Prostatic hyperplasia

Overview

The prostate gland is a walnut-shaped gland in the male reproductive system. The prostate's primary role is to produce a fluid that enters sperm. Prostate fluid is required for male fertility. At the bladder's neck, the gland surrounds the urethra. The bladder neck is the junction of the urethra and the bladder. The lower urinary tract includes the bladder and urethra. The prostate consists of two or more lobes or parts surrounded by an outer layer of tissue and is located in front of the rectum, right below the bladder. The urethra is the tube that transports urine from the bladder to the exterior of the body. In men, the urethra also transports sperm to the penis.

The prostate is not required for life, but it is necessary for reproduction. Healthy sperm has the ideal consistency and habitat for transit and survival, as well as fertilization. Semen contains enzymes such as PSA (which is frequently examined as part of prostate cancer screening) as well as other components produced by the seminal vesicles and prostate such as zinc, citrate, and fructose (that actually gives sperm energy to make the journey to the egg). Semen also includes antibacterial and antiviral chemicals that may protect the urinary system and sperm from bacteria and other diseases.

The prostate is separated into anatomic zones or areas. The vast majority of prostate cancers begin in the peripheral zone (the rear of the prostate), near the rectum. That is why, in addition to the PSA blood test, a digital rectal exam (DRE), in which a clinician checks the prostate by inserting a gloved finger into the rectum, is a popular and beneficial screening test.

Urinary difficulty is not generally a sign of prostate cancer. Lower urinary tract symptoms are most often caused by Benign Prostatic Hypertrophy (BPH), a non-cancerous prostate disorder that originates from the transition zone that surrounds the urethra, or urine tube (closer to the middle of the prostate).

What is Prostatic hyperplasia?

BPH, or benign prostatic hyperplasia, is a disorder in which the prostate gland enlarges but is not malignant. BPH is sometimes referred to as benign prostatic hypertrophy or benign prostatic obstruction. As a man matures, his prostate goes through two major growth stages. The first is when the prostate doubles in size throughout puberty. The second stage of development begins at the age of 25 and lasts for the rest of a man's life. The second growth phase is frequently associated with benign prostatic hyperplasia.

As the prostate grows in size, it pushes on and compresses the urethra. The bladder's wall thickens. The bladder may eventually weaken and lose its capacity to completely empty, leaving some pee in the bladder. Many of the issues connected with benign prostatic hyperplasia are caused by urethral constriction and urine retention (the inability to completely empty the bladder).

According to research, having BPH does not raise your chance of acquiring prostate cancer. However, the symptoms of BPH and prostate cancer are identical. If you have BPH, you may also have undiscovered prostate cancer. Every individual with a prostate should get a prostate screening every year between the ages of 55 and 69 to help detect prostate cancer in its early stages. If you are Black or have a family history of prostate cancer, you are at a higher risk of developing the disease. If you have a higher risk of prostate cancer, you should begin tests at the age of 40.

Epidemiology of prostatic hyperplasia

BPH is the most prevalent prostate issue in males and persons who were born male (AMAB). Almost everyone who has a prostate will experience some enlargement as they get older.

BPH causes symptoms by restricting urine passage via the urethra. Symptoms of BPH are evident in one out of every four men by the age of 55, and in half of men over the age of 75. However, therapy is only required if symptoms become unbearable. By the age of 80, 20% to 30% of men have BPH symptoms severe enough to necessitate treatment. Until the recent approval of minimally invasive treatments that open the prostatic urethra and medications that can ease symptoms by decreasing the prostate or relaxing the prostate muscular tissue that constricts the urethra, surgery was the sole option.

What causes Prostatic hyperplasia?

The etiology of benign prostatic hyperplasia is unknown; nevertheless, it is more common in older men. Men whose testicles were removed before adolescence do not develop benign prostatic hyperplasia. As a result, some experts believe that variables connected to ageing and the testicles may induce benign prostatic hyperplasia.

Throughout their lifetimes, males generate testosterone, a male hormone, and trace quantities of estrogen, a feminine hormone. As men age, the quantity of active testosterone in their blood diminishes, leaving a larger proportion of estrogen. According to scientific evidence, benign prostatic hyperplasia may arise because a larger proportion of estrogen within the prostate boosts the action of chemicals that encourage prostate cell proliferation.

