Enlarged Prostate Affects Older Men

 Enlarged prostate is also known as benign prostate hyperplasia, or simply BPH. It is not cancer, and it does not raise your risk for prostate cancer. Prostate enlargement happens to almost all men as they get older. As the gland grows, it can press on the urethra and cause urination and bladder problems. This narrowing of the urethra can cause some men with prostate enlargement to have trouble with urination. Prostate enlargement may be the most common health problem in men older than 60 years of age. 

Causes

The prostate gland is the male organ that produces most of the fluid in semen, the milky-colored fluid that nourishes and transports sperm out of the penis during ejaculation. It sits beneath your bladder. The tube that transports urine from the bladder out of your penis passes through the center of the prostate. So, when the prostate enlarges, it begins to block urine flow.

Most men have continued prostate growth throughout life. In many men, this continued growth enlarges the prostate enough to cause urinary symptoms or to significantly block urine flow. Doctors aren't sure exactly what causes the prostate to enlarge. It may be due to changes in the balance of sex hormones as men grow older.

Symptoms

Although an enlarged prostate is not in itself a life-threatening condition, it can give rise to a number of inconvenient symptoms which if severe enough, can affect your health and quality of life. As the prostate enlarges, it presses against the bladder and interferes with the way it works. This gives rise to a number of symptoms relating to bladder function and urination. The most common of these are: 

• Having to get up at night for a pee
• The need to pass water frequently 
• Poor urine flow – also known as poor stream
• Dribbling at the end of urination 

When the bladder does not empty completely, you become at risk for developing urinary tract infections. Other serious problems can also develop over time, including bladder stones, blood in the urine, incontinence, and acute urinary retention (an inability to urinate). A sudden and complete inability to urinate is a medical emergency; you should see your doctor immediately. In rare cases, bladder and/or kidney damage can develop from BPH.

Risk Factors

• Obesity
• Lack of physical activity
• Erectile dysfunction
• Increasing age
• Family history of BPH

Exams and Tests

Your doctor will ask you questions about your medical history and do a digital rectal exam to feel the prostate gland. Other tests you may have include:

• Urine flow rate
• Post-void residual urine test to see how much urine is left in your bladder after urination
• Pressure flow studies to measure the pressure in the bladder as you urinate
• Urinalysis to check for blood or infection
• Urine culture to check for infection
• Prostate-specific antigen (PSA) blood test to screen for prostate cancer
• Cystoscopy

You may be asked to fill out a form to rate how bad your symptoms are and how much they affect your daily life. Your doctor can use this score to judge if your condition is getting worse over time.

Treatments

The best treatment choice for you depends on several factors, including how much your symptoms bother you, the size of your prostate, other health conditions you may have, your age and your preference. If your symptoms aren't too bad, you may decide not to have treatment and wait to see whether your symptoms become more bothersome over time.

Self-Help

For mild symptoms:

• Urinate when you first get the urge. Also, go to the bathroom when you have the chance, even if you don't feel a need to urinate.
• Avoid alcohol and caffeine, especially after dinner.
• Don't drink a lot of fluid all at once. Spread out fluids during the day. Avoid drinking fluids within 2 hours of bedtime.
• Try NOT to take over-the-counter cold and sinus medicines that contain decongestants or antihistamines. These drugs can increase BPH symptoms.
• Keep warm and exercise regularly. Cold weather and lack of physical activity may worsen symptoms.
• Learn and perform Kegel exercises (pelvic strengthening exercises).
• Reduce stress. Nervousness and tension can lead to more frequent urination.

Medications

Medications are the most common treatment for moderate symptoms of prostate enlargement. Medications used to relieve symptoms of enlarged prostate include:

• Alpha blockers. These medications relax bladder neck muscles and muscle fibers in the prostate itself and make it easier to urinate. These medications include terazosin, doxazosin (Cardura), tamsulosin (Flomax), alfuzosin (Uroxatral) and silodosin (Rapaflo). Alpha blockers work quickly. Within a day or two, you'll probably have increased urinary flow and need to urinate less often. These may cause a harmless condition called retrograde ejaculation — semen going back into the bladder rather than out the tip of the penis.
• 5 alpha reductase inhibitors. These medications shrink your prostate by preventing hormonal changes that cause prostate growth. They include finasteride (Proscar) and dutasteride (Avodart). They generally work best for very enlarged prostates. It may be several weeks or even months before you notice improvement. While you're taking them, these medications may cause sexual side effects including impotence (erectile dysfunction), decreased sexual desire or retrograde ejaculation.
• Combination drug therapy. Taking an alpha blocker and a 5 alpha reductase inhibitor at the same time is generally more effective than taking just one or the other by itself.
• Tadalafil (Cialis). This medication, from a class of drugs called phosphodiesterase inhibitors, is often used to treat impotence (erectile dysfunction). It also can be used as a treatment for prostate enlargement. Tadalafil can't be used in combination with alpha blockers. It also can't be taken with medications called nitrates, such as nitroglycerin.

Surgery

Prostate surgery may be recommended if you have:

• Incontinence
• Recurrent blood in the urine
• Inability to fully empty the bladder (urinary retention)
• Recurrent urinary tract infections
• Decreasing kidney function
• Bladder stones

The choice of a specific surgical procedure is usually based on the severity of your symptoms and the size and shape of your prostate gland.

Transurethral resection of the prostate (TURP): 

This is the most common and most proven surgical treatment for BPH. TURP is performed by inserting a scope through the penis and removing the prostate piece by piece.

Simple prostatectomy:

An open prostatectomy is usually performed using general or spinal anesthesia. An incision is made through the abdomen or perineum (the area behind the scrotum). Only the inner part of the prostate gland is removed. The outer portion is left behind. This is a long procedure. Most people need to stay in the hospital for 5 to 10 days. This treatment is most often done on men who have very large prostate glands.

Most men who have prostate surgery have improvement in urine flow rates and symptoms.

Other, less-invasive procedures use heat to destroy prostate tissue. None have been proven to be better than TURP. Patients who receive these procedures are more likely to need surgery again after 5 or 10 years. However, these procedures may be a choice for:

• Younger men (many of the less-invasive procedures carry a lower risk for impotence and incontinence than TURP, although the risk with TURP is not very high)
• Elderly patients
• Patients with severe medical conditions, including uncontrolled diabetes, cirrhosis, alcoholism, psychosis, and serious lung, kidney, or heart disease
• Men who are taking blood-thinning drugs

Helping Yourself

There are a number of things you can do to help yourself if you suffer from an enlarged prostate. The typical high-fat Western diet and a lack of vegetables and pulses appear to be factors contributing to prostate enlargement. Foods such as broccoli, brussel sprouts, cabbage and kale appear to be beneficial as are foods rich in zinc such as pumpkin seeds, pine nuts and shellfish.

Prevention

There is no known way to prevent prostate enlargement. It is a common part of aging.

• Avoid drinking liquids after 6 p.m. to reduce the need to urinate frequently during the night.
• Drinking more fluid, up to eight glasses of water per day, may help prevent infection. However, for men already suffering with increased urinary frequency, this may only exacerbate the problem. In most cases, drinking a normal amount of fluid based on thirst is all that is necessary.
• There is evidence that cranberry juice may be helpful in the prevention of urinary tract infections in those who are prone to developing these.