
The symptoms of benign prostatic hyperplasia may resemble other conditions or medical problems. Always consult your physician for a diagnosis.
How is BPH diagnosed?
Diagnosing BPH in its earlier stages can lower the risk of developing complications. Delay can cause permanent bladder damage for which BPH treatment may be ineffective. In addition to a complete medical history and physical examination, diagnostic procedures for BPH may include the following:
Digital rectal exam (DRE). A procedure in which the physician inserts a gloved finger into the rectum to examine the rectum and the prostate gland for signs of cancer.
Intravenous pyelogram (IVP). A series of X-rays of the kidney, ureters, and bladder with the injection of a contrast dye into the vein to detect tumors, abnormalities, kidney stones, or any obstructions, and to assess renal blood flow.
Cystoscopy (also called cystourethroscopy). An examination in which a scope -- a flexible tube and viewing device -- is inserted through the urethra to examine the bladder and urinary tract for structural abnormalities or obstructions, such as tumors or stones.
Urine flow study. A test in which the patient urinates into a special device that measures how quickly the urine is flowing. A reduced flow may suggest BPH.