Benign prostatic hyperplasia, a noncancerous enlargement of the prostate gland, is the most common benign tumor found in men.
As is true for prostate cancer, BPH occurs more often in the West than in Eastern countries, such as Japan and China, and it may be more common among black people. Not long ago, a study found a possible genetic link for BPH in men younger than age 65 who have a very enlarged prostate: Their male relatives were four times more likely than other men to need BPH surgery at some point in their lives, and their brothers had a sixfold increase in risk.
WHAT IS BENIGN PROSTATIC HYPERPLASIA (BPH)?
BPH produces symptoms by obstructing the flow of urine through the urethra. Symptoms related to BPH are present in about one in four men by age 55, and in half of 75-year-old men. However, treatment is only necessary if symptoms become bothersome. By age 80, some 20% to 30% of men experience BPH symptoms severe enough to require treatment. Surgery was the only option until the recent approval of minimally invasive procedures that open the prostatic urethra, and drugs that can relieve symptoms either by shrinking the prostate or by relaxing the prostate muscle tissue that constricts the urethra.
SIGNS AND SYMPTOMS
BPH symptoms can be divided into those caused directly by urethral obstruction and those due to secondary changes in the bladder.
Typical obstructive symptoms are:
- Difficulty starting to urinate despite pushing and straining
- A weak stream of urine; several interruptions in the stream
- Dribbling at the end of urination
Bladder changes cause:
- A sudden strong desire to urinate (urgency)
- Frequent urination
- The sensation that the bladder is not empty after urination is completed
- Frequent awakening at night to urinate (nocturia)
As the bladder becomes more sensitive to retained urine, a man may become incontinent (unable to control the bladder, causing bed wetting at night or inability to respond quickly enough to urinary urgency).
Burning or pain during urination can occur if a bladder tumor, infection or stone is present. Blood in the urine (hematuria) may herald BPH, but most men with BPH do not have hematuria.
SCREENING AND DIAGNOSIS
The American Urological Association (AUA) Symptom Index provides an objective assessment of BPH symptoms that helps determine treatment. However, this index cannot be used for diagnosis, since other diseases can cause symptoms similar to those of BPH.
A medical history will give clues regarding conditions that can mimic BPH, such as urethral stricture, bladder cancer or stones, or abnormal bladder/pelvic floor function (problems with holding or emptying urine) due to a neurologic disorder (neurogenic bladder) or pelvic floor muscle spasms. Strictures can result from urethral damage caused by prior trauma, instrumentation (for example, catheter insertion) or an infection such as gonorrhea. Bladder cancer is suspected if there is a history of blood in the urine.
Pain in the penis or bladder area may indicate bladder stones, infections, or irritation or compression of the pudendal nerve. A neurogenic bladder is suggested when a man has diabetes or a neurologic disease such as multiple sclerosis or Parkinson’s disease, or recent deterioration in sexual function.
A thorough medical history should include questions about any worsening of urinary symptoms when taking cold or sinus drugs, and previous urinary tract infections or prostatitis (inflammation of the prostate, which may cause pain in the lower back and the area between the scrotum and rectum, and chills, fever and general malaise). The physician will also ask whether any over-the-counter or prescription medications are being taken, because some can make voiding symptoms worse in men with BPH.
The physical examination may begin with the doctor observing urination to completion to detect any urinary irregularities. The doctor will manually examine the lower abdomen to check for a mass, which may indicate an enlarged bladder due to retained urine. In addition, a digital rectal exam (DRE), which allows the physician to assess the prostate’s size, shape and consistency, is essential for proper diagnosis. During this important examination, a gloved finger is inserted into the rectum — this is only mildly uncomfortable.
The detection of hard or firm areas in the prostate raises suspicion of prostate cancer. If the history suggests possible neurologic disease, the physical may include an examination for neurologic abnormalities that indicate the urinary symptoms result from a neurogenic bladder.
A urinalysis, which is performed for all patients with symptoms of BPH, may be the only laboratory test if symptoms are mild and no other abnormalities are suspected from the medical history and physical examination. A urine culture is added if a urinary infection is suspected. With more severe, chronic BPH symptoms, blood creatinine of blood urea nitrogen (BUN) and hemoglobin are measured to rule out kidney damage and anemia. Measuring prostate specific antigen (PSA) levels in the blood to screen for prostate cancer is recommended, as well as performing the DRE. PSA testing alone cannot determine if symptoms are due to BPH or prostate cancer, because both conditions can elevate PSA levels.
WHEN IS BPH TREATMENT NECESSARY?
