Lourdes Urology Expert Explains Common Prostate Condition and When to Seek Help
The American Cancer Society recommends that men be offered annual prostate screening starting at age 50. High-risk men may be offered screening even earlier.
While urologists are looking for signs and symptoms of cancer, not all prostate conditions are cancerous. Benign prostatic hyperplasia (BPH) is one such condition.
“Benign prostatic hyperplasia is an enlarged prostate,” said urologist Rajen Butani, MD, FACS, who treats patients at Delaware Valley Urology as well at Our Lady of Lourdes Medical Center. “It’s not cancer and having it does not make you more likely to develop prostate cancer. At first, BPH can be just bothersome. But it can worsen over time if not treated, leading to worsening voiding symptoms, urinary tract infections, bladder decompensation or kidney damage, bladder stones and incontinence. So it’s critical to have a urologic evaluation.”
According to the NIH, approximately 4.5 million visits were made to physician offices to for a primary diagnosis of BPH and almost eight million visits were made with a primary or secondary diagnosis of BPH in 2000.
BPH occurs in many men as they age. Prostate enlargement rarely causes symptoms before age 40, but more than half of men in their 60s and as many as 90 percent in their 70s and 80s report problems.
As a man matures, the prostate goes through two main periods of growth, first early in puberty and then around age 25. It’s normally the size of a walnut. By the time a man hits age 60, his prostate could be the size of a lemon.
“As the prostate becomes larger with age and compresses the urethra, the bladder wall can thicken and become more irritable. As this progresses, the bladder can begin to contract even when it contains small volume of urine, causing more frequent urination,” said Dr. Butani. “Eventually, if untreated, in some, the bladder loses the ability to empty itself.”
Common BPH symptoms include:
- Trouble getting a urine stream started and completely stopped (dribbling)
- Often feeling like you need to urinate, especially at night
- A weak urine stream
- A sense that your bladder is not completely empty after you urinate
The cause of BPH is not well understood, but is believed to be linked to hormone changes and cell growth. The size of the prostate does not always determine the severity of symptoms.
Sometimes a man does not realize he has BPH until he finds himself unable to urinate, said Dr. Butani. This painful condition, called acute urinary retention, may be triggered by taking over-the-counter cold or allergy medication. These medicines can prevent the bladder from relaxing and allowing urine to empty. Urinary retention also can be brought on by alcohol, cold temperatures or a long period of immobility. Men who are unable to urinate at all should seek immediate medical attention, according to Dr. Butani.
“It’s also important to make sure the urination problems are not caused by another medical condition like prostate cancer, which can have similar symptoms,” he said.
BPH treatments include:
- Lifestyle changes. Practice “double voiding,” urinating more than once before bedtime. Also, limit drinking at night, especially those containing alcohol or caffeine and avoid medicines that make urination difficult.
- Drug therapy. A number of medications have been approved to ease urine flow and relieve symptoms. Some of these include Proscar, Avodart, Hytrin, Cardura Flomax, .Uroxatral, Rapaflo and Cialis.
- Surgery. The most common is transurethral resection of the prostate (TURP). With TURP, a long scope is inserted through the tip of the penis to the prostate. The scope contains a light, valves for controlling irrigating fluid and an electrical loop that cuts tissue and seals blood vessels. The loop shaves obstructing tissue. The pieces of tissue are carried by fluid into the bladder and then flushed at the end of the procedure.
- Laser. Another option involves a laser. As with TURP, the doctor passes a scope through the tip of the penis to the prostate. Short bursts of energy destroy prostate tissue and cause the gland to shrink.
“Many effective options are available for the treatment of BPH,” said Dr. Butani. “Speak to your physician about the best treatment for you.”
To make an appointment with a Lourdes urologist, please call 1-888-LOURDES (568-7337) or visit www.lourdesnet.org.