Benign prostatic hyperplasia(BPH) : Causes, Symptoms & Treatment
Medically Reviewed by Dr Sravya, MBBS, MS
Introduction
Benign prostatic hyperplasia (BPH) is linked with the most frequently occurring conditions in ageing men. Prostate enlargement and Lower Urinary Tract Symptoms (LUTS) are also part of it. BPH is proven in 30 to 40% of men, and its prevalence increases about 70 to 80% linearly in the age group of 80 years and above.
Increased risk factors, like metabolic disease and obesity, have been seen in BPH cases. Because of unregulated hyperplastic growth of the fibromuscular and
epithelial tissues of the transition zone and periurethral region, there is an enlargement of the prostate gland.
The normal prostate size is considered to be 20 g, and that body attains between 18 to 20 years of age. Clinical BPH has been defined as prostate adenoma/adenoma causing bladder outlet obstruction that may result in harm to the bladder and the kidneys.
Table of Contents
What are the causes of Benign prostatic hyperplasia (BPH)?
- The exact cause of Benign prostatic hyperplasia (BPH) is not well understood although it occurs mainly in older men. According to some researchers, factors related to aging and the testicles cause BPH.
- Some scientific studies have suggested that a higher proportion of estrogen within the prostate causes prostate enlargement by promoting prostate cell growth. As men age the amount of testosterone decreases and estrogen accumulates in a higher proportion which develops a risk of BPH in men of age 60 and above.
- Another study focuses on dihydrotestosterone, a male hormone that is involved in prostate development and growth. Accumulation of DHT promotes prostate cells to continue to grow. Scientists have studied that men who don’t produce dihydrotestosterone don’t develop BPH.
- A role for insulin also has been considered in BPH, as epidemiological studies have proven increased incidences of BPH in patients diagnosed with diabetes.
- An alteration in the stability of cellular homeostasis is primary in BPH development. Activation of the androgen receptor leads to an increase in growth factors responsible for proliferation.
Prevalence
1. Age :
The prevalence of Benign prostatic hyperplasia (BPH) increases with advancing age.Autopsy studies have shown histological prevalence of up to 80% in some last decades.Some studies have demonstrated that older age is a risk factor for clinical BPH progression.
2. Genetics :
Research studies suggest genetic inheritance is a strong component to cause BPH. In a case-control study, in which men below age 64 years underwent the surgery for prostate enlargement it was observed that his brothers and male relative also had a 6-fold and 4-fold increase, respectively in age-specific risks for BPH surgery. The investigators of this study further delivered the conclusion that 50% of men under the age of 60 years going through surgery for BPH had an inherited form of the disease.
3. Lifestyle :
Today modified lifestyle factors substantially influence the natural history and the risk of BPH. The following lifestyle changes are affecting the risk of BPH.
Diet: The increased energy intake, adjusted energy protein intake, red meat, fat, milk, and some dairy products, bread, and starch all potentially increase the risks of clinical BPH and surgery, while on the other hand vegetables, fruits, polyunsaturated fatty acids, linoleic acid and vitamin D are decreasing the risk. Whereas increased intake of micronutrients like vitamin E, lycopene, selenium, and carotene is lowering the risk of BPH.
Exercise : Regular physical activity and exercise have been consistently decreasing the risks of BPH surgery, lower urinary tract symptoms, and clinical and histological BPH.
Alcohol consumption : Moderate alcohol consumption also has proven to be protective against many outcomes related to BPH. A meta-analysis of some published studies has observed that up to 35% decreased probable BPH among men who used to drink daily.
4. Health condition :
Obesity: Consistently it has been observed that increased adiposity is associated with increased prostate volume. Body weight, body mass index (BMI), and waist circumference have all been associated with BPH in various study populations.
Diabetes: In patients diagnosed with diabetes, increased serum insulin level, and fasting plasma glucose level have been associated with increased risk of prostate enlargement, clinical BPH, and surgery.
Inflammation: Inflammation may be responsible for the development and progression of BPH as proven by the strong links between BPH and histological inflammation in samples obtained from prostate biopsies and BPH surgery.
Benign prostatic hyperplasia (BPH) Symptoms: What are they?
The size of the prostate does not always regulate the seriousness of the blockages or any symptoms. Some men having extreme increases in prostate size have a minimal blockages and few symptoms, whereas others who have minimal increase in the prostate have huge blockages and extra symptoms.
