Enlarged Prostate Gland
Benign prostatic hyperplasia is commonly known as an enlarged prostate gland.
The prostate glad is about the size and shape of a walnut. Located just below the bladder, it surrounds the urethra, which carries urine out of the bladder. The prostate produces semen, the fluid that carries sperm.
The prostate gland continues to grow throughout a man's life. This rarely causes problems until later in life. The layer of tissue around the prostate keeps it from growing outward. As a result, the prostate gland begins to press on the urethra like a clamp. It is a noncancerous condition.
Benign prostate hyperplasia causes the prostate gland to squeeze the urethra that it surrounds. In time, this blocks the flow of urine and causes a number of symptoms, including:
- Not being able to empty the bladder completely
- Needing to go to the bathroom more often. There may be a sense of urgency connected to this. The need to go to the bathroom may wake you during the night.
- Hesitation in starting to urinate and a weak urine stream once it begins
Because the bladder isn't completely emptied, other conditions can happen such as kidney stones, bladder infections, prostate infections or not being able to urinate at all.
Causes and Risk Factors
It is not well understood what causes benign prostatic hyperplasia. Almost half of all men older than 60 are estimated to have some symptoms of an enlarged prostate. There may be some involvement of hormones, which change as a man ages, as well.
Most men with enlarged prostates see their doctor when the symptoms begin to intrude on their quality of life.
Some of the signs of an enlarged prostate gland are the same as those for prostate cancer. A man who has an enlarged prostate glad may also have undetected prostate cancer. Having an enlarged prostate glad doesn't seem to increase the chances of getting prostate cancer.
It is important that a man with symptoms of an enlarged prostate be checked for the possibility of prostate cancer.
Benign prostatic hyperplasia can be diagnosed in the urologist's office using simple, painless tests. These include:
- A digital rectal exam, in which your doctor inserts a gloved finger into the rectum to feel that portion of the prostate gland that is closest to the rectum
- A prostate specific antigen (PSA) blood test. This helps rule out the possibility that cancer is causing the enlargement of the prostate gland.
- A urine flow study. For this study you will be asked to urinate into a special device that measures how much and how quickly the urine is flowing.
- An ultrasound of your bladder or rectum. This diagnostic technique uses sound waves to create an image of the prostate gland.
A variety of treatment options are available depending on your symptoms.
Usually, the most conservative options are tried first, before surgical ones. Several medications are available to help relax the bladder outlet and prostate glad or to shrink the prostate. For most men, relief is only partial. That may be enough to measurably improve your quality of life. If this approach is satisfactory, you will need to be reevaluated from time to time and to rule out prostate cancer. This follow-up evaluation is usually done by your own urologist, although it can be done at the Urology Academic Practice.
If medications don't work, surgery may be considered.
There are two surgical approaches to treating benign prostate hyperplasia. One is to remove prostate tissue so it no longer blocks the urethra. Procedures that fall into this category are:
- Transurethral electro-resection of the prostate (TURP) - This procedure is the traditional way to remove prostate tissue using minimally invasive surgical techniques. This procedure requires a one- to two-day stay in the hospital.
- Transurethral electro-vaporization of the prostate (TUEVAP) - This procedure uses electrical current in a roller ball to heat prostate tissue until it is reduced to vapor. After having the procedure, patients can leave the hospital the same day or the morning after the procedure.
The second surgical approach is to modify the tissue so it no longer blocks the urethra. These types of procedures are:
- Transurethral microwave technology (TUMT) shrinks prostate tissue using heat from a microwave device. Guided by a computer, the tissues are shrunk during a series of 30- to 60-minute sessions. This is an outpatient procedure.
Following any of these procedures, you will need to be regularly monitored to make sure that there is no cancer. This is usually done by your personal urologist, although it can be done at the Urology Academic Practice at Cedars-Sinai.
After prostate surgery, the tissue removed is routinely checked for hidden cancer cells. In about one out of 10 cases, some cancer tissue is found, but often it is limited to a few cells of a nonaggressive type of cancer, and no treatment is needed.