Bert Vorstman MD, MS, FAAP, FRACS, FACS
Benign prostatic hyperplasia, or BPH as it is more commonly known, is a condition that causes an enlargement of the prostate gland. While this condition is very common, in some men it leads to urinary dysfunction. When the problems associated with BPH begin to impact quality of life, most men will seek treatment.
Understanding the Causes of BPH
The causes of BPH are largely unknown. At this time, doctors know that age is one of the biggest risk factors of the condition, as the likelihood of BPH increases as a man ages. In fact, some doctors believe all men, if they live long enough, will have an enlarged prostate gland, and 90 percent of men over the age of 80 have the condition.
The second risk factor is the presence of dihydrotestosterone (DHT). DHT is a substance that comes from the prostate gland’s testosterone, and some medical professionals believe DHT controls growth of the prostate gland. An accumulation of DHT in the prostate gland may encourage cells to grow, eventually leading to a growth in the gland itself.
BPH only needs to be treated if it is affecting quality of life. Most men can simply take an active surveillance approach to their condition. If, however, the prostate enlarges to the point that bladder function is lost or the urinary tract becomes obstructed, treatment is necessary. Common treatments include:
- Herbal treatment – Saw palmetto has been used to ease the symptoms of BPH by those who prefer an alternative medicine approach. Scientific studies into the use of saw palmetto have been met with mixed results.
- Medication – Medications cannot stop BPH, but it can control the urinary symptoms associated with the condition.
- Surgery – Because surgery on the prostate gland has serious side effects that can destroy a man’s quality of life, it should only be considered if the effects of the BPH are impacting a man’s overall health or severely impacting quality of life. Surgery can be laser surgery, open surgery or transurethral surgery.
- Transurethral microwave procedures – A minimally invasive procedure that uses microwaves to destroy excessive prostate tissue to alleviate symptoms of BPH.
- Transurethral Needle Ablation – This minimally invasive treatment delivers low-level radiofrequency through needles to burn away a portion of the prostate.
For any BPH treatment, the potential risks must be weighed against the potential benefit. Like with treating Gleason 6 (3 + 3) prostate “cancers,” often the risks of treatment are actually must worse than the potential benefits.
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