Enlarged Prostate (Benign Prostatic Hyperplasia/BPH)

An enlarged prostate occurs when a man's prostate gland slowly grows bigger as he ages. More than half of men over age 60 have this condition, also called benign prostatic hyperplasia (BPH). Some men have symptoms and others don't. The exact causes are unknown, but one thing is sure: BPH is not cancer and it does not lead to cancer. The prostate sits below the bladder and produces fluid for semen.

Symptom

·         Frequent Need to Urinate

Do you have to pee more often these days? Especially at night, when you're trying to sleep? That’s a common symptom of BPH. It happens when the growing prostate presses on the urethra, the tube that carries urine out of your body. The bladder has to contract more strongly to get urine out. As a result, the bladder may start to contract even when it only contains a little urine, which makes you get the urge to go more often.

·         Difficulty Urinating

With an enlarged prostate, it may take you longer to get the flow of urine going, and the flow may be weaker than it used to be. You may dribble urine or feel as if there's still some inside even though you're finished urinating. These symptoms happen because the pressure on the urethra makes it narrow, so your bladder must work harder to pass urine.

·         Inability to Urinate

This can happen when advanced BPH blocks your urethra entirely -- or as a result of a bladder infection. Bladder muscles also may become too weak to force urine out of the body. From any cause, it can lead to permanent kidney damage. You can prevent this by seeing your doctor as soon as you notice symptoms. If you suddenly can't urinate, go to a hospital emergency room immediately.

Who Gets an Enlarged Prostate?

Most men get an enlarged prostate as they age. The prostate gland grows throughout most of a man's life, first at puberty and then from about age 25 on. It usually doesn't cause symptoms before the age of 40. But by age 85, up to 90% of men have symptoms. Only about a third of men with an enlarged prostate are bothered by symptoms.

What Causes the Prostate to Grow?

No one knows for sure. It is believed that different hormones such as testosterone, dihydrotestosterone (DHT), and estrogen may play a role. It is also unclear why some men with BPH will have symptoms while others do not. Vasectomy and sex do not raise the risk of having BPH.

Getting Diagnosed Early

BPH symptoms can be similar to those of other conditions. If you have symptoms, it's important to see your doctor, who can rule out other possible causes, such as an infection or cancer.

Ruling Out Prostate Cancer

Symptoms of BPH can be scary because some of them are the same as those for prostate cancer. But an enlarged prostate is much more common than prostate cancer. And if you have BPH, you are no more likely than other men to develop prostate cancer. Because the two conditions share some symptoms and can occur at the same time, however, your doctor will need to evaluate you.

How Will Your Doctor Diagnose BPH?

Your doctor will ask about your symptoms and may do these tests:

·         A digital rectal exam to check for prostate enlargement or irregularities

·         Lab tests of urine or blood

·         An ultrasound scan and a prostate biopsy

·         A urine flow study to measure the strength of your urine stream

·         A cytoscopy, in which a thin tube inserted through the penis allows the doctor to view and evaluate the urethra and the bladder

When Does BPH Need to Be Treated?

Whether you need to treat BPH depends on your symptoms. If you have none or your symptoms are not severe, you probably won't need treatment. But recurring infections, kidney damage, difficulty urinating, or a leaky bladder can really impact your quality of life. In these cases, medications or surgery may help.

Treatment

·         Watchful Waiting

If your symptoms are mild, you and your doctor may choose to monitor your condition. With this approach, you'll probably need to visit the doctor one or more times a year. And if your symptoms don't get worse, that may be all you ever need to do. Up to a third of all mild cases of BPH have symptoms that clear up on their own.

·         Lifestyle Changes

These strategies may help:

• Ø  Cut down or cut out alcohol and caffeine.
• Ø  Drink small amounts all day rather than large amounts all at once.
• Ø  Avoid fluids at bedtime.
• Ø  Avoid decongestants and antihistamines.
• Ø  Go when you have the urge and when a bathroom is handy.
• Ø  Double void: Empty your bladder, wait a moment, then try to empty it again.
• Ø  Relax. Stress can trigger the urge to pee.
• Ø  Exercise regularly.

