How Dangerous Is Having an Enlarged Prostate?

About half of men older than 50 have an enlarged prostate. Here are some of the basic facts you need to know about this common condition.

As men age, many experience prostate gland enlargement. This condition is known as benign prostatic hyperplasia (BPH).

The prostate gland surrounds the urethra, the hollow tube that carries urine out of the body. When the prostate gets bigger, it can squeeze or partially block the urethra, which leads to problems urinating.

BPH is quite common in older men. In fact, the condition impacts about 50% of men between the ages of 51 and 60. For men 80 and older, the prevalence of BPH is approximately 90%, according to the National Institute of Diabetes and Digestive and Kidney Diseases.

While BPH can have serious complications, it is not a cancer and is generally linked to a man’s aging process. Although the causes of BPH are not entirely understood, some researchers have investigated whether hormonal changes and cell growth as men age could be related to the development of the condition. If left untreated, BPH can lead to bladder, urinary tract or kidney problems.

Signs and symptoms

Although many men with BPH have no symptoms, others show signs, known as lower urinary tract symptoms. They can range from mild and barely noticeable to serious, but the amount of prostate enlargement is not directly related to the severity of the symptoms.

“Men usually see a urologist because they’re annoyed that they have to wake up, or their partner will encourage them to come see the urologist, because they’re getting woken up in the middle of the night, when he goes to urinate,” explains Leo R. Doumanian, MD, a urologist at Keck Medicine of USC and associate professor of clinical urology at the Keck School of Medicine of USC. “Or, he’ll be at his desk job and realize he’s got to go every 15 or 20 minutes to the bathroom.

“It’s a quality of life parameter, and that’s what usually brings the patient here. As you age, you have more susceptibility to an enlarged prostate, and then you seek treatment options, if indeed, it affects your quality of life enough.”

Some symptoms may get worse because of cold weather or as a result of physical or emotional stress. Some over-the-counter medicines also can make BPH worse, such as diphenhydramine (Benadryl), pseudoephedrine (Sudafed) and oxymetazoline spray (Afrin). A number of prescription medications also can negatively impact BPH, such as antidepressants, water pills, testosterone and pain medicine.

Some of the most common symptoms of BPH are:

• Difficulty starting a urine stream (hesitancy and straining)
• Decreased strength of the urine stream, also known as weak flow
• Dribbling after urination
• Feeling that the bladder is not completely empty
• Having the urge to urinate again, soon after finishing
• Feeling pain during urination
• Waking at night to urinate
• Frequent urination
• A sudden, uncontrollable urge to urinate

A person experiencing symptoms of BPH should contact his doctor immediately, if:

• He is completely unable to urinate.
• Urination is painful, and he has a fever of more than 100.4 degrees Fahrenheit (38 degrees Celsius), chills or body aches.
• He feels pain in his lower back, just below the rib cage, that is not related to an injury or physical effort.
• There is blood or pus in his urine or semen.

Diagnosis

A physician can diagnose BPH, by asking questions about the symptoms and by doing a physical exam. A urine test and a digital rectal exam also may be necessary.

In some cases, a prostate-specific antigen test is done to help rule out prostate cancer. Although prostate cancer and BPH are not related, they can have some of the same symptoms.

If symptoms are mild to moderate and aren’t too bothersome, home treatment may be all that is needed to keep them under control. A doctor may need to be consulted regularly to check on symptoms and make sure other related problems haven’t come up.

Treatments

Because BPH cannot be cured, the treatment focuses on reducing the symptoms. The treatment is based on how severe the symptoms are, how much they bother the patient and whether there are complications. The more irritating the symptoms are, the more aggressive treatment should be.

Complications, such as ongoing inability to urinate, urinary tract infections, bladder stones, kidney damage or ongoing blood in the urine, should be treated with surgery. Surgery also may be needed, if symptoms have not been helped with other treatments.

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