BPH and prostate cancer risk
A fact sheet that describes the PSA screening test for prostate cancer and explains the benefits and limitations of the test. Benign prostatic hyperplasia was the predominant lesion (%) in the The location of the prostate gland is at the neck of the bladder. Prostate cancer generally presents in one of three ways: asymptomatic patients who are screened (usually by a PSA test); men with LUTS who are investigated.
Inadequate bladder emptying resulting in damage to the kidneys Complete inability to urinate after acute urinary retention Incontinence due to overfilling or increased sensitivity of the bladder Bladder stones Recurrent severe hematuria Symptoms that trouble the patient enough to diminish his quality of life Treatment decisions are more difficult for men with moderate symptoms.
They must weigh the potential complications of treatment against the extent of their symptoms. Each individual must determine whether the symptoms bother him enough, or interfere with his life enough, to merit treatment. When selecting a treatment, both patient and doctor must balance the effectiveness of different forms of therapy against their side effects and costs.
Watchful waiting Medication Surgery prostatectomy If medications prove ineffective in a man who is unable to withstand the rigors of surgery, urethral obstruction and incontinence may be managed by intermittent catheterization or an indwelling Foley catheter which has an inflated balloon at the end to hold it in place in the bladder.
The catheter can stay in place indefinitely in which case, it is usually changed monthly. Watchful Waiting Because the progress and complications of BPH are unpredictable, a strategy of watchful waiting-meaning, no immediate treatment is attempted-is best for those with minimal symptoms that are not especially bothersome. Physician visits are needed about once a year to review the progress of symptoms, carry out an examination, and do a few simple laboratory tests. During watchful waiting, the man should avoid tranquilizers and over-the-counter cold and sinus remedies that contain decongestants.
These drugs can worsen obstructive symptoms. Avoiding fluids at night may lessen nocturia. Medication Drug treatment of BPH is a new development, and data is still being gathered on the benefits and possible adverse effects of longterm therapy. Currently, two types of drugsalpha-reductase inhibitors and alpha-adrenergic blockers-are used to treat BPH.
In some men, finasteride can relieve BPH symptoms, increase urinary flow rate, and actually shrink the size of the prostate, though it must be used indefinitely to prevent recurrence of symptoms. It may take as long as six months, however, to achieve maximum benefits from finasteride.
An analysis of six studies found that finasteride only improved BPH symptoms in men with an initial prostate volume of over 40 cc cubic centimeters ; finasteride did not reduce symptoms in men with smaller glands. Since finasteride shrinks the prostate, men with smaller glands are probably less likely to respond to the drug because the urinary symptoms result from causes other than physical obstruction for example, smooth muscle constriction.
Finasteride causes relatively few side effects. Finasteride may also decrease the size of the ejaculate. Another adverse effect is gynecomastia breast enlargement.
A study from England found gynecomastia in 0. Because it is not clear that the gynecomastia is caused by the drug or increases the risk of breast cancer, men taking the drug are being carefully monitored until these issues are resolved.
The fall in PSA levels, and any adverse effects on sexual function, disappear when finasteride is stopped. To get the benefits of finasteride for BPH without compromising the detection of early prostate cancer, men should have a PSA test before starting treatment with finasteride; subsequent PSA values can then be compared to this baseline value.
If a man is already on finasteride and no baseline PSA level was obtained, the results of a current PSA test should be multiplied by two to estimate the true PSA level. Any increase in PSA levels while taking finasteride also raises the possibility of prostate cancer.
Benign Prostatic Hyperplasia (BPH)
Alpha-adrenergic blockers These drugs, originally used to treat high blood pressure, reduce the tension of smooth muscles in blood vessel walls and also relax smooth muscle tissue within the prostate. As a result, daily use of an alpha-adrenergic bloeftv drug may increase urinary flow and relieve symptoms of urinary freurgency, and nocturia. Lower daily doses of terazosin 2 and 5 mg did not produce as much benefit as the 10 mg dose.
Thus, the authors of this report recommended that physicians gradually increase the dose to 10 mg unless troublesome side effects occur. Possible side effects of alpha-adrenergic blockers are: In this study, orthostatic hypotension was the most frequent side effect.
The authors noted that this problem can be mitigated by taking the daily dose of the drug in the evening.
Benign Prostatic Hyperplasia (BPH) | Johns Hopkins Medicine Health Library
An advantage of alpha blockers, compared to finasteride, is that they work almost immediately; they have the additional benefit of treating hypertension when it is present in BPH patients. However, whether terazosin is superior to finasteride may depend more on the size of the prostate. When the two drugs were compared in a study published in The New England journal of Medicine, terazosin appeared to produce greater improvement of BPH symptoms and urinary flow rate than finasteride.