·         Drugs for Urine Flow

Often prescribed for high blood pressure, alpha blockers help relax the muscles in the prostate gland and bladder. This allows urine to flow more freely. Alpha blockers approved by the FDA to treat BPH include alfuzosin, doxazosin, tamsulosin, and terazosin.

·         Drugs to Slow Prostate Growth

A class of medications known as 5-alpha reductase inhibitors may stop the prostate from growing or even shrink it in some men. They lower the production of DHT, a hormone involved in prostate growth. However, these medications -- which include dutasteride and finasteride -- can also lower sex drive and cause erectile dysfunction. And it can take up to a year to feel the benefits.

·         Medicine Combos

Some men benefit from taking more than one medication for their enlarged prostate. In fact, combining a medicine that relaxes the bladder muscles with one that slows prostate growth may work better than either drug alone. Medicines used to manage an overactive bladder may also be added to standard BPH medications.

·         Complementary Medicine

In some studies, saw palmetto extract has shown promise in treating BPH symptoms. These include frequent urination and trouble starting and maintaining flow. Other studies have found it to be no better than a sugar pill. With no clear benefit yet -- and a risk that herbal treatments may interfere with other drugs -- the American Urological Association does not recommend saw palmetto or other complementary medicines for BPH.

·         Less Invasive Procedures

When medication doesn't do the job, a number of procedures can remove excess tissue from the prostate, easing obstruction of the urethra. These outpatient procedures are less invasive than surgery and may take no more than an hour. Two of them -- transurethral needle ablation (TUNA), also known as radiofrequency ablation, and transurethral microwave therapy (TUMT) -- may require temporary use of a catheter after treatment. Other procedures include the use of laser and stenting.

·         Surgery

The most common surgery is a transurethral resection of the prostate, or TURP, which is done under general anesthesia. An instrument is inserted through the tip of the penis and into the urethra to remove parts of the enlarged prostate, relieving pressure on the urethra.

Will BPH Affect My Sex Life?

There is some evidence that older men with severe BPH symptoms may be more likely to have problems in the bedroom, compared to other men their age. Some of the medications commonly used to treat BPH have been associated with problems getting an erection and ejaculating. If you develop sexual issues, talk to your doctor. A change in medications may be enough to correct them.

Living with BPH

Some men never even know they have BPH. Others are never troubled by it. But if you have bothersome symptoms, there are many options for treating them to help you maintain a high quality of life. The most important thing is to see your doctor as soon as you notice symptoms.

 Trans Urethral Resection of the Prostate (TURP) :

Prostate Cancer

Prostate cancer develops in a man's prostate, the walnut-sized gland just below the bladder that produces some of the fluid in semen. It's the most common cancer in men after skin cancer.  Prostate cancer often grows very slowly and may not cause significant harm.  But some types are more aggressive and can spread quickly without treatment.

Symptoms

In the early stages, men may have no symptoms.  Later, symptoms can include:

·         Frequent urination, especially at night

·         Difficulty starting or stopping urination

·         Weak or interrupted urinary stream

·         Painful or burning sensation during urination or ejaculation

·         Blood in urine or semen

Advanced cancer can cause deep pain in the lower back, hips, or upper thighs.

Enlarged Prostate or Prostate Cancer?

The prostate can grow larger as men age, sometimes pressing on the bladder or urethra and causing symptoms similar to prostate cancer. This is called benign prostatic hyperplasia (BPH). It's not cancer and can be treated if symptoms become bothersome. A third problem that can cause urinary symptoms is prostatitis. This inflammation or infection may also cause a fever and in many cases is treated with medicine.