Another idea focuses on dihydrotestosterone (DHT), a male hormone that aids in the formation and expansion of the prostate. According to several studies, even when blood testosterone levels are low, elderly men continue to manufacture and accumulate significant quantities of DHT in the prostate. This DHT buildup may stimulate prostate cells to proliferate. Men who do not make DHT do not get benign prostatic hyperplasia, according to research.

What are the symptoms of Prostatic hyperplasia?

The size of the prostate does not necessarily predict the degree of the obstruction or symptoms. Some men with considerably enlarged prostates have little obstruction and few symptoms, whereas other men with marginally enlarged prostates have more blockage and symptoms. Lower urinary tract symptoms are experienced by less than half of all men with benign prostatic hyperplasia.

Men may not realize they have a blockage until they are unable to urinate. This disease, known as acute urinary retention, can be caused by using over-the-counter cold or allergy drugs containing decongestants such pseudoephedrine or oxymetazoline. One of these drugs' potential negative effects is that it prevents the bladder neck from relaxing and discharging urine.

Antihistamine-containing medications, such as diphenhydramine, can impair the contraction of bladder muscles, resulting in urine retention, difficulty urinating, and painful urination. Urinary retention can develop in males who have a partial urethra blockage as a result of alcohol use, low weather, or a prolonged period of inactivity.

Lower urinary tract symptoms that may indicate benign prostatic hyperplasia include:

• Urinary frequency—urinating eight or more times per day
• Urinary urgency—the inability to delay urination 
• Difficulty starting a urine stream 
• A weak or interrupted urine stream 
• Dribbling at the end of urination 
• Nocturia—frequent urination during periods of sleep 
• Urinary retention
• Urinary incontinence—accidental loss of urine
• Pain after ejaculation or during urination

Men with benign prostatic may experience other issues that might arise from hyperplasia including:

• Urinary retention (acute)
• Urinary retention that is chronic or long-term
• Blood in the urine
• Urinary tract infections (UTIs) 
• Bladder damage 
• Kidney failure

How is Prostatic hyperplasia diagnosed?

If your doctor feels you have BPH, he or she may recommend you to a urologist. A urologist is a doctor who specializes in the treatment of urinary system disorders. He will make a diagnosis of benign prostatic hyperplasia based on the following criteria:

• A personal and family medical history
• A physical examination
• Medical testing

Personal and Family Medical History:

Taking a personal and family medical history is one of the first things a health care provider may do to help diagnose benign prostatic hyperplasia. A healthcare provider may ask a man

• What symptoms are present?
• When the symptoms began and how frequently did they occur?
• Whether he has a history of recurrent UTIs?
• What medications he uses, both prescription and over-the-counter?
• How much liquid does he drink on a daily basis?
• Whether he takes coffee or alcohol?
• His general medical history, including any severe illnesses or operations

Physical Exam:

A physical exam may help diagnose benign prostatic hyperplasia. During a physical exam, a healthcare provider most often:

• Examines a patient's body, which may involve examining for:
  • Urethral discharge
  • Swollen or sore groin lymph nodes
  • Swollen or tender scrotum
• Taps on certain bodily parts of the patient
• Conducts a digital rectal exam

A digital rectal exam, often known as a rectal exam, is a physical evaluation of the prostate. To complete the exam, the doctor instructs the guy to bend over a table or lie on his side with his legs near to his chest. The healthcare professional inserts a gloved, lubricated finger into the rectum and feels the portion of the prostate that is adjacent to the rectum. During the rectal exam, the guy may experience little pain.

A rectal exam is often performed during an office visit by a health care professional, and males do not require anesthetic. The exam allows the doctor to check if the prostate is swollen or sensitive, or if there are any abnormalities that necessitate further testing. Many healthcare practitioners do a rectal exam as part of a standard physical check for men aged 40 and over, regardless of whether they have urinary difficulties.

