Enlarged Prostate


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The prostate is a walnut-sized gland that forms part of the male
reproductive system. The gland is made of two lobes, or regions,
enclosed by an outer layer of tissue. As the diagrams show, the prostate
is located in front of the rectum and just below the bladder, where
urine is stored. The prostate also surrounds the urethra, the canal
through which urine passes out of the body.

Scientists do not know all the prostate's functions. One of its
main roles, though, is to squeeze fluid into the urethra as sperm move
through during sexual climax. This fluid, which helps make up semen,
energizes the sperm and makes the vaginal canal less acidic.

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Enlarged Prostate

  1. 1. Fitango Education Health Topics Enlarged Prostatehttp://www.fitango.com/categories.php?id=286
  2. 2. OverviewThe prostate is a walnut-sized gland that formspart of the malereproductive system. The gland is made of twolobes, or regions,enclosed by an outer layer of tissue. As thediagrams show, the prostate 1
  3. 3. Overviewis located in front of the rectum and just below thebladder, whereurine is stored. The prostate also surrounds theurethra, the canalthrough which urine passes out of the body.Scientists do not know all the prostates functions.One of its 2
  4. 4. Overviewmain roles, though, is to squeeze fluid into theurethra as sperm movethrough during sexual climax. This fluid, whichhelps make up semen,energizes the sperm and makes the vaginal canalless acidic. 3
  5. 5. SymptomsMany symptoms of BPH stem from obstruction ofthe urethra and gradualloss of bladder function, which results inincomplete emptying of thebladder. The symptoms of BPH vary, but the mostcommon ones involve 4
  6. 6. Symptomschanges or problems with urination, such as-- a hesitant, interrupted, weak stream-- urgency and leaking or dribbling-- more frequent urination, especially at night 5
  7. 7. SymptomsThe size of the prostate does not always determinehow severethe obstruction or the symptoms will be. Somemen with greatly enlargedglands have little obstruction and few symptomswhile others, whoseglands are less enlarged, have more blockage andgreater problems. 6
  8. 8. SymptomsSometimes a man may not know he has anyobstruction until hesuddenly finds himself unable to urinate at all. Thiscondition, calledacute urinary retention, may be triggered by takingover-the-countercold or allergy medicines. Such medicines contain adecongestant drug, 7
  9. 9. Symptomsknown as a sympathomimetic. A potential sideeffect of this drug mayprevent the bladder opening from relaxing andallowing urine to empty.When partial obstruction is present, urinaryretention also can bebrought on by alcohol, cold temperatures, or along period of 8
  10. 10. Symptomsimmobility.It is important to tell your doctor about urinaryproblems suchas those described above. In eight out of 10cases, these symptomssuggest BPH, but they also can signal other, moreserious conditions 9
  11. 11. Symptomsthat require prompt treatment. These conditions,including prostatecancer, can be ruled out only by a doctorsexamination.Severe BPH can cause serious problems over time.Urineretention and strain on the bladder can lead tourinary tract 10
  12. 12. Symptomsinfections, bladder or kidney damage, bladderstones, andincontinence-the inability to control urination. Ifthe bladder ispermanently damaged, treatment for BPH may beineffective. When BPH isfound in its earlier stages, there is a lower risk ofdeveloping such 11
  13. 13. Symptomscomplications. 12
  14. 14. DiagnosisYou may first notice symptoms of BPH yourself, oryour doctor mayfind that your prostate is enlarged during a routinecheckup. When BPHis suspected, you may be referred to a urologist, adoctor who 13
  15. 15. Diagnosisspecializes in problems of the urinary tract and themale reproductivesystem. Several tests help the doctor identify theproblem and decidewhether surgery is needed. The tests vary frompatient to patient, butthe following are the most common. 14
  16. 16. DiagnosisDigital Rectal Examination (DRE)This examination is usually the first test done. Thedoctorinserts a gloved finger into the rectum and feelsthe part of theprostate next to the rectum. This examinationgives the doctor a general 15
  17. 17. Diagnosisidea of the size and condition of the gland.Prostate-Specific Antigen (PSA) Blood TestTo rule out cancer as a cause of urinarysymptoms, your doctormay recommend a PSA blood test. PSA, a proteinproduced by prostate 16
  18. 18. Diagnosiscells, is frequently present at elevated levels in theblood of men whohave prostate cancer. The U.S. Food and DrugAdministration (FDA) hasapproved a PSA test for use in conjunction with adigital rectalexamination to help detect prostate cancer in menwho are age 50 or 17
  19. 19. Diagnosisolder and for monitoring men with prostate cancerafter treatment.However, much remains unknown about theinterpretation of PSA levels,the tests ability to discriminate cancer frombenign prostateconditions, and the best course of action followinga finding of 18
  20. 20. Diagnosiselevated PSA.A fact sheet titled "The Prostate-Specific Antigen(PSA) Test:Questions and Answers" can be found on theNational Cancer Institutewebsite atwww.cancer.gov/cancertopics/factsheet/Detection/PSA. 19