Risk Factors You Can't Control

Growing older is the greatest risk factor for prostate cancer, particularly after age 50. After 70, studies suggest that most men have some form of prostate cancer, though there may be no outward symptoms. Family history increases a man's risk: having a father or brother with prostate cancer doubles the risk. African-Americans are at high risk and have the highest rate of prostate cancer in the world.

Risk Factors You Can Control

Diet seems to play a role in the development of prostate cancer, which is much more common in countries where meat and high-fat dairy are mainstays. The reason for this link is unclear. Dietary fat, particularly animal fat from red meat, may boost male hormone levels. And this may fuel the growth of cancerous prostate cells. A diet too low in fruits and vegetables may also play a role.

Myths About Prostate Cancer

Here are some things that will not cause prostate cancer: Too much sex, a vasectomy, and masturbation.  If you have an enlarged prostate (BPH), that does not mean you are at greater risk of developing prostate cancer. Researchers are still studying whether alcohol use, STDs, or prostatitis play a role in the development of prostate cancer.

Can Prostate Cancer Be Found Early?

Screening tests are available to find prostate cancer early, but government guidelines don't call for routine testing in men at any age. The tests may find cancers that are so slow-growing that medical treatments would offer no benefit.  And the treatments themselves can have serious side effects. The American Cancer Society advises men to talk with a doctor about screening tests, beginning at:

·         50 for average-risk men who expect to live at least 10 more years.

·         45 for men at high risk. This includes African-Americans and those with a father, brother, or son diagnosed before age 65.

·         40 for men with more than one first-degree relative diagnosed at an early age.

Screening:

 DRE and PSA

Your doctor may initially do a digital rectal exam (DRE) to feel for bumps or hard spots on the prostate.  After a discussion with your doctor, a blood test can be used to measure prostate-specific antigen (PSA), a protein produced by prostate cells. An elevated level may indicate a higher chance that you have cancer, but you can have a high level and still be cancer-free. It is also possible to have a normal PSA and have prostate cancer.

PSA Test Results

A normal PSA level is considered to be under 4 nanograms per milliliter (ng/mL) of blood, while a PSA above 10 suggests a high risk of cancer. But there are many exceptions:

·         Men can have prostate cancer with a PSA less than 4.

·         A prostate that is inflamed (prostatitis) or enlarged (BPH) can boost PSA levels, yet further testing may show no evidence of cancer.

·         Some BPH drugs can lower PSA levels, despite the presence of prostate cancer, called a false negative.

If either your PSA or DRE are abnormal, your doctor will order other tests.

Prostate Cancer Biopsy

If a physical exam or PSA test suggests a problem, your doctor may recommend a biopsy. A needle is inserted either through the rectum wall or the skin between the rectum and scrotum. Multiple small tissue samples are removed and examined under a microscope. A biopsy is the best way to detect cancer and predict whether it is slow-growing or aggressive.

Biopsy and Gleason Score

A pathologist looks for cell abnormalities and "grades" the tissue sample from 1 to 5. The sum of 2 Gleason grades is the Gleason score. These scores help determine the chances of the cancer spreading. They range from  2, less aggressive, to 10, a very aggressive cancer. Gleason scores helps guide the type of treatment your doctor will recommend.

Prostate Cancer Imaging

Some men may need additional tests to see if the cancer has spread beyond the prostate. These can include ultrasound, a CT scan, or an MRI scan (seen here). A radionuclide bone scan traces an injection of low-level radioactive material to help detect cancer that has spread to the bone.

In the MRI scan shown here, the tumor is the green, kidney-shaped mass in the center, next to the prostate gland (in pink).

Prostate Cancer Staging

Staging is used to describe how far prostate cancer has spread (metastasized) and to help determine the best treatment.

·         Stage I: Cancer is small and still within the prostate.

·         Stage II: Cancer is more advanced, but still confined to the prostate.

·         Stage III: Cancer has spread to the outer part of the prostate and nearby seminal vesicles.

·         Stage IV: Cancer has spread to lymph nodes, nearby organs or tissues such as bladder or rectum, or distant organs such as bones or lungs.

