Enlarged Prostate

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Enlarged Prostate
Most prostatic enlargement is due to benign prostatic hyperplasia (BPH), a problem that bothers men increasingly with advancing age. The process of BPH generally begins in a man's 30s, evolves very slowly and usually causes symptoms only after he has passed the half-century mark.

In BPH the normal elements of the prostate gland grow in size and number. Their sheer bulk may compress the urethra which courses through the center of the prostate and impedes the flow of urine through the urethra from the bladder to the outside. The urethral compression leads to urine retention and the need for frequent urination. If severe enough, complete blockage can occur.
BPH is very common. Half of all men over 50 develop symptoms of PBH, but only 10% need medical or surgical intervention.
BPH is completely benign. It is not a precursor (a forerunner) to prostate cancer.
Treatment of BPH is usually reserved for men with significant symptoms. Watchful waiting with medical monitoring once a year is appropriate for most men with BPH.
The medical therapy of BPH includes medication. The prostate enlargement in BPH is directly dependent on dihydrotestosterone (DHT), the principal androgen hormone in the prostate, certain medication blocks the enzyme needed to make DHT and so lowers blood and tissue DHT levels and helps reduce the size of the prostate. Other medication belongs to a class of drugs called alpha-1 blockers which relax the smooth muscle of the prostate and the bladder neck. Relaxing these muscles helps relieve the urinary obstruction caused by the enlarged prostate
Common symptoms include:
a weak urine flow
needing to urinate more often, especially at night
a feeling that your bladder has not emptied properly
difficulty starting to urinate
dribbling urine
needing to rush to the toilet - you may occasionally leak urine before you get there
blood in your urine.
The prostate gland is located beneath your bladder. The tube that transports urine from the bladder out of your penis (urethra) passes through the center of the prostate. When the prostate enlarges, it begins to block urine flow.
Most men have continued prostate growth throughout life. In many men, this continued growth enlarges the prostate enough to cause urinary symptoms or to significantly block urine flow.

It isn't entirely clear what causes the prostate to enlarge. However, it might be due to changes in the balance of sex hormones as men grow older.
Digital Rectal Exam. Due to the natural position of the prostate gland, an enlargement may be felt through the wall of the rectum. Your physician will insert a gloved finger into the rectum in order to assess the size and condition of the prostate gland.
Urinalysis. With a urine sample, the laboratory can test for infections or other problems. This is a simple way to rule out bladder infection and bladder cancer, which can cause similar symptoms.
Prostate Specific Antigen Test (PSA). Similar to a urinalysis, the PSA monitors the level of prostate-specific antigen in a patient's blood. Through a routine blood draw, this test can be used to check for prostate cancer and an enlarged prostate. Additionally, a man’s PSA may actually be an indicator of whether or not he is at risk for continued prostate enlargement.
Urodynamic Tests. Urodynamics are a group of diagnostic tests done to evaluate the performance of the lower urinary tract. Measuring bladder pressure and urinary flow, these tests investigate problems such as urine control, urinary frequency or urgency, poor bladder emptying, and intermittent urination. A low flow and high pressure usually indicate obstruction to the urinary outlet.
Enlarged Prostate