CHENNAI: Benign Prostatic Hyperplasia (BPH) is a common urological disease affecting the elderly. It is a noncancerous enlargement of the prostate gland, which surrounds the urethra, the tube that carries urine from the bladder, and the most common benign tumour found in men.
Globally, the burden of BPH is rising at an alarming rate, particularly in low and middle income countries, as life expectancy increases and people are living longer worldwide.
“Men over the age of 50 are likely to develop BPH, but all of them will not have bothersome urinary symptoms. It is common for men to have BPH without urinary symptoms and vice versa,” said Dr Shameer VK, assistant professor, Government Medical College, Kozhikode.
Although the exact cause is not known, some factors that can result in the onset of BPH include hormonal changes (androgen level), family history, obesity, sedentary lifestyle and sexual inactivity in males. Increase in dihydrotestosterone, a form of testosterone is also believed to be one of the causative factors.
“The diagnosis of BPH is mainly based on medical history, physical examination, and various tests such as digital rectal exam, prostate-specific antigen blood test and imaging studies like ultrasonography of abdomen. Treatment options for BPH depend on the severity of symptoms,” said Dr Mohammed Shahid Ali, consultant urologist, Manipal Hospital, Bengaluru.
Untreated BPH may lead to complications like bleeding from the urethra (urethrorrhagia), bladder stones, retention of urine and kidney changes in the form of hydronephrosis. “Hence, any symptoms of benign prostatic hyperplasia need to be treated,” Dr Shameer added. Symptoms of BPH include frequent or urgent need to urinate, difficulty in starting urination, weak or interrupted urine stream, sense of incomplete emptying of the bladder, increased frequency of urination at night, urinary retention and bleeding in urine.
The condition is initially monitored without immediate intervention, especially if symptoms are mild. “The treatment starts with medications and will go to interventional treatment methods if there is no response,” said Dr Sandip Prabakaran, senior consultant urologist, Aster Medcity, Kochi. Medication is the most common treatment for mild to moderate symptoms. Options include taking alpha blockers which work by relaxing the muscles of the bladder neck and prostate.
Side effects may include dizziness and retrograde ejaculation. Another medication available is 5-alpha reductase inhibitors which shrink the prostate by preventing hormone changes that cause the prostate to grow. Doctors may also prescribe a combination of both if either medicine doesn’t work alone.
“Treatment strategies hinge on symptom severity, ranging from lifestyle adjustments like weight loss, reducing caffeine intake, restricting fluid intake in the evening, implementing Kegel muscle exercises and rescheduling diuretic medications to reduce risk factors, and improve urinary symptoms with medical therapy such as alpha-blockers for mild cases or in combination with five alpha-reductase inhibitors for large symptomatic BPH,” said Dr Manoj Kumar Das, associate professor, urology and kidney transplant Dr Manoj Kumar Das, AIIMS, Bhubaneswar.
Surgery and other treatment options are considered when medicines don’t provide relief or if the patient is unable to pee, have kidney problems, keeps getting bladder stones, has blood in the urine or urinary tract infection. Surgery can also be opted if taking medicines is not preferred. “Rezum-water vapour therapy and the UroLift system are two non-surgical methods that have emerged in a big way in recent times for those who want to avoid surgery or medicines.
Minimally invasive laser enucleation of the prostate and holmium laser prostate surgery are the gold standard surgical methods for BPH,” Dr Prabakaran said. Laser therapy may be considered in patients who take blood-thinning medicines and should not consider other prostate procedures. “Medications like antimuscarinics or sympathomimetic drugs may be necessary in cases of bladder over activity.
Transurethral resection of the prostate and holmium/thulium laser techniques are the popular surgical interventions,” Dr Das said. “There will be case-to-case variations when it comes to treatment cost. Newer non-invasive methods are expensive compared to surgical methods and may cost from Rs 2 lakh to Rs 2.5 lakh,” he added.
Doctors stress on the importance of early detection and how addressing symptoms early can lead to more effective management. Besides, awareness is important to understand the difference between BPH and prostate cancer, and to alleviate unnecessary fears and misconceptions.
(With inputs from Anna Jose, Aknisree Karthik and Hemant Kumar Rout)