Unpacking Benign Prostatic Hyperplasia with insights from a urology expert
By Siti Salihah
Benign Prostatic Hyperplasia (BPH) is a common condition that many men face as they get older, yet it’s often overlooked or avoided due to embarrassment or misunderstanding. This non-cancerous enlargement of the prostate often causes frustrating urinary issues. While it isn’t life-threatening, its impact on daily life can be significant, and the symptoms can sometimes mimic those of more serious conditions.
In this article, we explore the causes of BPH, its effects on men, and available treatments with Dr. Allen Sim Soon Phang, a Consultant Urologist and Robotic Surgeon at Regency Specialist Hospital. Known for his compassionate approach, Dr. Allen ensures his patients feel comfortable and informed about sensitive issues like urinary and sexual health. Committed to offering advanced, minimally invasive treatments, he helps men regain control and improve their quality of life. Dr. Allen’s patient-first philosophy ensures no one has to face BPH alone.
1Twenty80: What is Benign Prostatic Hyperplasia, and what is the primary cause?
Dr. Allen: Benign Prostatic Hyperplasia (BPH) is a non-cancerous enlargement of the prostate gland, which is common as men age. The prostate gland, located below the bladder, surrounds the urethra, which carries urine from the bladder out of the body. As the prostate enlarges, it can obstruct the urethra, leading to urinary symptoms.
The primary cause of BPH is believed to be hormonal changes that occur with aging. Specifically, the imbalance between estrogen and testosterone levels in older men contributes to prostate growth. Genetics also plays a role; if you have a family history of BPH, you’re at an increased risk of developing it.
1Twenty80: What are the most common symptoms patients experience when they have Benign Prostatic Hyperplasia?
Dr. Allen: Patients with BPH typically experience symptoms such as:
- Frequent urination, especially at night (nocturia)
- Difficulty starting urination
- Weak or interrupted urine flow
- Inability to empty the bladder completely
- Dribbling after urination
- A sense of urgency to urinate
These symptoms occur because the enlarged prostate presses on the urethra, affecting the flow of urine. If untreated, BPH can lead to complications like bladder stones, kidney damage, or urinary tract infections (UTIs).
1Twenty80: Urinary control and sexual function are often sensitive topics, how do you address them with patients?
Dr Allen: I approach urinary control and sexual function with sensitivity and empathy, recognizing that these topics can be embarrassing for patients. I emphasize that BPH is a common condition and that they are not alone. I also explain that while BPH can impact both urinary and sexual function, these issues are manageable.
I reassure my patients that we have treatment options that can help them regain control and improve their quality of life. I make sure to answer all questions, address concerns, and provide clear explanations about the potential effects of BPH and its treatments on sexual health.
1Twenty80: Are there any medical conditions or risks that make someone more prone to Benign Prostatic Hyperplasia?
Dr. Allen: Yes, certain medical conditions and risk factors can increase the likelihood of developing BPH. These include:
- Age: BPH is primarily an age-related condition, with symptoms typically appearing in men over the age of 50.
- Family history: Men with a family history of BPH are at a higher risk.
- Obesity: Research indicates that obesity, especially central obesity (fat around the abdomen), is linked to an increased risk of developing BPH.
- Diabetes and heart disease: Both conditions have been associated with a higher incidence of BPH, likely due to the role of insulin resistance and vascular health.
1Twenty80: Are there any common misconceptions about Benign Prostatic Hyperplasia?
Dr. Allen: A common misconception is that BPH leads to prostate cancer. While BPH is a benign condition, it is not cancerous. However, some symptoms of BPH, like difficulty urinating, can overlap with those of prostate cancer. This makes it important for men to undergo proper diagnosis and screening.
Another misconception is that all men will eventually develop BPH as they age. While the likelihood of developing BPH increases with age, not all men will experience symptoms severe enough to need treatment.
1Twenty80: In the diagnosis process, how do you differentiate between Benign Prostatic Hyperplasia and other prostate conditions like prostate cancer?
