Benign Prostatic Hyperplasia
(BPH · Prostate Problems)
In this condition factsheet:
Diagnosing Benign Prostatic Hyperplasia
BPH diagnosis is made by taking a medical history that focuses on your urinary symptoms. The size of your prostate does not always predict symptoms: you can have a small but tight prostate causing many symptoms or a large prostate that causes few symptoms. In either case, symptoms are due to the blockage caused by the prostate.
A physical exam includes a digital rectal exam, in which the doctor feels for the prostate with a gloved finger to check its size and texture. There's also a blood test that measures a specific protein that is secreted by the prostate gland (also known as prostate specific antigen, or PSA). PSA can be mildly elevated in BPH or more elevated in men with prostate cancer. There can be overlap in PSA levels between these 2 conditions, and only a prostate biopsy can tell the difference.
Treating and Preventing Benign Prostatic Hyperplasia
Your doctor may recommend watchful waiting, especially if the symptoms are mild and do not interfere with your daily life. Watchful waiting involves monitoring for signs of worsening symptoms without any treatment.
Medications called alpha-blockers (e.g., terazosin*, alfuzosin, tamsulosin, silodosin) can help relax the bladder outlet, allowing easier passage of urine, especially if the obstruction of the urethra isn't too severe. Other medications (e.g., dutasteride, finasteride) help reduce the size of the prostate.
These medications can remove the need for surgery in many people with BPH. However, surgery is the only way to eliminate the problem completely. The most commonly used technique is called a TURP (transurethral resection of the prostate), which can be used for most cases except those with extremely large prostate glands. A tube equipped with a camera and a loop is inserted into the urethra (the tube that runs the length of the penis and back to the bladder) to remove strips of enlarged prostate. TURP causes fewer postoperative problems than open surgery, which involves an abdominal incision and the risk of blood transfusion.
Other techniques like TUIP (transurethral incision of the prostate), laser prostatectomy, and plasma vaporization aim to reduce the size of the prostate, often with fewer side effects than TURP. Only a specialist can decide which technique is most appropriate in each case.
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