What is BPH?

Benign prostatic hyperplasia (BPH) is an enlargement of the prostate due to an increase in the number of cells in the prostate. BPH begins in an area of the inner prostate called the transition zone, a ring of tissue that makes a natural circle around the urethra (the tube that carries urine from the bladder through the prostate to the penis). In BPH, the growth is inward toward the prostate’s core, constantly tightening around the urethra, and may interfere with urination.

What is the prevalence of BPH?

The risk of BPH increases every year after age 40: BPH is present in 20% of men in their fifties, 60% of men in their sixties, and 70% of men by age 70.

Is BPH Prostate Cancer?

Remember, the “B” stands for benign. BPH is not prostate cancer, and having BPH doesn’t mean a man is more or less likely to get prostate cancer.

Prostate cancer begins in the outer peripheral zone of the prostate, and grows outward, invading surrounding tissue (as opposed to the inward growth of BPH). It often has no symptoms for months or even years, prompting scientists to dub it “silent”. Because BPH grows inward, it produces annoying, difficult-to-ignore symptoms. An enlarged prostate alone may or may not cause symptoms (the size of the prostate is not indicative of the degree of urinary symptoms). However, the degree of bothersome symptoms is the most common reason men seek treatment.

How is BPH Treated (and When)?

One-quarter of men with BPH (more than 350,000 a year in the United States alone) will eventually require treatment, some more than once, to relieve the urinary obstruction caused by BPH.

Based on the figures mentioned above, it’s likely that after age 60, a majority of men will either be taking medication for BPH or considering it.

BPH is treated with alpha blockers, medications that relax the muscles of the urinary sphincter, or 5-alpha reductase inhibitors (decreasing DHT levels, which feed prostatic growth), medications that shrink the volume of the prostate. Currently approved alpha blockers include: terazosin (Hytrin), doxazosin (Cardura), tamsulosin (Flomax), alfuzosin (Uroxatrol), and silodosin (Rapaflo). Approved 5-alpha reductase inhibitors include: finasteride (Proscar) or dutasteride (Avodart). These classes of medications will often be used in combination to prevent urinary obstruction and ease symptoms.

Medication doesn’t help everyone. Men experiencing more severe symptoms, or those who have not sought treatment until the disease has advanced, will likely find surgery to be the best option.

How can treatment affect the risk of prostate cancer?

While BHP is not prostate cancer, the 5-alpha reductase inhibitors (which shrink the prostate) can reduce a man’s risk over time of developing prostate cancer by about 25%. There are two benefits to this: First, it makes prostate cancer easier to detect, and second, it prevents the treatments down the road that cause side effects. These hormonal agents are not as effective on more aggressive prostate cancers, and have not been shown to save lives due to prostate cancer. As always, it’s important to discuss the risks and benefits of these medicines with your doctor.

Terms to know from this article:

BPH

see benign prostatic hyperplasia

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