General description
Benign prostatic hyperplasia, or BPH, (also known as benign prostatic
hypertrophy) is a term referring to noncancerous enlargement of
the prostate gland. The prostate is a walnut-sized gland that forms
part of the male reproductive system. The gland is made of two lobes,
or regions, enclosed by an outer layer of tissue. Located in front
of the rectum and just below the bladder, the prostate surrounds
the urethra, the canal through which urine passes out of the body.
In BPH, the prostate enlarges and presses against the urethra like
a clamp, causing urinary problems such as an interrupted, weak urine
stream, increased urgency to urinate, increased leaking or dribbling,
and the need to urinate more frequently, especially at night. BPH
rarely causes symptoms before age 40, but more than half of men
in their sixties and as many as 90 percent in their seventies and
eighties have some symptoms of BPH. In the United States alone,
375,000 hospital stays each year involve a diagnosis of BPH.1
Contributing factors
Although the exact cause of BPH is not fully understood, the condition
appears to stem from age-related changes in hormone levels. Around
age 50, a man's testosterone and free testosterone levels decrease,
while levels of other hormones, such as prolactin and estrogen,
increase. This results in an increase in levels of dihydrotestosterone
(DHT), a very potent form of testosterone, within the prostate.
High concentrations of DHT within the prostate stimulate the overproduction
(hyperplasia) of prostate cells, ultimately resulting in prostate
enlargement. Prostate enlargement often goes unnoticed until it
progresses to the point where it compresses the urethra, causing
urinary tract disfunction.
Surgical treatment
While most men with BPH require some form of treatment at some
time, early treatment may not be needed because symptoms clear
up on their own in as many as one third of all mild cases. If
the condition begins to pose a danger to the patient's health
or causes a major inconvenience to him, treatment is usually recommended.
Most doctors recommend removal of the enlarged part of the prostate
as the best long-term solution for patients with BPH. During surgery
for BPH, only the enlarged tissue that is pressing against the
urethra is removed; the rest of the prostate tissue is left intact.
The most common type of surgery for BPH is a procedure called
transurethral resection of the prostate (TURP), which is used
about 90 percent of the time. In this type of surgery, no external
incision is needed. After giving anesthesia, the surgeon reaches
the prostate by inserting an instrument through the urethra. In
the few cases when TURP can not be used, open surgery, which requires
an external incision, may be used. Another relatively new treatment
for BPH is laser surgery, which causes less blood loss than other
surgical procedures and allows for shorter recovery time. However,
laser surgery may not be effective on larger prostates, and its
long-term effectiveness is not known.
Drug treatment
The FDA has approved four drugs for treatment of BPH, and these
drugs may relieve common symptoms. Finasteride (Proscar¬) inhibits
the production of DHT and may actually shrink the prostate in
some men. Other drugs relax the smooth muscle of the prostate
and bladder to improve urine flow and reduce bladder outlet obstruction.
This class of drugs, known as alpha blockers, includes terazosin
(Hytrin¬), doxazosin (Cardura¬), and tamsulosin (Flomax¬). Herbs
like saw palmetto and pygeum, which are commonly prescribed in
Europe for treatment of BPH, have not been approved by the FDA
for this application. However, studies have shown saw palmetto
extracts to be as effective as finasteride in alleviating BPH
symptoms.2,3
Other nonsurgical treatment
Because drug treatment is not effective in all cases, researchers
in recent years have developed a number of procedures that relieve
BPH symptoms but are less invasive than surgery, including transurethral
microwave thermotherapy (TUMT) and transurethral needle ablation
(TUNA). TUMT uses computer-regulated microwaves to destroy portions
of the prostate while a cooling system protects the urethra. TUNA
delivers low-level radiofrequency energy through twin needles
to burn away a well-defined region of the enlarged prostate while
shields protect the urethra from heat damage. No impotence or
incontinence have been reported with these procedures, but their
long-term effectiveness is still unknown.
Nutritional considerations
While some degree of prostate enlargement can be seen as an inevitable
part of aging, there are some dietary factors that may help minimize
the impact of BPH. A healthy intake of essential fatty acids is
important for prostate function. Beta-sitosterol, a nutrient found
in rice bran, wheat germ, corn oil, and soybeans, has been shown
to significantly improve BPH symptoms in some studies,4,5
as have certain herbs including saw palmetto 2,3 and
pygeum.6,7 Avoidance of substances that can irritate
the prostate (such as caffeine, alcohol, and tobacco), and activities
that put pressure on the prostate (such as bicycle or motorcycle
riding, and sitting for extended periods) is recommended.8
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