The prostate gland is part of the male reproductive system. Along with other smaller glands, it produces fluid (also known as semen) that carries sperm and provides them with nutrition.
- The prostate gland is located at the base of a man's bladder. It surrounds the tube that drains urine to the outside of the body (the urethra). It also carries semen, which is released during sexual relations.
- The prostate gland is normally the size of a walnut. Its size usually increases with age. This non-cancerous enlargement is called benign prostatic hyperplasia/hypertrophy (BPH). Infections or tumors can also increase the size of the prostate.
- Because of its location, an enlarged prostate can block the flow of urine from the bladder. This can affect a man's ability to urinate normally.
- Nerves that control erectile function are located on both sides of the gland. These nerves can be damaged by some of the treatments for an enlarged prostate.
A prostate biopsy is needed to determine whether prostate enlargement is due to cancer. BPH is not considered a risk factor for prostate cancer. However, it can cause an elevated level of PSA, which is used to screen for prostate cancer.
BPH is due to a noncancerous (benign) growth of the prostate gland. It is very common in men over the age of 50, and its occurrence increases with age.
- The exact cause of BPH is unknown, but it is felt that hormones are an important factor.
- Men who have a family history of BPH appear to have an increased risk.
There may be no symptoms in the early stages of an enlarged prostate. Some of the symptoms that can develop as the prostate enlarges include:
- Difficulty starting urination or a urine flow that is slower than normal
- Leaking of urine, especially after urinating
- Having to strain to push urine out or difficulty emptying the bladder
- Urinary tract infections
Contact your healthcare provider if you have symptoms of an enlarged prostate. They may do a prostate exam (digital rectal exam or DRE) and a blood test called a prostate-specific antigen (PSA) test. (A PSA test should not be done for 24 to 48 hours after a DRE or sexual relations. This is because the test can elevate the PSA level.)
- Digital rectal exams and PSA tests are only for screening. They do not diagnose prostate cancer. If the results of these tests are abnormal, follow up testing may be necessary.
- Experts do not agree on when, or even if, routine prostate cancer screening should be done. Therefore, it is important to discuss your personal risks and screening needs with your healthcare provider.
- The American Urological Association (AUA) developed the American Urological Association Symptom Score Questionnaire. The questionnaire scores a man's symptoms in order to evaluate their severity. The score can be used to determine the best treatment option and evaluate the response to treatment.
- Men diagnosed with BPH may have follow up PSA testing to monitor their condition. PSA levels may be elevated for a variety of reasons and cannot definitively determine whether the cause of symptoms is BPH or prostate cancer.
BPH progresses slowly and remains stable in many men. Therefore, your healthcare provider may elect to monitor your symptoms rather than recommend a specific form of treatment, such as medications or surgery.
- Your doctor may schedule yearly exams to monitor the size of your prostate and your symptoms.
- Medications may be added if the symptoms become more bothersome.
- Surgery may be needed if symptoms are severe. Minimally invasive surgery may be an option.
Men with BPH should usually avoid taking decongestants (such as pseudoephedrine), antihistamines (such as diphenhydramine) or any medications that contain a decongestant or antihistamine. Other medications may also make symptoms of BPH worse, so tell your doctor or pharmacist about your BPH before taking prescription or over-the-counter medications.
Make an appointment with your healthcare provider if you have symptoms of BPH.
- Bring a copy of your medical history (past illnesses, surgeries, and hospitalizations).
- Bring a list of your medications (including over-the-counter)
- Write down any questions, symptoms or concerns you want to talk about.
- If your healthcare provider prescribes a medication for you, ask for a generic version. If your doctor thinks that a generic version is not right for you, ask for a medication on the lowest available tier of your Prescription Drug List (PDL).
What should I ask my healthcare provider about my prostate symptoms?
- What is my diagnosis? What is my AUA symptom score? What does it mean?
- Is observation an option for me? What are my non-surgical treatment options and their side effects?
- Do I need any special tests? What are the benefits and risks of having the tests? Will the results of the tests change my treatment plan?
- What are my treatment options and their side effects? What are the goals of my treatment?
- Are there any things I can do to improve or lessen my symptoms?
- When should I start to see improvement in my symptoms?
- Will I need surgery? Are there less invasive types of surgery available to me? What are the risks and benefits of each option?
- Do I need to see an urologist? What types of prostate treatments do they offer? Do they perform any treatments in the office?