Less than half of all cases with Benign prostatic hyperplasia (BPH) have lower urinary tract symptoms. Lower urinary tract symptoms related to BPH may include:- Urinary frequency- urination more than 8 times a day
- Trouble in processing a urine stream
- A weak or discontinued urine stream
- Nocturia- Frequently waking up in the night for urination.
- Urinary retention- Unable to empty all the urine from the bladder.
- Urinary incontinence- The accidental loss of urine
- Pain while urinating and ejaculation
- Unusual color and smell of urine
- Blockage in urethra
How do you diagnose benign prostatic hyperplasia (BPH)?
- Blood Sample :A blood test is used to identify this condition. However, it is often used to find abnormalities.
- Urine Sample:To check for signs of infection, the doctor may check your urine in a lab. For this, you have to pee in a cup provided by them.
- Ultrasound:To see images of your testicles and scrotum, the doctor may use ultrasound tests.
- Swab Sample:In this test, the doctor will check your penis discharge. For this, the doctor will insert a narrow swab into your penis tip. This test is usually used to diagnose sexually transmitted infections such as gonorrhea or chlamydia.
What are the benign prostatic hyperplasia (BPH) treatments?
Treatment will be planned according to the cause of Benign prostatic hyperplasia (BPH).
A surgical approach by prostate tissue resection, vaporization, or enucleation has been a great treatment in Benign prostatic hyperplasia (BPH) management.
Specifically for severe symptoms or disease complications. Patients within this solution generally have symptoms that are not responding to medical therapies. Because of some risks associated with surgeries in cases with milder symptoms, medical therapy is the first option.
The treatment involves a monotherapy or a combination therapy of α-blockers and 5ARIs which acts on the smooth muscle within the prostatic urethra, relaxing it, enabling better flow of urine and conversion of testosterone to DHT and reducing the
impact of the AR on cell proliferation.
Table for Current and future medical treatments and surgeries in the management of
Treatment | Treatment Type | Treatment Description |
|---|---|---|
Current therapies: | ||
5-alpha reductase inhibitor | Medical | Blocks the conversion
of testosterone to
DHT reducing the
growth effects of
androgens
on the prostate |
Alpha blocker | Medical | It relaxes the smooth muscle of the prostate and bladder by inhibiting sympathetic activity |
TURP (transurethral resection of the prostate) | Surgical | Resection of the prostate through the urethra with the help of monopolar electrocautery |
Bipolar TURP | Surgical | Resection of the prostate through the urethra with help of bipolar electrocautery |
HOLEP( holmium laser enucleation of the prostate) | Surgical/Laser | Pulsed laser, utilizing a solid medium that combines carbon dioxide and neodymium: YAG lasers to deliver tissue cutting and cauterization |
Greenlight Laser Therapy | Surgical/Laser | High-powered KTP (potassium-titanyl-phosphate) 532-nm wavelength photoselective vaporization system |
Thulium Laser Therapy | Surgical/Laser | It utilizes a rare elemental metal, thulium, that provides a continuous wave laser that produces cut through vaporization |
Prostatic Urethral lift | Surgical | Positioning mechanical implants in the prostatic urethra, which retract the prostatic lobes |
Treatment | Treatment Type | Treatment Description |
|---|---|---|
Future (researched) and novel therapies: | ||
Silodosin | Medical | Higher selectivity alpha blocker |
NX-1207 & PRX302 Medical/Injection Intraprostatic injection | Medical/Injection | Intraprostatic injection |
Prostate Artery Embolization | Surgical | Embolization of the prostatic artery is done to prohibit growth and promote apoptosis |
Convective water vapor energy ablation therapy | Surgical | Resection of the prostate with the help of
Convective water energy vapor ablation
|
Robot-assisted simple prostatectomy | Surgical | Minimally invasive removal of the enlarged prostate |
Conclusion
The increase in the risk factors of BPH in recent years has also increased treatment options for its management. The Doctors should determine which treatment is most suitable for the particular patient.
Also, before that, the Doctor must decide whether the patient should be given medical therapy or undergo surgical intervention.
According to the changing form of risk factors of BPH, further research into developing effective treatment is ongoing. There have been several years of research into the pathological process of Benign prostatic hyperplasia (BPH), but we are still far from having a particular reason for the initiating and maintaining actor(s) for BPH.