Medical Tests:

Urinalysis

Urinalysis is the testing of a urine sample. In a healthcare provider's office or a commercial facility, the patient takes a urine sample in a particular container. During an office visit, a healthcare professional analyses the sample or sends it to a lab for examination. A nurse or technician performs the test by inserting a strip of chemically treated paper, known as a dipstick, into the urine. The color of the dipstick patches changes to show the presence of infection in the urine.

PSA blood test

During an office visit or at a commercial facility, a healthcare professional may collect blood for a PSA test and send the sample to a lab for analysis. PSA is a protein produced by prostate cells. Prostate cancer patients may have increased levels of PSA in their blood. A high PSA level, on the other hand, does not always indicate prostate cancer. Indeed, elevated PSA levels are frequently caused by benign prostatic hyperplasia, prostate infections, inflammation, age, and natural variations. Much is uncertain about how to interpret a PSA blood test, the test's capacity to distinguish between cancer and prostate diseases such as benign prostatic hyperplasia, and the best course of action to follow if the PSA level is high.

Urodynamic tests

Urodynamic tests are a group of techniques used to assess how effectively the bladder and urethra hold and discharge urine. Urodynamic tests are performed by a health care professional at an office visit, an outpatient clinic, or a hospital. Some urodynamic tests are performed without anesthetic, while others may require a local anesthetic. The bladder's capacity to store pee and drain steadily is the subject of most urodynamic testing.

Cystoscopy

Cystoscopy is a technique that looks inside the urethra and bladder using a tube-like equipment called a cystoscope. A urologist inserts the cystoscope into the lower urinary system through the hole at the tip of the penis. Cystoscopy is performed by a urologist at an office visit, an outpatient clinic, or a hospital. The urologist will administer local anesthetic to the patient; however, in rare situations, the patient may require sedation as well as regional or general anesthesia. Cystoscopy may be used by a urologist to examine for blockages or stones in the urinary system.

Transrectal ultrasound

Transrectal ultrasonography employs a transducer, which bounces harmless, painless sound waves off organs to provide a picture of their anatomy. To evaluate different organs, the health care professional might move the transducer to different angles. The treatment is performed in a health care provider's office, an outpatient facility, or a hospital by a properly trained technician, and the pictures are interpreted by a radiologist—a doctor who specializes in medical imaging; the patient is not sedated.

Transrectal ultrasonography is the most common method used by urologists to assess the prostate. The technician puts a transducer little bigger than a pen into the man's rectum, adjacent to the prostate, during a transrectal ultrasonography. The ultrasound scan displays the prostate's size as well as any anomalies, such as malignancies. Transrectal ultrasonography is ineffective in detecting prostate cancer.

Biopsy

A biopsy is a process in which a tiny bit of prostate tissue is removed for examination under a microscope. In an outpatient clinic or a hospital, the biopsy is performed by a urologist. The urologist will administer mild sedation and local anaesthetic to the patient; but, in certain circumstances, general anesthesia will be required. The urologist guides the biopsy needle into the prostate using imaging modalities such as ultrasound, computed tomography, or magnetic resonance imaging. In a lab, a pathologist (a specialist who specializes in studying tissues to identify illnesses) analyses prostate tissue. The test can determine whether or not prostate cancer is present.

How is Prostatic hyperplasia treated?

If your symptoms are minor, you may not need therapy. Your doctor may advise you to take a "watchful waiting" strategy, in which you arrange regular consultations to ensure that your BPH does not worsen. Among the treatment possibilities are:

Medical treatment:

The most typically recommended drugs relax the prostate muscle, reducing stress on the urethra. Here are several examples:

• Tamsulosin
• Terazosin
• Doxazosin
• Alfuzosin
• Silodosin

Some drugs reduce the production of the hormone DHT, which can delay the growth of your prostate gland. These drugs are especially effective to men who have bigger prostates. Examples include:

• Finasteride
• Dutasteride

Your doctor may recommend a combination of drugs to address your symptoms as well as enhance your urine flow. Tamsulosin and dutasteride are two examples. It may take one to eight weeks for your symptoms to improve after you start taking medication.

