Attention men: What exactly is benign prostatic hyperplasia and why should you care?
Benign Prostatic Hyperplasia | BPH
What is Benign Prostatic Hyperplasia (BPH)?
The prostate gland commonly becomes enlarged as a man ages. Doctors call this condition benign prostatic hyperplasia (BPH). When the prostate becomes enlarged, it compresses the urethra (the tube that carries urine from the bladder out of the body) and can cause difficulty with urination.
Who gets BPH?
BPH affects more than 50 percent of men over the age of sixty and as many as 90 percent of men over seventy.
Prostate gland enlargement varies in severity, but tends to gradually worsen over time. Common symptoms include:
- Weak urine stream
- Difficulty starting urination
- Stopping and starting while urinating
- Dribbling at the end of urination
- Frequent or urgent need to urinate
- Increased frequency of urination at night (nocturia)
- Straining while urinating
- Not being able to completely empty the bladder
- Urinary tract infection
- Formation of stones in the bladder
- Reduced kidney function
Many individuals notice BPH symptoms. If you don’t, your physician may find prostate enlargement by performing a digital rectal examination (DRE).
Additional tests can include:
- Urine flow study. Urinating into a device that measures how quickly urine is flowing.
- Cystoscopy. A small tube with a lens and light called a cytoscope is inserted through the urethra’s opening in the penis to determine the location and degree of the urethra obstruction.
- Prostate specific antigen (PSA) blood test. While BPH does not cause prostrate cancer, the two do have similar symptoms. This test is used to rule out cancer.
Mild cases of BPH may warrant a recommendation of no treatment and regular checkups to watch for early problems.
Cases in which the symptoms cause significant discomfort and problems, medicines may be prescribed or surgery may be recommended.
Surgical procedures often involve removing the enlarged part of the prostate. Surgeons use transurethral resection of the prostate (TURP) for 90 percent of all BPH-related surgeries.
As the above article indicates, BPH does not mean you have prostate cancer. But a PSA test is commonly done to rule this out. As you will read, there is some diffence of opinion about the PSA test. Ask your urologist for his take on the test.
Here is what you need to know about the PSA test. No worries, guys, they just draw some blood.
A prostate surgeon’s warning: Federal guidelines for PSA test put men in danger
What’s wrong with the USPSTF guidelines?
In regards to population screening, the African-American male population is ignored, as well as the effect of family history and morbidity associated with prostate cancer. However, African-American men are 56 percent more likely to develop prostate cancer and more than twice as likely to die from the disease compared to Caucasian men. They are also more likely to develop aggressive prostate cancer.
Instead of focusing on the benefits of PSA screening and how much it has actually helped the health care system, their recommendations focus on the complications of treatment, such as incontinence and erectile dysfunction. However, these complications depend on how experienced the surgeon is that you are being treated by.
The USPSTF is made up of 16 volunteer members who are experts in prevention, evidence-based medicine, and primary care. Their fields of practice and expertise include behavioral health, family medicine, geriatrics, internal medicine, pediatrics, obstetrics and gynecology, and nursing. However, no one on the USPSTF has actually treated patients with prostate cancer.
Prostate cancer mortality was on the decline before the USPSTF issued its recommendation. Since incorporating the PSA test, there has been a 40 percent reduction in prostate cancer mortality in the United States.
The USPSTF also ignores how the PSA has actually been valuable and has helped the health care system. Prostate cancer mortality was on the decline before the USPSTF issued its recommendation. Since incorporating the PSA test, there has been a 40 percent reduction in prostate cancer mortality in the United States.
Pros of PSA screening
- PSA screening can help you detect prostate cancer early
- Prostate cancer is easier to treat and is more likely to be cured if it’s diagnosed in the early stages of the disease
- PSA testing can be done with a simple, widely available blood test.
- Knowledge is power. Having a PSA test can provide you with the comfort of knowing that you don’t have it or that you do and now have options to have it treated.
- The number of deaths from prostate cancer has gone down since PSA testing became available.
Cons of PSA screening
- Prostate cancer can be slow-growing and never spread beyond the prostate gland.
- Not all prostate cancers need treatment or treatment right away.
- PSA levels may be elevated when cancer isn’t present or may not be elevated when prostate cancer is present.
- Being diagnosed with prostate cancer can cause anxiety and confusion. This can make can make decision making for non-life threatening cancers complicated.
- It’s not yet clear whether the decrease in deaths from prostate cancer is due to early detection and treatment based on PSA testing or due to other factors.
What people should know about PSA screening
- Screening doesn’t lower your risk of having prostate cancer; it increases the chance you’ll find out you have it.
- PSA testing can detect early-stage cancers that a DRE would miss.
- A “normal” PSA level of 4.0 ng/mL or below doesn’t guarantee that you are cancer-free; in about 15% of men with a PSA below 4.0 ng/mL, a biopsy will reveal prostate cancer.
- A high PSA level may prompt you to seek treatment, resulting in possible urinary and sexual side effects.
- Conditions other than cancer, such as benign prostatic hyperplasia and prostatitis, can elevate your PSA level.
Dr. Samadi is a board-certified urologic oncologist trained in open and traditional and laparoscopic surgery and is an expert in robotic prostate surgery. He is chairman of urology, chief of robotic surgery at Lenox Hill Hospital and professor of urology at Hofstra North Shore-LIJ School of Medicine. He is a medical correspondent for the Fox News Channel’s Medical A-Team and the chief medical correspondent for am970 in New York City. Learn more at roboticoncology.com. Visit Dr. Samadi’s blog at SamadiMD.com. Follow Dr. Samadi on Twitter and Facebook.
We hope this helps. But the bottom line is this: most men don’t get regular medical check ups. Dude, you’re playing with fire. If you have any of the symptoms of BPH, schedule an appointment with a urologist. You can thank us later (we also would accept a beer or an attaboy.)