The Prostate, its Growth, and BPH
The prostate is a small walnut-sized and shaped gland that is an important component of the male reproductive system. It sits just beneath the bladder, in front of the rectum, and straddles the urethra. Prostate tissue has a primary purpose: to provide fluid that nourishes and protects sperm. When ejaculation is about to commence, the prostate gland contracts and squeezes prostatic fluid into the urethra, combining sperm from the testes and additional fluid from the seminal vesicles to create semen. A normal size prostate weighs about 25 grams, but an enlarged prostate can grow three times that size or more. Benign prostatic hyperplasia, also called BPH or prostatic hyperplasia, is a medical term used to describe the condition in men that results in an enlarged prostate. As its name suggests, it is benign and thus non-cancerous, and does not raise a man’s risk of prostate cancer, even though BPH symptoms can coexist with prostate cancer as two separate issues.
There are two primary growth phases for a man’s prostate. The first phase begins during puberty when the prostate gland essentially doubles in size from its adolescent diameter. The second growth phase for prostate tissue commences when a man reaches around 25 years of age and will continue throughout most of his life.
When urinary and prostate symptoms are mild, it’s unnecessary to worry too much about BPH. Prostatic hyperplasia is a slow-progressing condition that can eventually develop into a more serious condition over time if left unchecked, but being proactive and staying ahead of BPH is a good strategy.
The main cause of BPH isn’t fully understood, but it is believed that as men age, hormonal changes play an important role in why prostate tissue continues to grow and benign prostatic hyperplasia becomes more bothersome. The prostate may feel more sensitive when BPH is in its early stages but could become sore as BPH becomes more severe.
Benign prostatic hyperplasia is known to mainly affect men who are 40 or older. Men who have a family history of BPH, participate in little to no exercise, experience heart or circulatory disease or diabetes, are obese, or have erectile dysfunction issues are even more susceptible. Therefore, age, genetics, and lifestyle choices appear to be contributing factors to developing prostatic hyperplasia. To help prevent BPH, the adoption of healthy lifestyle changes can increase the odds of staving off BPH for longer and possibly keeping it away for a much longer period or even for good.
Men sometimes aren’t sure if they are experiencing benign prostatic hyperplasia or something else such as a urinary tract infection, prostatitis, or kidney or bladder stones, but BPH can be diagnosed and evaluated by a urologist who specializes in urinary conditions.
BPH Signs and Symptoms
There are inherent and distinguishable differences between BPH signs and symptoms. The two are often intertwined because they appear to be synonymous with each other, but BPH signs are health issues that a physician can perceive based on objective, observable and measurable conditions, whereas BPH symptoms are subjective experiences felt by a patient and can’t necessarily be observed by a physician.
The warning signs and symptoms of BPH are listed below. These conditions can begin affecting men as early as their 20s and 30s when prostate tissue begins its second phase of growth. As men reach their 40s, 50s, and 60s, BPH symptoms typically begin accelerating their pace as the enlarged prostate begins causing more difficulties. One will know if they have BPH if the following signs and symptoms are being experienced and can be confirmed by a urologist. The following exams, tests, procedures, and symptoms diagnose BPH.
- Enlarged prostate – DRE, TRUS, MRI
- Weak urinary stream – urinary flow test
- Blood in urine – urine sample
- PSA – test for prostate-specific antigen
- Bladder emptying – urine volume test
- Blood Test – checks for kidney issues
- 24-hour voiding log – frequency and amount
- Cystoscopy – cystoscope inserted into urethra
- Urine – unusual color
- Urinary frequency – 8 or more times per day
- Urinary hesitancy – trouble starting, keeping flow
- Dribbling – after urination
- Urinary urgency – having to “go” immediately
- Nocturia – waking up frequently to urinate
- Urinary retention – can’t empty some or all urine
- Urinary incontinence – loss of urine involuntarily
- Pain – after urination or ejaculation
- Urine – unusual smell
Urinary symptoms caused by benign prostatic hyperplasia can range from mild to severe, depending on an individual’s age and circumstances. And, an enlarged prostate can mean different things to different men. The severity of BPH symptoms doesn’t necessarily correlate with prostate size since some men with slightly enlarged prostates have demonstrated severe urinary symptoms, whereas some men with very large prostates may only exhibit mild BPH Symptoms.
The difference between mild and severe BPH is determined by the severity of lower urinary tract symptoms and defined by storage and voiding issues. If the above symptoms are being experienced, there is a good chance prostatic hyperplasia is present to one degree or another.
