Benign enlargement of the prostate (benign prostatic hyperplasia) is a very common situation in men. In men older than 80 years of age, the condition occurs in 8 out of 10 men. The disease is not serious, but it may cause subjective troubles and in addition, its symptoms are very similar to much more severe diagnosis of prostate cancer.
Benign enlargement of the prostate means that its cells begin to multiply excessively and this leads to enlargement of the gland. The prostate is a male gland located in the pelvic are just below the urinary bladder. The prostate has a close anatomical relationship to urethra, which runs through the prostate and this is exactly the location where the reproductive tract joins the urinary tract. During ejaculation, prostatic gland excretes fluid that makes a substantial part of the ejaculate. Substances contained in the prostatic fluid are important for longer survival of sperm in the female genital tract, for sperm motility and contractions of the uterine muscles. Prostate is located in the vicinity of the anterior wall of the rectum and can be indirectly palpated by digital rectal examination.
What are the causes of benign overgrowth of prostate cells? The risk factors include high age and long-lasting exposure to sex hormones, especially the testosterone (main male sex hormone) and estrogen (primarily female sex hormone, but it is also produced in men in small amount). In older men, the level of testosterone decreases and level of estrogen slightly increases. This hormonal imbalance results in greater sensitivity of prostatic cells to hormones and the proliferation of the tissue.
The majority of symptoms occur due to local compression of urethra by the enlarged prostatic tissue. The patient suffers from frequent urination at night, intermittent urination and feeling of incomplete emptying. Advanced stages may cause disorders of urine outflow with accumulation of urine (increased risk of urinary tract infections) and hydronephrosis.
Scheme - narrowing of the urethra by enlarged prostate
The diagnostic approach should include information about patient's symptoms and physical examination including the digital rectal examination. The indirect palpation of prostatic tissue may help to confirm the enlargement and helps to evaluate the stiffness of the tissue. Benign enlarged prostate tends to be soft, prostate cancer is hard on touch.
It is very advisable to evaluate the value of PSA in patient's serum. PSA (prostate-specific antigen) is a prostatic tumor marker. Its slight elevation is present in benign enlargement of prostate and high elevation occurs in prostatitis or prostate cancer. However, PSA may be significantly increased due to irritation of prostate by digital rectal examination and therefore, PSA should not be evaluated after this examination.
Ultrasound of the abdomen may also examine the prostate, measure its size and exclude larger prostate cancer. When there is a suspicion of an early prostate cancer, it is advisable to perform prostate biopsy.
The therapy may be conservative and surgical. Conservative treatment includes administration of drugs that inhibit the prostatic growth. The drugs belong among so-called alpha-blockers, inhibitors of 5-alpha-reductase and certain herbal preparations. Surgical intervention focuses on removal of part of the prostatic tissue to enable proper outflow of urine. The surgery may be performed either through urethra, or by classic surgical approach through the abdominal wall.