Enlarged Prostate

What is the prostate?

The prostate is part of a man’s sex organs. It’s about the size of a walnut and surrounds the tube called the urethra, located just below the bladder.

The urethra has two jobs: to carry urine from the bladder when you urinate and to carry semen during a sexual climax, or ejaculation. Semen is a combination of sperm plus fluid that the prostate adds.

What are prostate problems?

For men under 50, the most common prostate problem is prostatitis.

For men over 50, the most common prostate problem is prostate enlargement. This condition is also called benign prostatic hyperplasia (BPH). Older men are at risk for prostate cancer as well, but this disease is much less common than BPH. More information about prostate cancer is available from the National Cancer Institute.

What is prostate enlargement, or BPH?

If you’re a man over 50 and have started having problems urinating, the reason could be an enlarged prostate, or BPH. As men get older, their prostate keeps growing. As it grows, it squeezes the urethra. Since urine travels from the bladder through the urethra, the pressure from the enlarged prostate may affect bladder control.

If you have BPH, you may have one or more of these problems:

  • A frequent and urgent need to urinate. You may get up several times a night to go to the bathroom.
  • Trouble starting a urine stream. Even though you feel you have to rush to get to the bathroom, you find it hard to start urinating.
  • A weak stream of urine
  • A small amount of urine each time you go
  • The feeling that you still have to go, even when you have just finished urinating
  • Leaking or dribbling urine
  • Small amounts of blood in your urine

Is BPH a sign of cancer?

No. It’s true that some men with prostate cancer also have BPH, but that doesn’t mean that the two conditions are always linked. Most men with BPH don’t develop prostate cancer. However, because the early symptoms are the same for both conditions, you should see a doctor to evaluate these symptoms.

Is BPH a serious disease?

By itself, BPH is not a serious condition, unless the symptoms are so bothersome that you can’t enjoy life. But BPH can lead to serious problems. One problem is urinary tract infections.

If you can’t urinate at all, you should get medical help right away. Sometimes this happens suddenly to men after they take an over-the-counter cold or allergy medicine.

In rare cases, BPH and its constant urination problems can lead to kidney damage.

What tests will my doctor order?

Several tests help the doctor identify the problem and decide on the best treatment.

  • Digital rectal exam. This exam is usually the first test done. The doctor inserts a gloved finger into the rectum and feels the prostate, which sits directly in front of the rectum. This exam gives the doctor a general idea of the size and condition of the prostate.
  • Blood test. The doctor may want to test a sample of your blood to look for prostate-specific antigen (PSA). If your PSA is high, it may be a sign that you have prostate cancer. But this test isn’t perfect. Many men with high PSA scores don’t have prostate cancer.
    Imaging. The doctor may want to get a picture of your prostate using either x rays or a sonogram. An intravenous pyelogram (IVP) is an x ray of the urinary tract. For an IVP, dye will be injected into a vein. Later, when the dye passes out of your blood into your urine, it will show up on the x ray. A rectal sonogram uses a probe, inserted into the rectum, to bounce sound waves off the prostate.
  • Urine flow study. You may be asked to urinate into a special device that measures how quickly the urine is flowing. A reduced flow may mean you have BPH.
  • Cystoscopy. Another way to see a problem from the inside is with a cystoscope, which is a thin tube with lenses like a microscope. The tube is inserted into the bladder through the urethra while the doctor looks through the cystoscope.

How is BPH treated?

Several treatments are available. Work with your doctor to find the one that’s best for you.

  • Watchful waiting. If your symptoms don’t bother you too much, you may choose to live with them rather than take pills every day or have surgery. But you should have regular checkups to make sure your condition isn’t getting worse. With watchful waiting, you can be ready to choose a treatment as soon as you need it.
  • Medicines. In recent years, scientists have developed several medicines to shrink or relax the prostate to keep it from blocking the bladder opening.
  • Nonsurgical procedures. A number of devices have been developed that allow doctors to remove parts of the prostate during nonsurgical procedures. These procedures can usually be done in a clinic or hospital without an overnight stay. The procedures are transurethral, which means the doctor reaches the area by going through the urethra. The doctor uses thin tubes inserted through the urethra to deliver controlled heat to small areas of the prostate.

A gel may be applied to the urethra to prevent pain or discomfort. You won’t need drugs that make you go to sleep. Several transurethral

procedures are treatments for BPH:

  • PVP (photoselective vaporization of the prostate): destroys excess prostate tissue interfering with the exit of urine from the body by using a controlled laser beam inside the prostate.
  • TUIP (transurethral incision of the prostate): widens the urethra by making a few small cuts in the bladder neck, where the urethra joins the bladder, and in the prostate gland itself.
  • TUMT (transurethral microwave thermotherapy): destroys prostate tissue by using a probe in the urethra to deliver microwaves.
  • TUNA (transurethral needle ablation): destroys excess prostate tissue with electromagnetically generated heat by using a needle-like device in the urethra.

Surgical treatment. Surgery to remove a piece of the prostate can be done through the urethra or in open surgery, which requires cutting through the skin above the base of the penis. Your doctor may recommend open surgery if your prostate is especially large. The most common surgery is called transurethral resection of the prostate (TURP). In TURP, the surgeon inserts a thin tube up the urethra and cuts away pieces of the prostate with a wire loop while looking through a cystoscope. TURP and open surgery both require general anesthesia and a stay in the hospital.

Is TURP the same as removing the prostate?

No. TURP and other procedures for BPH remove only enough tissue to relieve urine blockage. In a few cases, the prostate may continue to grow, and urinary problems return. You should continue to have your prostate checked once a year even after surgery to make sure that BPH or prostate cancer has not developed.

A prostate removal, or radical prostatectomy, is usually done only to stop prostate cancer from spreading.

What are the side effects of prostate treatments?

Surgery for BPH may have a temporary effect on sexual function. Most men recover complete sexual function within a year after surgery. The exact length of time depends on how long you had symptoms before surgery was done and on the type of surgery. After TURP, some men find that semen does not go out of the penis during orgasm. Instead, it goes backwards into the bladder. In some cases, this condition can be treated with a drug that helps keep the bladder closed. A doctor who specializes in fertility problems may be able to help if backwards ejaculation causes a problem for a couple trying to get pregnant.

If you have any problems after treatment for a prostate condition, talk with your doctor or nurse. Erection problems and loss of bladder control can be treated, and chances are good that you can be helped.

If your prostate is removed completely to stop cancer, you’re more likely to have long-lasting sexual and bladder control problems, such as leaking or dribbling. Your doctor may be able to use a technique that leaves the nerves around the prostate in place. This procedure makes it easier for you to regain bladder control and sexual function. Not all men can have this technique, but most men can be helped with other medical treatments.

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