Surgical options:

Several methods of surgery can be used to remove prostate tissue that is blocking your urethra. These are some examples:

• Transurethral resection of the prostate (TURP). Your urologist will place a special instrument (resectoscope) through your urethra to see and remove prostate tissue. 
• Transurethral incision of the prostate (TUIP). To expand your urethra and enhance urine flow, your urologist makes two small incisions in your prostate and where your urethra and bladder unite (bladder neck).
• Transurethral electro-vaporization. Your urologist will use an electrode to heat the tissue in your prostate. This converts the tissue cells in your prostate's swollen parts into steam.
• Green Light laser. Your urologist will use a specific laser to remove the swollen prostate tissue.

You should be able to resume normal activities within a few days or a week of surgical treatment.

Minimally invasive procedures:

New BPH therapies are less intrusive and less harmful to healthy tissue than surgery. In general, most of these therapies are outpatient operations, which means you may go home the same day. They're also less expensive, have less side effects, and allow for a speedier recovery. However, because these treatments are new, there isn't much evidence on their long-term impacts or difficulties.

The following are some examples of minimally invasive treatments:

• Prostatic urethral lift. This surgery divides your enlarged prostate lobes in order to widen your urethra, making it simpler to pee. A special device (UroLift) is inserted into your urethra and up to your prostate by your urologist. The UroLift ejects tiny implants that pull your prostate lobes apart and open your urethra when it reaches the side wall of your prostate. Depending on the size of your prostate, your urologist may install two to six implants.
• Water vapor therapy. A tool is inserted into your urethra and moved to your prostate by your urologist. The needle is subsequently inserted into your prostate by your urologist. The needle produces steam vapor, which condenses into water. The warm energy of the water kills your prostate cells. The dead cells are reabsorbed by your body, and your prostate shrinks.

The most typical negative effects of these therapies include increased peeing and pain or irritation while your prostate recovers. You should be able to resume your usual activities in a few days after minimally invasive surgery. Within three to six weeks, you should notice an improvement in your symptoms.

Prevention of Prostatic hyperplasia

Making lifestyle changes that enhance your prostate and heart health, as well as taking supplements, are the most effective approaches to lower your chance of having BPH. Exercising for at least 30 minutes every day may help prevent BPH or reduce the development of the prostate. It is also critical to maintain appropriate cholesterol, blood pressure, and blood sugar levels.

The herbal supplements listed below may also help minimize your chance of getting BPH:

• Beta-sitosterol. Plants contain beta-sitosterol, a vitamin that may help keep your heart healthy.
• Pygeum africanum. Pygeum africanum is a herbal extract derived from the bark of the African cherry tree that may aid in prostate shrinkage.
• Flaxseed. Flax is high in dietary fiber and omega-3 fatty acids, both of which may help decrease cholesterol.
• Pumpkin seed oil. 

Conclusion

Benign prostatic enlargement (BPE) is the medical name for an enlarged prostate, a disorder that can influence how you pee (urinate). It is more frequent in men over the age of 50. It's not cancer, and it's typically not a severe health risk. Many men are concerned that having an enlarged prostate means they are more likely to acquire prostate cancer. This is not the case. The risk of prostate cancer is no higher in men with enlarged prostates than in men without enlarged prostates.

The etiology of prostate enlargement is uncertain; however, it is thought to be related to hormonal changes that occur as men age. As you age, the balance of hormones in your body changes, which may cause your prostate gland to expand.

When the prostate enlarges, it can put pressure on the bladder and the urethra, which is the tube through which urine flows. This can have an impact on how you pee and may result in:

• Difficulty beginning to pee 
• Frequent peeing
• Difficulty completely emptying your bladder

The severity of your symptoms will determine how you are treated for an enlarged prostate. Mild symptoms normally do not necessitate prompt treatment. If and when you require more check-ups, your doctor will agree with you.

You will almost certainly be recommended to adopt lifestyle modifications such as:

• Drinking less alcohol, coffee, and fizzy drinks
• Limiting your intake of artificial sweeteners 
• Regular exercise
• Drinking less in the evening

To treat moderate to severe symptoms of an enlarged prostate, medication to shrink the prostate and relax the bladder may be advised. Surgery is often reserved for moderate to severe symptoms that have failed to respond to medication.