Dr. Allen: Diagnosis begins with a thorough medical history and physical examination, including a digital rectal exam (DRE) to feel the size and texture of the prostate. A blood test to measure prostate-specific antigen (PSA) levels is also commonly used, although PSA levels can be elevated in both BPH and prostate cancer.
Further tests like ultrasound, urine flow tests, or cystoscopy can help clarify the diagnosis. If there is suspicion of prostate cancer, a biopsy may be recommended to confirm the presence of cancer cells.
1Twenty80: Can Benign Prostatic Hyperplasia be managed with medication, or is surgery the only option? If yes, what medication is typically prescribed?
Dr. Allen: BPH can often be managed with medication, especially in the early stages. The most common types of medications include:
- Alpha-blockers (e.g. tamsulosin) help relax the muscles around the prostate and bladder neck, improving urine flow.
- 5-alpha reductase inhibitors (e.g. finasteride) reduce the size of the prostate by blocking the hormone that causes prostate growth.
- Combination therapy may also be used for more severe symptoms.
Surgery is considered when medications are ineffective or if complications such as urinary retention occur. Options like transurethral resection of the prostate (TURP) or laser surgery are available.
1Twenty80: Are there any emerging technologies, procedures, or less invasive options for treating Benign Prostatic Hyperplasia?
Dr. Allen: Yes, there have been exciting advancements in minimally invasive treatments for BPH. For example:
- GreenLight laser therapy: This procedure uses laser energy to remove prostate tissue, offering quicker recovery times and less bleeding than traditional surgery.
- Prostate artery embolization (PAE): A less invasive procedure where blood flow to the enlarged prostate is reduced, shrinking the gland.
- Robotic-assisted prostate surgery: This technology offers greater precision with smaller incisions, resulting in faster recovery and fewer complications.
- Rezūm therapy: A steam-based procedure that uses water vapor to shrink excess prostate tissue, reducing urinary symptoms with minimal downtime.
- Prolieve: A combination of heat and pressure applied through the urethra to reduce prostate size, typically performed as an outpatient procedure with quick recovery.
These innovations allow for more effective, quicker recovery treatments with fewer risks compared to traditional surgery.
1Twenty80: Are there any lifestyle changes a patient can make to prevent the progression or reduce the symptoms of Benign Prostatic Hyperplasia?
Dr. Allen: Lifestyle changes can certainly help reduce symptoms or slow the progression of BPH. These include:
- Maintaining a healthy weight: This can reduce abdominal pressure on the bladder and improve symptoms.
- Avoiding caffeine and alcohol: Both can irritate the bladder and worsen urinary symptoms.
- Staying active: Regular exercise, particularly pelvic floor exercises, can improve bladder control.
- Reducing fluid intake at night: This helps to reduce nocturia (frequent nighttime urination).
While lifestyle changes alone may not cure BPH, they can significantly improve quality of life and reduce the severity of symptoms.
1Twenty80: What is the likelihood of the condition reappearing after treatment, and how can it be prevented?
Dr. Allen: After treatment, BPH symptoms may not necessarily return, especially if medications are effective or surgery successfully removes excess prostate tissue. However, the condition may recur in some cases, particularly in men with a family history of BPH or those who continue to experience hormonal imbalances.
To reduce the risk of recurrence, it is essential to follow a prescribed treatment plan, monitor symptoms, and make lifestyle modifications that improve urinary function.
1Twenty80: How do you determine the suitable course of treatment for a patient with Benign Prostatic Hyperplasia?
Dr. Allen: Treatment decisions depend on the severity of symptoms, the patient’s overall health, and their preferences. For mild symptoms, lifestyle changes and medications may be sufficient. If symptoms are more severe or medications are ineffective, surgery may be recommended.
I take into consideration factors such as the patient’s age, comorbid conditions, and whether they have a strong desire to avoid surgery. I also involve the patient in the decision-making process, explaining the benefits and risks of each treatment option.
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