The prostate gland is part of the male reproductive organs. It is shaped like a chestnut and located below the bladder, surrounding the initial part of the urethra. Normally, it weighs about 15-20 grams. The prostate gland functions to produce fluid that acts as a lubricant and transports sperm during ejaculation. Generally, the prostate stops growing after the age of 20 until around 45 years old, after which it may enlarge again, marking the beginning of benign prostatic hyperplasia (BPH).
Benign prostatic hyperplasia (BPH) is a condition where the prostate gland abnormally enlarges, compressing the urethra and narrowing it. It is commonly found in men aged 45 and older, with increasing prevalence as age advances. Especially in elderly men aged 80 and above, it can be found in up to 80% of cases.
What causes benign prostatic hyperplasia?
- There is no confirmed evidence of a definite cause.
- It may be related to male hormone levels, as testosterone and dihydrotestosterone hormones stimulate prostate cells to multiply and contribute to the full development of the prostate gland.
- Genetics
Incomplete urination: One of the symptoms of benign prostatic hyperplasia
Symptoms of BPH vary. Some people have mild symptoms, such as a slight decrease in urine flow strength but no significant discomfort, while others may have severe symptoms or complications, including urinary retention. Whether you have BPH can be observed through the following signs:
- Frequent urination
- Weak urine stream
- Urgency to urinate, unable to wait
- Feeling of incomplete bladder emptying after urination
- Intermittent urine flow
- Need to strain to urinate
- Frequent urination at night, more than 1-2 times
Additionally, there are complications from BPH such as urinary retention, urinary tract infections, bladder stones, kidney or bladder damage, and hematuria (blood in urine), which may also occur.
How is benign prostatic hyperplasia diagnosed?
- The doctor will take a medical history, ask about symptoms, duration, and may have the patient complete a questionnaire about abnormal urination symptoms (International Prostate Symptom Score: IPSS) to assess the severity of urinary problems.
- Digital rectal examination to palpate the prostate and assess its physical characteristics.
- Urinalysis to check for infection, inflammation, or abnormal blood cells.
- Blood tests for PSA (Prostatic Specific Antigen) and kidney function (Creatinine).
- Uroflowmetry to measure urine flow rate combined with post-void residual urine measurement to evaluate severity, complications, and monitor treatment.
- Ultrasound examination, usually performed when abnormalities are found in urinalysis, but increasingly popular due to its safety and benefits.
- Other tests such as cystoscopy and urodynamic studies may be performed when clearly indicated to ensure accurate diagnosis.
How is benign prostatic hyperplasia treated?
- Non-medication treatment: If symptoms are mild and do not affect quality of life, watchful waiting may be recommended. The doctor may advise lifestyle modifications, such as reducing fluid intake, tea, coffee, or avoiding excessive alcohol, especially in the evening or before bedtime. If symptoms improve, medication may not be necessary.
Medication treatment is divided into 3 groups as follows:
- Alpha-adrenergic blockers: These drugs act quickly by relaxing the smooth muscles in the prostate and bladder neck, improving urine flow. Patients usually feel relief within 2-3 days, but symptoms may return if the medication is stopped.
- Alpha reductase inhibitors: These inhibit the conversion of testosterone to dihydrotestosterone, which stimulates prostate enlargement. These drugs can reduce prostate size by about 30%, but act slowly, taking 3-6 months to show effects. They are beneficial mainly for patients with moderately to severely enlarged prostates.
- Herbal medicines: Various types exist, such as Saw palmetto, but their effectiveness has not been conclusively proven.
Surgical treatment
- Transurethral resection of the prostate (TURP) is the current standard surgical procedure. It is used for patients with complications or when medication is ineffective. The surgeon inserts a small camera and surgical instruments through the urethra to shave off the prostate tissue compressing the urethra, improving urine flow.
- Photoselective vaporization of the prostate (Laser PVP) involves inserting a small camera through the urethra like TURP but uses laser light instead of a resectoscope to vaporize the prostate tissue. This method causes less bleeding and is suitable for elderly patients or those with comorbidities such as heart disease.
- Heat therapy (using heat on prostate tissue) can reduce BPH symptoms. This outpatient procedure uses microwave or radiofrequency energy to shrink the prostate. It is chosen for patients unsuitable for conventional surgery.
- Open prostatectomy is considered when the prostate is excessively large and cannot be treated by other surgical methods. This involves open abdominal surgery to remove excess prostate tissue.
