Prostate Enlargement (Benign Prostatic Hypertrophy, BPH)

About one-third of all men over age 50 experience noncancerous enlargement of the prostate gland, the result of a gradual process that can eventually cause severe obstruction of urinary flow. The prostate gland surrounds the neck of the male bladder and the urethra, the tube that carries urine from the bladder during voiding. Why it enlarges with age is not completely understood. Some theorize that chronic inflammation of the prostate may cause the enlargement; others suggest nutritional or metabolic factors play a role.

An enlarged prostate presses against the urethra and sometimes the bladder, preventing the bladder from emptying completely. Typically, an older man notices that he needs to urinate more often, the flow is slow to start, and the stream is weak, with dribbling at the end of voiding. There may also be pain and burning during urination, especially if the prostate is pressing against the urethral canal. If stagnant urine collects in the bladder, it increases the risk of urethritis and bladder stones. More severe blockage can cause urine to back up to the kidneys, damaging those organs.

Diagnostic Studies and Procedures

Two tests are useful in diagnosing benign prostatic enlargement. One is a digital rectal examination, during which a doctor palpates the prostate with a gloved finger inserted into the rectum, feeling it for enlargement and unusual hardness or lumps that may suggest the presence of cancer.

The other is a relatively new blood test that measures levels of prostate specific antigen (PSA), a substance normally produced by prostate tissue. In 30 to 50 percent of men with prostate enlargement, the PSA is elevated; the test is considered worthwhile because it can screen for prostate cancer. Blood for the test should be drawn before the digital rectal examination because palpating the prostate may produce a misleading temporary rise in PSA levels.

Other diagnostic studies may include placing a catheter in the bladder to measure the amount of urine remaining after voiding; an ultrasound examination; and cystoscopy, the insertion of a viewing tube into the bladder. A biopsy may be ordered to rule out cancer.

Medical Treatments

Initial therapy may involve medication to treat the urinary infections and kidney problems that frequently accompany an enlarged prostate. A bladder catheter may be necessary if the urinary flow is obstructed.

Until recently, the only treatment for the condition itself was surgery, usually transurethral resection of the prostate, or TURP. For this procedure, the surgeon uses a cytoscope (flexible tube) to reach the prostate through the urethra and then inserts a scalpel-like device through the tube to snip away overgrown prostate tissue. Most men who undergo this procedure remain in the hospital for about three days. The operation usually provides long-term relief from the symptoms of prostate enlargement.

A new drug, finasteride (Proscar), that shrinks the overgrown prostate when taken long-term now offers an alternative to surgery for some men. Experimental treatments include dilation of the portion of the urethra surrounded by the prostate, a method similar to the balloon angioplasty used to open clogged arteries.

Alternative Therapies

Herbal Medicine. Parsley and corn silk teas are popular herbal remedies advocated for alleviating mild prostate problems. An extract of saw palmetto berry is said to inhibit production of dihydro-testosterone, a body chemical that may be instrumental in prostatic enlargement. Herbalists also claim that ginseng can shrink an enlarged prostate.

Hydrotherapy. Warm sitz baths taken for 3 to 10 minutes two or three times a day may relieve symptoms, at least temporarily. Water temperature should be 105° to U5°F (40,5° to 46°C).

Naturopathy and Nutrition Therapy. Because zinc deficiency has been linked to prostate inflammation and enlargement, supplements of zinc may be advocated both to prevent and alleviate an enlarged prostate. Some nutritionists also recommend taking 1 teaspoon of flax, evening primrose, or walnut oil a day. Drinking two to four ounces of coconut milk daily is also said to tone the prostate gland.

Its a good idea to drink at least 8 to 10 glasses of water or other clear fluids a day. You should, however, be sure to avoid alcohol and caffeine.

Self-Treatment

You cannot prevent the development of an enlarged prostate. You should, however, avoid certain drugs that worsen the problem, including cold and allergy pills, which can cause urinary retention. Some prescription drugs, including medications used to treat ulcers, irritable bowel syndrome, and depression, may have a similar effect.

Other Causes of Prostate Symptoms

Prostate inflammation and prostate cancer produce symptoms similar to those of enlarged prostate; both should be ruled out in the diagnostic process.