Prostate Cancer Survival Rates

The good news about prostate cancer is that it usually grows slowly. And 9 out of 10 cases are found in the early stages. Overall, the 5-year relative survival rate is 100% for men with disease confined to the prostate or nearby tissues, and many men live much longer. When the disease has spread to distant areas, that figure drops to 31%. But these numbers are based on men diagnosed at least 5 years ago. The outlook may be better for men diagnosed and treated today.

Treatment:

~ Watchful Waiting

With low-risk cancer, one option is to watch and wait. This is determined by your biopsy, PSA test, and Gleason scores. Your doctor will order periodic testing. Other treatments -- with the risk of sexual or urinary problems -- may not be necessary. Some men who are older or have serious health conditions may not need treatment. However, more aggressive treatment is usually recommended for younger men or those with more aggressive disease.

~ Radiation Therapy

External beam radiation to kill cancer cells can be used as a first treatment or after prostate cancer surgery. It can also help relieve bone pain from the spread of cancer. In brachytherapy, tiny radioactive pellets about the size of a grain of rice are inserted into the prostate. Both methods can impair erectile function. Fatigue, urinary problems, and diarrhea are other possible side effects.

~ Surgery

Removing the prostate, or radical prostatectomy, is used to eliminate the cancer when it is confined to the prostate. New techniques use smaller incisions and seek to avoid damaging nearby nerves. If lymph nodes are also cancerous, prostatectomy may not be the best option. Surgery may impair urinary and sexual function, but both can improve over time.

~ Hormone Therapy

Hormone therapy may shrink or slow the growth of your cancer, but unless it is used with another therapy it will not eliminate the cancer. Drugs or hormones block or stop the production of testosterone and other male hormones, called androgens. Side effects can include hot flashes, growth of breast tissue, weight gain, and impotence.

~ Chemotherapy

Chemotherapy kills cancer cells throughout the body, including those outside the prostate, so it is used to treat more advanced cancer and cancer that did not respond to hormone therapy.  Treatment is usually intravenous and is given in cycles lasting 3-6 months. Because the chemotherapy kills other fast-growing cells in the body, you may have hair loss and mouth sores. Other side effects include nausea, vomiting,  and fatigue.

~ Cryotherapy

Cryotherapy freezes and kills cancerous cells within the prostate (like the highly magnified cells shown here.) It is not as widely used because little is known about its long-term effectiveness. It's less invasive than surgery, with a shorter recovery time. Because the freezing damages nerves, as many as 80% of men become impotent after cryosurgery. There can be temporary pain and burning sensations in the bladder and bowel.

~ Prostate Cancer Vaccine

 

This vaccine is designed to treat, not prevent, prostate cancer by spurring your body's immune system to attack prostate cancer cells. Immune cells are removed from your blood, activated to fight cancer, and infused back into your blood. Three cycles occur in one month. It's used for advanced prostate cancer that no longer responds to hormone therapy. Mild side-effects can occur such as fatigue, nausea, and fever.

Hope for Advanced Cancer

Your doctor will continue to monitor your PSA levels and may perform other tests after treatment for prostate cancer. If it recurs or spreads to other parts of the body, additional treatment may be recommended. Lifestyle choices may matter, too. One study found that prostate cancer survivors who exercised regularly had a lower risk of dying.

Coping With Erectile Dysfunction

Erectile dysfunction is a common side effect of prostate cancer treatments. Generally, erectile function improves within two years after surgery. Improvement may be better for younger men than for those over 70. You also may benefit from ED medications. Other treatments, such as injection therapy and vacuum devices, may help.

Food for Health 5

A cancer-conscious diet may be the best choice for survivors who want to bolster their health and those hoping to lower their risk. That means:

·         Five or more fruits and veggies a day

·         Whole grains instead of white flour or white rice

·         Limit high-fat meat

·         Limit or eliminate processed meat (hot dogs, cold cuts, bacon)

·         Limit alcohol to 1-2 drinks per day (if you drink)

Foods high in folate may have some action against prostate cancer (spinach, orange juice, lentils). Studies found mixed results on lycopene, an antioxidant found in tomatoes.