But this difference may have been due to the larger number of men in the study with small prostates, who would be more likely to have BPH symptoms from smooth muscle constriction, rather than from physical obstruction by excess glandular tissue. Doxazosin was evaluated in three different clinical studies involving men with BPH. Patients took either a placebo or 4 to 12 mg of doxazosin a day.
Despite the previously held belief that doxazosin was only effective for mild or moderate BPH, patients with severe symptoms experienced the greatest improvement. In men treated for hypertension, the doses of other antihypertensive drugs may need to be adjusted to account for the blood-pressure-lowering effects of an alpha-adrenergic blocker.
These drugs may also induce angina in men with coronary heart disease. A doctor will be able to determine which individuals are good candidates for their use. Surgery Prostatectomy Prostatectomy is a very common-operation: Aboutof these procedures are carried out annually in the U. A prostatectomy for benign disease BPH involves removal of only the inner portion of the prostate simple prostatectomy. This operation differs from a radical prostatectomy for cancer, in which all prostate tissue is removed.
Simple prostatectomy offers the best and fastest chance for improving BPH symptoms, but may not totally alleviate discomfort. For example, surgery may relieve the obstruction, but symptoms may persist due to bladder abnormalities.
Surgery is also associated with the greatest number of long-term complications, including: The frequency of these complications depends on the type of surgery. Surgery is delayed until any urinary tract infection is successfully treated and kidney function is stabilized if urinary retention has resulted in kidney damage.
Men taking aspirin should stop taking the drug 7 to 10 days prior to surgery, since aspirin interferes with blood's ability to clot. Since the timing of prostate surgery is elective, men who may need a transfusion-primarily those with a very large prostate, who are more likely to experience significant blood loss-have the option of donating their own blood in advance, in case they need it during or after surgery.
This option is referred to as an autologous blood transfusion. Transurethral prostatectomy TURP This procedure is considered the "gold standard" of BPH treatment-the one against which other therapeutic measures are compared.
It involves removal of the core of the prostate with a resectoscope-an instrument passed through the urethra into the bladder. A wire attached to the resectoscope removes prostate tissue and seals blood vessels with an electric current.
A catheter remains in place for one to three days, and a hospital stay of one to two days is generally required. TURP is associated with little or no pain, and full recovery can be expected by three weeks after surgery.
In carefully selected cases patients with medical problems and smaller prostatesTURP may be possible as an outpatient procedure. Improvement after surgery is greatest in those with the worst symptoms. The mortality from TURP is very low 0. Like TURP, it is done with an instrument that is passed through the urethra.
BPH and prostate cancer risk
But instead of removing excess tissue, the surgeon only makes one or two small cuts in the prostate with an electrical knife or laser. Both conditions are rare in men under age A few other factors can increase your risk for BPH and prostate cancer, including: Both of these conditions run in families.
If your father or brother had prostate cancer, your risk of getting the disease more than doubles. Being obese increases your risk for BPH. Other risks for BPH include: Your other health conditions: Having diabetes or heart disease could make you more likely to get BPH. Blood pressure-lowering drugs called beta-blockers might affect your BPH risk.
Other risks for prostate cancer include: Your risk of dying from prostate cancer is highest if you live in a northern area, such as Boston or Ohio. This may be due to low levels of vitamin D.
Firefighters work with chemicals that might increase their risk. Agent Orange, a weed killer used during the Vietnam War, has also been linked to prostate cancer. Exercise may reduce your risk for prostate cancer. Yet eating too few vegetables may lead to a more aggressive form of the disease.
How is each condition diagnosed? Doctors use many of the same tests to diagnose both of these conditions. Prostate-specific antigen PSA test: This blood test detects PSA, a protein your prostate gland makes.
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When your prostate grows, it produces more of this protein. A high PSA level can only tell your doctor that your prostate has grown. Digital rectal exam DRE: Your doctor will insert a gloved, lubricated finger into your rectum. This test can show if your prostate is enlarged or abnormally shaped. A urinary flow test measures the speed of your urine flow.
A post-void residual volume test measures how much urine is left in your bladder after you urinate. Tests to diagnose prostate cancer These tests can confirm a prostate cancer diagnosis: Ultrasound uses sound waves to make pictures of your prostate gland.
A biopsy removes a sample of prostate tissue and checks it under a microscope for cancer.