Benign Prostate Enlargement (BPH)

The prostate starts as a 15 gram organ (about the size of walnut) in young man. It starts growing around age 30 and progressively gets bigger as time goes by. By age 70, 90% of all men will have developed some form of BPH.

For some individuals, the prostate enlargement is mildly bothersome. For others, it can be severely bothersome. The symptoms can range from a slow urinary stream, urgency of urination, frequency, and nocturia. Some patients also develop urine incontinence or urinary infection.

Diagnostic workup includes a rectal examination, urinalysis to rule out infection and hematuria, blood test to check for kidney function and PSA (prostate-specific antigen), cystoscopy (for internal inspection of the prostate and bladder), post-void residual by bladder ultrasound, urodynamic study, and sometimes transurethral ultrasound for measurement of the prostate size.

In the early stages, the patient can try adjusting his lifestyle. This would include adjusting fluid intake particularly toward the end of the day, so you can minimize getting up at night. If you take excessive amounts of coffee, carbonated drinks, or alcohol, your urinary symptoms can get worse.

In terms of treatment, there are two general choices available, either medications or surgery of some type.

Medications can include a variety of different drugs. There are two general classes of medications, one are called alpha blockers of which there are several brands. The most common medicine in this class is Flomax, although other brands include Uroxatral and Rapaflo. They work by relaxing the prostate to help with urination. They can take up to two weeks to work.

The second class of medications are alpha-reductase inhibitors. One is Proscar and the second is Avodart. These work by shrinking some of the prostate. They may take up to 3 months to work.

One thing to remember about medications is this is a lifetime course of medical treatment and you have to keep on taking the medicines; otherwise, you will lose the effect. They do have some side effects ranging from mild drop in blood pressure to some decrease in erections. More recently there is some reports about alpha reductase inhibitors causing some depression side effects.