PROSTATE, ENLARGED

General Information

DEFINITION--Enlargement of the prostate (a gland surrounding the neck of the bladder and urethra in the male). The enlargement does not cause problems unless it obstructs the flow of urine from the bladder.

BODY PARTS INVOLVED--Prostate gland; bladder; urethra.

SEX OR AGE MOST AFFECTED--Men over age 50.

SIGNS & SYMPTOMS

• Increased urinary urgency and frequency, especially at night.
• Weak urinary stream.
• Straining and dribbling on urination.
• Feeling that the bladder cannot be emptied completely.
• Urine of abnormal color.
• Impotence (sometimes).
• Burning on urination.

CAUSES--Exact cause unknown, may be due to hormonal changes that accompany aging.

RISK INCREASES WITH--Aging.

HOW TO PREVENT--No specific prevention known. Appears to be a part of the aging process.

What To Expect

DIAGNOSTIC MEASURES--

• Your own observation of symptoms.
• Medical history and physical exam by a doctor. The degree of difficulty BPH is causing you should be determined with a question and answer interview about your specific symptoms. This can help in making treatment decisions, and then after treatment, provide a good indication of degree of improvement.
• Diagnostic tests may include digital rectal examination, a urinary flow rate with post-void residual and a cystourethroscopy (visual examination, with a lighted instrument, of the inside of the urinary bladder and urethra).
• Intravenous pyelogram, biopsy or ultrasound may be used (See Glossary for all).

APPROPRIATE HEALTH CARE

• Doctor's treatment. Urinary retention, hydronephrosis (kidney disorder), azotemia (excess urea in the blood) and worsening obstructive symptoms are the usual indications for treatment.
• Surgery, transurethral resection of the prostate (TURP), may be recommended. Complications are rare, but are of great concern to patients. Balloon dilatation of the prostate is sometimes effective in patients with mild obstruction. New surgery methods using lasers are under development. (See 2 topics on Prostate-Gland Removal in Surgery section.)
• Treatment with medications is an option.

POSSIBLE COMPLICATIONS--About 11-13% of males with BPH will be found to have clinically undetectable prostate cancer.

PROBABLE OUTCOME--Symptoms in the majority of patients remain stable, while 10-20% will need treatment.

How To Treat

GENERAL MEASURES--

• Urinate as soon as you feel the urge. Don't let the bladder become too full before emptying it.
• For an explanation of surgery and postoperative care, see Prostate-Gland Removal in Surgery section.

MEDICATION--

• Your doctor may prescribe Finasteride (brand name Proscar) for treatment of mild to moderate disease. Alpha-adrenergic blockers, hormonal agents and anti-androgens to improve urinary flow and other symptoms. Antibiotics if you develop a urinary-tract infection.
• Read labels on all non-prescription medicines. Avoid those that state "not recommended if you have prostatic hypertrophy" (examples are antidiarrheals and antihistamines).

ACTIVITY--No restrictions on activities; however, avoid when possible, long bus, train or plane rides unless restrooms are available so you can urinate at any time.

DIET--No special diet. Avoid spicy foods and pepper, which irritate the urethra.

Call Your Doctor If

• You cannot urinate.
• You develop fever.
• You have an enlarged prostate and the symptoms are worsening.