The course of BPH in any individual is not predictable. Symptoms, as well as objective measurements of urethral obstruction, can remain stable for many years and may even improve over time for as many as one-third of men, according to some studies.
In a study from the Mayo Clinic, urinary symptoms did not worsen over a 3.5-year period in 73% of men with mild BPH. A progressive decrease in the size and force of the urinary stream and the feeling of incomplete bladder emptying are the symptoms most correlated with the eventual need for treatment. Although nocturia is one of the most annoying BPH symptoms, it does not predict the need for future intervention.
If worsening urethral obstruction is left untreated, possible complications are a thickened, irritable bladder with reduced capacity for urine; infected residual urine or bladder stones; and a backup of pressure that damages the kidneys.
Decisions regarding treatment are based on the severity of symptoms (as assessed by the AUA Symptom Index), the extent of urinary tract damage and the man’s overall health. In general, no treatment is indicated in those who have only a few symptoms and are not bothered by them. Intervention — usually surgical — is required in the following situations:
- Inadequate bladder emptying resulting in damage to the kidneys
- Complete inability to urinate after acute urinary retention
- Incontinence due to overfilling or increased sensitivity of the bladder
- Bladder stones
- Infected residual urine
- Recurrent severe hematuria
- Symptoms that trouble the patient enough to diminish his quality of life
Treatment decisions are more difficult for men with moderate symptoms. They must weigh the potential complications of treatment against the extent of their symptoms. Each individual must determine whether the symptoms interfere with his life enough to merit treatment. When selecting a treatment, both patient and doctor must balance the effectiveness of different forms of therapy against their side effects and costs.
BETA-SITOSTEROL IS AN EFFECTIVE TREATMENT FOR BPH
Beta-sitosterol: One of the very best studies done was published in the British Journal of Urology, volume 80 (1997), at the University of Dresden. Drs. Klippel, Hilti, and Schipp studied 177 men for six months who suﬀered from BPH. Half the men got the prescription extract Azuprostat containing 130 mg of beta-sitosterol. They cited a full thirty-two references to substantiate their research.
They concluded by suggesting, “These results show that beta-sitosterol is an eﬀective option in treatment of BPH.” Beta- sitosterol supplement has also been used by both men and women to promote healthy cholesterol and triglyceride levels.
A research article suggested that years ago studies showed its eﬀect with no change in diet or exercise. Over ﬁfty articles have been published in international medical journals for studies done on both humans and laboratory animals. Beta-sitosterol may be diﬃcult to ﬁnd in drug stores or health food stores.
The oil, a constituent of a few plants, including soy beans and pygeum, contains a mixture of phytosterols, a hormone called beta-sitosterol. Studies validate a minimum of twenty mg per day of beta-sitosterol to increase urine ﬂow and decrease residual urine volume signiﬁcantly, research suggests that beta-sitosterol inhibits prostaglandin synthesis, thus reducing inﬂammation.
Bible verses for today’s meditation and inspiration: Matthew E. McLaren
For the Spirit God gave us does not make us timid, but gives us power, love and self-discipline. 2 Timothy 1:7 NIV
But the Lord is faithful, and he will strengthen you and protect you from the evil one. 2 Thessalonians 3:3 NIV
Look to the Lord and his strength; seek his face always. 1 Chronicles 16:11 NIV
I love you, Lord, my strength. The Lord is my rock, my fortress and my deliverer; my God is my rock, in whom I take refuge, my shield and the horn of my salvation, my stronghold. Psalm 18:1-2 NIV
But I will sing of your strength, in the morning I will sing of your love; for you are my fortress, my refuge in times of trouble. Psalm 59:16 NIV
Be on your guard; stand firm in the faith; be courageous; be strong. 1 Corinthians 16:13 NIV
Ah, Sovereign Lord, you have made the heavens and the earth by your great power and outstretched arm. Nothing is too hard for you. Jeremiah 32:17 NIV
The Sovereign Lord is my strength; he makes my feet like the feet of a deer, he enables me to tread on the heights. Habakkuk 3:19 NIV
For the word of God is alive and active. Sharper than any double-edged sword, it penetrates even to dividing soul and spirit, joints and marrow; it judges the thoughts and attitudes of the heart. Hebrews 4:12 | NIV
Finally, be strong in the Lord and in his mighty power. Ephesians 6:10 NIV
Yours, Lord, is the greatness and the power and the glory and the majesty and the splendor, for everything in heaven and earth is yours. Yours, Lord, is the kingdom; you are exalted as head over all. 1 Chronicles 29:11 NIV
Love the Lord your God with all your heart and with all your soul and with all your mind and with all your strength. Mark 12:30 NIV
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