Supplements: Buyer Beware

Be wary of supplements that are marketed to prevent prostate cancer. Some herbal substances can interfere with PSA levels. A 10-year study showed an increase in the risk of cancer for men who took folic acid supplements. A 5-year study of selenium and vitamin E did not show a decreased risk of prostate cancer. Be sure to tell your doctor if you are taking vitamins or supplements.

VIDEO : Robotic Radical Prostatectomy

What Is Metastatic Prostate Cancer?

If your prostate cancer spreads to other parts of your body, your doctor may tell you that it's "metastatic" or that your cancer has "metastasized."
Most often, prostate cancer spreads to the bones or lymph nodes. It's also common for it to spread to the liver or lungs. It's rarer for it to move to other organs, such as the brain.
It's still prostate cancer, even when it spreads. For example, metastatic prostate cancer in a bone in your hip is not bone cancer. It has the same prostate cancer cells the original tumor had.
Metastatic prostate cancer is an advanced form of cancer. There's no cure, but you can treat it and control it. Most men with advanced prostate cancer live a normal life for many years.
The goals of treatment are to:

• Manage symptoms
• Slow the rate your cancer grows
• Shrink the tumor

Some cancers are called "locally advanced." That means the cancer has spread from the prostate to nearby tissue. It's not the same as metastatic cancer since it hasn't spread to other parts of your body. Many locally advanced prostate cancers can be cured.

 

How Prostate Cancer Spreads

Cancer cells sometimes break away from the original tumor and go to a blood or lymph vessel. Once there, they move through your body. The cells stop in capillaries -- tiny blood vessels -- at some distant location.
The cells then break through the wall of the blood vessel and attach to whatever tissue they find. They multiply and grow new blood vessels to bring nutrients to the new tumor. Prostate cancer prefers to grow in specific areas, such as lymph nodes or in the ribs, pelvic bones, and spine.
Most break-away cancer cells form new tumors. Many others don't survive in the bloodstream. Some die at the site of the new tissue. Others may lie inactive for years or never become active.

 

Chances of Developing Metastatic Prostate Cancer

About 50% of men diagnosed with local prostate cancer will get metastatic cancer during their lifetime. Finding cancer early and treating it can lower that rate.
A small percentage of men aren't diagnosed with prostate cancer until it has become metastatic. Doctors can find out if it's metastatic cancer when they take a small sample of the tissue and study the cells.

 

How Doctors Find Metastatic Prostate Cancer

When you are diagnosed with prostate cancer, your doctor will order tests such as:

• X-rays
• CT scans
• MRI scans

These tests may focus on your skeleton and in your belly and pelvic areas. That way doctors can check for signs that the cancer has spread.
If you have symptoms such as bone pain and broken bones for no reason, your doctor may order a bone scan. It can show if you have metastatic cancer in your bones.
Your doctor will also ask for blood tests, including a check of PSA levels, to look for other signs that the cancer is spreading.
PSA is a protein made by the prostate gland. A rise in PSA is one of the first signs your cancer may be growing. But PSA levels can also be high without there being cancer, such as if you have an enlarged prostate or a prostate infection.
If you've been treated, especially if a surgeon removed your prostate, your PSA levels should be so low they can't be found on a test. The presence of any PSA after surgery is a concern.
Any rise in PSA after radiation or hormone treatment suggests the possibility the cancer is spreading. In that case, your doctor may order the same tests used to diagnose the original cancer, including a CT scan, MRI, or bone scan.
Though very rare, it's possible to have metastatic prostate cancer without a higher-than-normal PSA level.
On average, 8 years pass from the time a man is first diagnosed with prostate cancer to the discovery that it has become metastatic. If you've had prostate cancer, work with your doctor to check your risk and set a schedule for routine PSA checks.