The International Prostate Symptom Score (IPSS)
The International Prostate Symptom Score card (IPSS) is an 8-question screening tool doctors employ to determine the severity of lower urinary tract symptoms or LUTS. It addresses the following urinary symptoms and offers “frequency” choices within each category for men to choose from based on how often each symptom occurs. The last topic is a lifestyle question meant to discover how impactful the current urinary symptoms are in a man’s life so an overall score can be formulated.1
- Incomplete Emptying
- Weak Stream
- If you were to spend the rest of your life with your urinary condition just the way it is now, how would you feel about that?
The mild, moderate, and severe designations below are a rough estimation of what men experience when they mention they are having a particular severity of lower urinary tract symptoms. The IPSS score that a doctor collects from a patient is meant to be more exact.
Mild lower urinary tract symptoms (LUTS), concurrent with benign prostatic hyperplasia, can present themselves in the form of having to get up at night to use the restroom (nocturia) an extra time or two a week when it wasn’t necessary at a younger age. Men may also begin experiencing a decreased urine stream or may find they are starting to develop intermittency (starting and stopping) of their urine flow due to their prostate tissue enlarging.
Moderate LUTS is often represented by having to get up to urinate once or twice at night and needing to use the restroom more frequently during the day. The urine stream continues to weaken and intermittency often becomes more of an issue. Having to strain to urinate, dribbling, some urgency, and getting the feeling that the bladder isn’t fully emptying can also be signs of moderate LUTS.
Severe LUTS in men with prostatic hyperplasia will often present itself in the form of having to get up many times a night to use the restroom and/or having to urinate every hour or two during the day. Intermittency and straining can worsen and a sense of urgency (overactive bladder) to immediately relieve oneself can increase when LUTS becomes severe. Urine retention also comes into play, with the real possibility of needing an emergency catheter to relieve complete urine blockage in the form of bladder outlet obstruction (BOO).
For mild urinary symptoms, the first line of treatment for BPH is to consult with a primary care physician or urologist to determine if a “wait and see” approach is possible, assuming BPH isn’t yet leading to lifestyle changes. Since Benign prostatic hyperplasia is typically a slow-developing condition in the prostate gland that tends to worsen over time, BPH treatment is necessary only when the condition becomes bothersome.
If urinary symptoms are more moderate and prostatic hyperplasia is beginning to require changes to one’s daily routine, then a urologist may recommend medication that can relieve symptoms. Medications used in the treatment of BPH include alpha-blockers such as Flomax, Uroxatral, and Rapaflo which relax the muscles of the prostate and bladder neck to increase urine flow, and 5-alpha-reductase inhibitors such as Proscar, Propecia, and Avodart which are used to shrink the prostate to provide better urine flow. A combination of the two medications may be needed for some men to find relief. The medications have some side effects depending on the exact formulation.
When urinary symptoms consistent with BPH become severe and start affecting one’s life, dictating daily changes, becoming undesirable, and “wait and see” or medications are no longer effective, the best treatment for BPH is prostate surgery that addresses each of the symptoms and preserves all urinary and sexual functionality. When prostatic hyperplasia gets severe enough, it needs to be taken more seriously to avoid a host of bladder issues, including the possibility of a decompensated bladder that could lead to permanent incontinence.
Benign prostatic hyperplasia is a common condition that affects most men as they age. BPH signs and symptoms can range from mild to severe and factor prominently enough to impact one’s lifestyle. However, since BPH presents symptoms gradually over time, it’s not a situation in which to worry too much about right away unless moderate to severe LUTS are already being experienced.
The best course of action to address prostatic hyperplasia is to remain proactive, continue PSA testing and see a urologist each year, read additional information on BPH signs and symptoms and stay ahead of the curve with guidance from a general practitioner or urologist.
1. Barry MJ, et al. (1992). American Urological Association symptom index for benign prostatic hyperplasia. Journal of Urology, 148(5): 1549–1557.
All surgical treatments have inherent and associated side effects. Individual’s outcomes may depend on a number of factors, including but not limited to patient characteristics, disease characteristics and/or surgeon experience. The most common side effects are mild and transient and may include mild pain or difficulty when urinating, discomfort in the pelvis, blood in the urine, inability to empty the bladder or a frequent and/or urgent need to urinate, and bladder or urinary tract infection. Other risks include ejaculatory dysfunction and a low risk of injury to the urethra or rectum where the devices gain access to the body for treatment. Further, there may be other risks as in other urological surgery, such as anesthesia risk or the risk of infection, including the potential transmission of blood borne pathogens. For more information about potential side effects and risks associated with Aquablation therapy for Benign Prostatic Hyperplasia (BPH) treatment, speak with your urologist or surgeon. Prior to using our products, please review the Instructions for Use, Operator’s Manual or User Manual, as applicable, and any accompanying documentation for a complete listing of indications, contraindications, warnings, precautions and potential adverse events. No claim is made that the AquaBeam Robotic System will cure any medical condition, or entirely eliminate the diseased entity. Repeated treatment or alternative therapies may sometimes be required.