What Is It?

The prostate is a small gland approximately the size and shape of a walnut that is located at the base of the penis. It sits in front of the rectum and directly below the bladder. The prostate is an integral part of the male reproductive tract. It produces fluid that helps to move the sperm through the urethra during sexual climax.

At birth, the prostate gland is tiny. When testosterone levels rise during puberty, the prostate grows rapidly, doubling in size by age 20. Growth slows down for the next two decades and the prostate usually does not cause problems for many years. Less than 10 percent of 30-year-old men have an enlarged prostate. When a man reaches his 40s, the prostate goes through a second growth spurt. Half of all men have an enlarged prostate by the time they reach age 60, and by age 85, 90 percent of the men are affected.

The prostate surrounds the urethra where the urethra connects to the bladder. During puberty, the prostate expands evenly. The enlargement that occurs in the second half of life is concentrated in the part of the gland next to the urethra. As the gland gets bigger, it interferes with the flow of urine out of bladder. That makes the bladder work harder to empty urine. Eventually, the bladder becomes thicker and can start having too many contractions. Over time, this extra effort causes the bladder muscle to weaken, and all the urine cannot be emptied. The combination of these problems leads to discomfort and complications.

An enlarged prostate can make it more difficult to urinate. Not all men who have an enlarged prostate experience symptoms. However, about one fourth of all men in the United States report some trouble urinating.

At first, symptoms may be mild because the bladder muscle is able to compensate for the pressure from the enlarged prostate on the urethra.

The pressure of the prostate on the urethra causes an interrupted or weak stream of urine. Other symptoms include:

• Difficulty starting to urinate
• Continuing to dribble after urination
• A feeling that you have not completely emptied your bladder

The severity of these problems depends on how much the prostate is putting pressure on the urethra.

Another set of symptoms happens when the urine that collects in the bladder causes irritation. These symptoms include:

• Painful urination
• A frequent need to empty the bladder, especially at night
• A feeling of urgency that accompanies the sensation to urinate

Potentially serious complications can occur if the bladder does not empty completely. The stagnant urine is a prime environment for the growth of bacteria, which can cause frequent urinary-tract infections. Also, urinary stones can form in the bladder lining due to an accumulation of debris and chemicals. Broken blood vessels can cause blood in the urine, often because of torn or enlarged veins on the inner surface of the prostate. Blood in the urine also can be caused by the sudden stretching of the bladder wall, which compromises its blood flow. If left untreated, so much urine can be retained in the bladder that urine backs up into the kidneys, which can cause the kidneys to malfunction.

As a first step in diagnosis, your doctor will ask you a set of questions to rate the severity of your urinary symptoms. The doctor also will perform a digital rectal exam to feel the size, shape and consistency of the prostate gland. If a nodule is felt, the doctor will order a blood test for PSA (prostate specific antigen). Other tests to measure urinary flow and retention may be performed.

Symptoms from an enlarged prostate are not always related directly to the size of the gland. Many men with and enlarged prostate don’t have any symptoms. In others, the obstruction and irritation are mild and progress slowly enough that they never develop more serious problems. About one-third of men with enlarged prostates have symptoms that continue to worsen, and require treatment.

Although you cannot prevent the prostate from enlarging, you can take measures to reduce your symptoms. You can:

• Limit your intake of liquids in the evening, especially those containing alcohol and caffeine. This helps to minimize the number of times you have to urinate during the night. In addition, excessive alcohol consumption is associated with swelling of the prostate.
• Cut down on stress, because it can make you need to urinate more often.
• Discuss with your doctor whether you can change or eliminate mediations that can aggravate the problem. These medications include antihistamines, diuretics, decongestants, antispasmodics, tranquilizers and certain types of antidepressants. These can weaken the bladder muscle or tighten the opening of the prostatic sphincter.
• Take every opportunity to use the bathroom and allow yourself enough time to empty your bladder completely.

You also may want to try an herbal remedy made from the berries of the saw palmetto tree. Some studies have shown this preparation to be helpful in controlling symptoms, although further research is needed to confirm its safety and effectiveness.

When to seek treatment and which action to take are personal decisions you should make with your doctor based on how much you are bothered by your symptoms.

Watchful Waiting
This is the first step if your symptoms are not terribly severe. Visit your doctor for a check-up and reassessment of your condition at least once a year.

Medications
For some men, the drug finasteride can shrink the size of the prostate and increase the flow of urine. The drawbacks to this medication are that it can take three to six months to begin working, and it causes impotence in approximately 4 percent of people who take it. Another type of drug, alpha-blockers, relaxes the bladder muscle and increases a man’s ability to urinate. Approximately 70 percent of men see improvement in their symptoms within a few days to a few weeks after beginning this medication. On the down side, it can cause dizziness, fatigue and excessively low blood pressure.

Surgery
This option offers the best chance for improving symptoms but also carries the greatest risk of complications. It may be done as an elective procedure or may be considered if blockage occurs (urinary retention). The usual approach is to place a Foley catheter in place to allow the bladder to empty. If normal urination cannot be re-established, surgery is performed after a short period of time. There are several types of surgical procedures:

• Transurethral resection of the prostate (TURP) — This is the most common procedure. Using a viewing instrument called a resectoscope, an electrical loop is advanced through the urethra to the enlarged prostate. The electrical loop carefully burns away the extra prostate tissue to open the urethral passage. The operation takes approximately 90 minutes and involves either general or regional anesthesia and an overnight hospital stay. The most common side effect is a condition called retrograde ejaculation, in which semen flows into the bladder rather than out the end of the penis.
• Transurethral incision of the prostate (TUIP) — Similar to TURP, this surgery involves widening the urethra by making small cuts in the bladder neck rather than removing prostate tissue. This procedure has the advantages of a low complication rate and no overnight hospital stay. It can be used only when there is minimal enlargement of the prostate.
• Transurethral microwave thermotherapy (TUMT) — This procedure involves inserting a microwave antenna into the urethra to heat the prostate and destroy overgrown tissue. TUMT costs less than TURP and has fewer complications. No overnight hospital stay is needed. However, approximately half of all men need additional treatment within four years.
• Transurethral ultrasound-guided laser-induced prostatectomy (TULIP) — Under ultrasound guidance, this procedure uses a laser beam to excise overgrown prostate tissue. A variation of this procedure using an endoscope rather than ultrasound is called visualized laser-assisted prostatectomy (VLAP).
• Open surgery — Occasionally, a very large prostate or other complication factors, such as bladder damage, require an incision above the pubic bone to remove dramatically enlarged prostate tissue.
• Balloon dilatation — Still considered experimental, this variation on angioplasty uses a balloon catheter inserted into the urethra. When the balloon is inflated with saline solution, the prostate tissue is compressed. Although many men experience immediate relief from symptoms after the procedure, problems often recur a few years later.
• Prostatic urethral stents — Mesh cylinders are inserted into the constricted portion of the urethra, where they are expanded.

You should call your doctor if you have bothersome symptoms or if you notice blood in your urine. Also, if your urine flow stops completely, seek immediate care. You also should seek medical care if you experience the symptoms of a urinary-tract infection.

Medical and surgical treatments both are likely to relieve symptoms. Surgery is slightly more successful in relieving symptoms, but the risk of complications is greater.

Diseases and Conditions Center

All ArmMed Media material is provided for information only and is neither advice nor a substitute for proper medical care. Consult a qualified healthcare professional who understands your particular history for individual concerns.