BPH Questions

Why is my prostate growing?

There are no clear answers to why prostate grows in the fourth decade of life. The most common theory is that there is a change in the level of testosterone in the body. Both men and women have levels of testosterone and estrogen in their bodies. As we age, these hormones change in quantity. More important than the quantity, is the proportion to the two hormones to each other. With the drop in testosterone, the proportion of estrogen, in the male body goes up. This change in the proportion is thought to be the cause for the increase in size of the prostate. Dihydrotestosterone [DHT] is the active form of testosterone. Researchers have shown that even with a drop in total testosterone, the level of DHT in older than seems to go up. The DHT accumulate in the prostate and may provide for cell growth inside the prostate, leading to BPH. Research has shown that men who do not have DHT rarely develop prostatism.

What of the most common symptoms of prostatism

Increase frequency of urination Increased nocturia [urination at night] Weak stream with dribbling at the end of urination Urgency with incontinence Straining to start urination Incomplete emptying of the bladder

What is Proscar

Proscar [finasteride] is in oral medication that blocks the action of dihydrotestosterone [DHT]. DHT has been noted to increase in the prostate as men get older. This increased DHT facilitates the growth of prostate cells. Proscar competes with an enzyme that activates DHT. By blocking the enzyme, DHT can no longer facilitate the growth of prostate cells, thus leading to a decrease in the size of the prostate. Because prostate growth is slow it can take months before any effect is seen by the use of Proscar. Studies done in the Veterans Administration hospital have shown that the use of Proscar is no better than the use of placebo in relieving the symptoms of prostatism. There may be a role for Proscar in early prevention of prostatism. Studies are now ongoing to see if men who are asymptomatic take Proscar and than development less problems with their prostate in the future.

What is Hytrin, Cardura and Flomax

Hytrin [Terazosin] is a medication that is known as an alpha-blocker. There are two other drugs that are also known as alpha-blocker call: Cardura and Flomax. All three of these drugs acted in a similar fashion. The bladder closes and opens in an area called the bladder neck. The opening and enclosing of the bladder neck controls the flow of urine. This opening mechanism is controlled by nerves all the alpha-receptors. The more stimulation these alpha-receptors receive the tighter the bladder neck closes. With a tight bladder neck urination becomes difficult. In Israeli Urologist, years ago theorized that blocking the alpha-receptors would facilitate the flow of urine. Hytrin, Cardura, and Flomax are all agents, which facilitate the flow of urine by blocking the alpha-receptors in the bladder neck. These three drugs in no way impact on the size of the prostate. Alpha-blockers improve the symptoms of prostatism by up to 65 percent of those patients who take the medication. The improvement can be from minimal to moderate to even marked improvement. Long-term results are still pending. In

If I have BPH will I get prostate cancer?

The diagnosis of BPH has nothing to do with cancer of the prostate. BPH simply means that the prostate has grown in size. This growth of the prostate is normal in most man over the age of 40. As a man gets older the size of his prostate increases. Cancer of the prostate is a completely different mechanism, which occurs unrelated to BPH. There is no statistical correlation between symptomatic BPH and prostate cancer.

Why is my PSA up?

PSA is only made by prostate tissue in the body. An elevated PSA is an indication that the prostate is growing. This growth can be either benign or malignant. There¹s no certain way of knowing what an elevated PSA means without a biopsy. Benign tissue grows slowly a slow rise in the PSA that takes many years usually benign. A rapid rise in the PSA indicates that the growth of the prostate is also rapid. Since cancer grows rapidly, a sudden elevation of PSA may indicate the presence of malignant tissue in the prostate. At this point a biopsy should be performed. Infection of the prostate can also cause the sudden and significant rise of PSA. Infarction of the prostate, the loss of blood supply to the prostate, is yet an other cause for sudden and elevated rise of the PSA.

When should I be treated?

There are absolute indications for treatment as well as relative indications. Inability to urine causing retention of urine is an absolute indication for treatment. Loss of kidney function or obstruction of the kidneys is another indication for treatment. Relative indications depend on the patient symptoms. Prior to treatment multiple factors have to be taken into consideration. If a patient is not in urinary retention (unable to empty the bladder) nor are his kidneys failing, careful consideration should be made prior to any treatment. The amount of symptoms the patient has does not predict future outcome. Often watchful waiting may be the correct answer.

What is bladder neck hypertrophy?

The point where the bladder and the prostate touch, is called the bladder neck. This area has the internal sphincter muscle, which keeps the bladder closed. The thickening of this area is called ³hypertrophy². The term hypertrophy indicates enlargement or thickening. Young men are more likely to experience hypertrophy of the bladder neck. Treatment is often started with low doses of the alpha blockers. Surgery is rarely indicated and should only be used in patients who have failed medical therapy.