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The Prostate
Gland
The prostate is a walnut-sized
gland that forms part of the male reproductive system. The gland
is made of two lobes, or regions, enclosed by an outer layer of
tissue. The prostate is located in front of the rectum and just
below the bladder, where urine is stored. The prostate also
surrounds the urethra, the canal through which urine passes out of
the body.
Scientists do not know all the
prostate's functions. One of its main roles, though, is to squeeze
fluid into the urethra as sperm move through during sexual climax.
This fluid, which helps make up semen, energizes the sperm and
makes the vaginal canal less acidic.
Why BPH Occurs
The cause of BPH is not well
understood. For centuries, it has been known that BPH occurs
mainly in older men and that it doesn't develop in men whose
testes were removed before puberty. For this reason, some
researchers believe that factors related to aging and the testes
may spur the development of BPH.
Throughout their lives, men produce
both testosterone, an important male hormone, and small amounts of
estrogen, a female hormone. As men age, the amount of active
testosterone in the blood decreases, leaving a higher proportion
of estrogen. Studies done with animals have suggested that BPH may
occur because the higher amount of estrogen within the gland
increases the activity of substances that promote cell growth.
Another theory focuses on
dihydrotestosterone (DHT), a substance derived from testosterone
in the prostate, which may help control its growth. Most animals
lose their ability to produce DHT as they age. However, some
research has indicated that even with a drop in the blood's
testosterone level, older men continue to produce and accumulate
high levels of DHT in the prostate. This accumulation of DHT may
encourage the growth of cells. Scientists have also noted that men
who do not produce DHT do not develop BPH.
Some researchers suggest that BPH
may develop as a result of "instructions" given to cells early in
life. According to this theory, BPH occurs because cells in one
section of the gland follow these instructions and "reawaken"
later in life. These "reawakened" cells then deliver signals to
other cells in the gland, instructing them to grow or making them
more sensitive to hormones that influence growth.
BPH Symptoms
Many symptoms of BPH stem from
obstruction of the urethra and gradual loss of bladder function,
which results in incomplete emptying of the bladder. The symptoms
of BPH vary, but the most common ones involve changes or problems
with urination, such as
The size of the prostate does not
always determine how severe the obstruction or the symptoms will
be. Some men with greatly enlarged glands have little obstruction
and few symptoms while others, whose glands are less enlarged,
have more blockage and greater problems.
Sometimes a man may not know he has
any obstruction until he suddenly finds himself unable to urinate
at all. This condition, called acute urinary retention, may be
triggered by taking over-the-counter cold or allergy medicines.
Such medicines contain a decongestant drug, known as a
sympathomimetic. A potential side effect of this drug may be to
prevent the bladder opening from relaxing and allowing urine to
empty. When partial obstruction is present, urinary retention also
can be brought on by alcohol, cold temperatures, or a long period
of immobility.
It is important to tell your doctor
about urinary problems such as those described above. In 8 out of
10 cases, these symptoms suggest BPH, but they also can signal
other, more serious conditions that require prompt treatment.
These conditions, including prostate cancer, can be ruled out only
by a doctor's exam.
Severe BPH can cause serious
problems over time. Urine retention and strain on the bladder can
lead to urinary tract infections, bladder or kidney damage,
bladder stones, and incontinence. If the bladder is permanently
damaged, treatment for BPH may be ineffective. When BPH is found
in its earlier stages, there is a lower risk of developing such
complications.
Diagnosis of
BPH
You may first notice symptoms of
BPH yourself, or your doctor may find that your prostate is
enlarged during a routine checkup. When BPH is suspected, you may
be referred to a urologist, a doctor who specializes in problems
of the urinary tract and the male reproductive system. Several
tests help the doctor identify the problem and decide whether
surgery is needed. The tests vary from patient to patient, but the
following are the most common.
Digital
Rectal Exam (DRE)
This exam is usually the first test
done. The doctor inserts a gloved finger into the rectum and feels
the part of the prostate next to the rectum. This exam gives the
doctor a general idea of the size and condition of the gland.
Prostate Specific Antigen (PSA) Blood Test
In order to rule out cancer as a
cause of urinary symptoms, your doctor may recommend a PSA blood
test. PSA, a protein produced by prostate cells, is frequently
present at elevated levels in the blood of men who have prostate
cancer. The U.S. Food and Drug Administration has approved a PSA
test for use in conjunction with a digital rectal exam to help
detect prostate cancer in men age 50 or older and for monitoring
prostate cancer patients after treatment. However, much remains
unknown about the interpretation of PSA levels, the test's ability
to discriminate cancer from benign prostate conditions, and the
best course of action following a finding of elevated PSA.
Because many unanswered questions
surround the issue of PSA screening, the relative magnitude of its
potential risks and benefits is unknown. Both PSA and ultrasound
tests enhance detection when added to DRE screening. But they are
known to have relatively high false-positive rates, and they may
identify a greater number of medically insignificant tumors. Thus,
PSA screening might lead to treatment of unproven benefit that
could result in morbidity (including impotence and incontinence)
and mortality. It cannot be determined from earlier studies
whether PSA screening will reduce prostate cancer mortality.
Ongoing studies are addressing this issue.
Rectal
Ultrasound
If there is a suspicion of prostate
cancer, your doctor may recommend a test with rectal ultrasound.
In this procedure, a probe inserted in the rectum directs sound
waves at the prostate. The echo patterns of the sound waves form
an image of the prostate gland on a display screen.
Urine
Flow Study
Sometimes the doctor will ask a
patient to urinate into a special device that measures how quickly
the urine is flowing. A reduced flow often suggests BPH.
Intravenous Pyelogram (IVP)
IVP is an x ray of the urinary
tract. In this test, a dye is injected into a vein, and the x ray
is taken. The dye makes the urine visible on the x ray and shows
any obstruction or blockage in the urinary tract.
Cystoscopy
In this exam, the doctor inserts a
small tube through the opening of the urethra in the penis. This
procedure is done after a solution numbs the inside of the penis
so all sensation is lost. The tube, called a cystoscope, contains
a lens and a light system, which help the doctor see the inside of
the urethra and the bladder. This test allows the doctor to
determine the size of the gland and identify the location and
degree of the obstruction.
BPH and
Prostate Cancer: No Apparent
Relation
Although some of the signs of BPH
and prostate cancer are the same, having BPH does not seem to
increase the chances of getting prostate cancer. Nevertheless, a
man who has BPH may have undetected prostate cancer at the same
time or may develop prostate cancer in the future. For this
reason, the National Cancer Institute and the American Cancer
Society recommend that all men over 40 have a rectal exam once a
year to screen for prostate cancer.
After BPH surgery, the tissue
removed is routinely checked for hidden cancer cells. In about 1
out of 10 cases, some cancer tissue is found, but often it is
limited to a few cells of a non aggressive type of cancer, and no
treatment is needed.