  21. 21. DiagnosisRectal Ultrasound and Prostate BiopsyIf there is a suspicion of prostate cancer, yourdoctor mayrecommend a test with rectal ultrasound. In thisprocedure, a probeinserted in the rectum directs sound waves at theprostate. The echo 20
  22. 22. Diagnosispatterns of the sound waves form an image of theprostate gland on adisplay screen. To determine whether anabnormal-looking area is indeed atumor, the doctor can use the probe and theultrasound images to guide a 21
  23. 23. Diagnosisbiopsy needle to the suspected tumor. The needlecollects a few piecesof prostate tissue for examination with amicroscope.Urine Flow StudyYour doctor may ask you to urinate into a specialdevice that 22
  24. 24. Diagnosismeasures how quickly the urine is flowing. Areduced flow often suggestsBPH.CystoscopyIn this examination, the doctor inserts a small tubethrough 23
  25. 25. Diagnosisthe opening of the urethra in the penis. Thisprocedure is done after asolution numbs the inside of the penis so allsensation is lost. Thetube, called a cystoscope, contains a lens and alight system that help 24
  26. 26. Diagnosisthe doctor see the inside of the urethra and thebladder. This testallows the doctor to determine the size of thegland and identify thelocation and degree of the obstruction. 25
  27. 27. TreatmentMen who have BPH with symptoms usually needsome kind of treatment atsome time. However, a number of researchershave questioned the needfor early treatment when the gland is just mildlyenlarged. The results 26
  28. 28. Treatmentof their studies indicate that early treatment maynot be needed becausethe symptoms of BPH clear up without treatmentin as many as one-thirdof all mild cases. Instead of immediate treatment,they suggest regular 27
  29. 29. Treatmentcheckups to watch for early problems. If thecondition begins to pose adanger to the patients health or causes a majorinconvenience to him,treatment is usually recommended.Since BPH can cause urinary tract infections, adoctor will 28
  30. 30. Treatmentusually clear up any infection with antibioticsbefore treating the BPHitself. Although the need for treatment is notusually urgent, doctorsgenerally advise going ahead with treatment oncethe problems becomebothersome or present a health risk. 29
  31. 31. TreatmentThe following section describes the types oftreatment that are most commonly used for BPH.Drug TreatmentOver the years, researchers have tried to find away to shrinkor at least stop the growth of the prostate withoutusing surgery. The 30
  32. 32. TreatmentFDA has approved six drugs to relieve commonsymptoms associated with anenlarged prostate.Finasteride (Proscar), FDA-approved in 1992, anddutasteride(Avodart), FDA-approved in 2001, inhibitproduction of the hormone DHT, 31
  33. 33. Treatmentwhich is involved with prostate enlargement. Theuse of either of thesedrugs can either prevent progression of growth ofthe prostate oractually shrink the prostate in some men.The FDA also approved the drugs terazosin (Hytrin)in 1993, 32
  34. 34. Treatmentdoxazosin (Cardura) in 1995, tamsulosin (Flomax)in 1997, and alfuzosin(Uroxatral) in 2003 for the treatment of BPH. Allfour drugs act byrelaxing the smooth muscle of the prostate andbladder neck to improve 33
  35. 35. Treatmenturine flow and to reduce bladder outletobstruction. The four drugsbelong to the class known as alpha blockers.Terazosin and doxazosinwere developed first to treat high blood pressure.Tamsulosin andalfuzosin were developed specifically to treat BPH. 34
  36. 36. TreatmentThe Medical Therapy of Prostatic Symptoms(MTOPS) Trial,supported by the National Institute of Diabetesand Digestive and KidneyDiseases (NIDDK), recently found that usingfinasteride and doxazosintogether is more effective than using either drugalone to relieve 35
  37. 37. Treatmentsymptoms and prevent BPH progression. The two-drug regimen reduced therisk of BPH progression by 67 percent, comparedwith 39 percent fordoxazosin alone and 34 percent for finasteridealone.Minimally Invasive Therapy 36
  38. 38. TreatmentBecause drug treatment is not effective in all cases,researchers in recent years have developed anumber of procedures thatrelieve BPH symptoms but are less invasive thanconventional surgery.Transurethral microwave procedures. In 1996, 37
  39. 39. Treatmentthe FDA approved a device that uses microwavesto heat and destroyexcess prostate tissue. In the procedure calledtransurethral microwavethermotherapy (TUMT), the device sendscomputer-regulated microwaves 38
  40. 40. Treatmentthrough a catheter to heat selected portions of theprostate to at least111 degrees Fahrenheit. A cooling system protectsthe urinary tractduring the procedure.The procedure takes about 1 hour and can beperformed on an 39
  41. 41. Treatmentoutpatient basis without general anesthesia. TUMThas not been reportedto lead to erectile dysfunction or incontinence.Although microwave therapy does not cure BPH, itreducesurinary frequency, urgency, straining, andintermittent flow. It does 40
  42. 42. Treatmentnot correct the problem of incomplete emptying ofthe bladder. Ongoingresearch will determine any long-term effects ofmicrowave therapy andwho might benefit most from this therapy. 41
  43. 43. TreatmentTransurethral needle ablation. Also in 1996, theFDA approved the minimally invasive transurethralneedle ablation (TUNA) system for the treatmentof BPH.The TUNA system delivers low-levelradiofrequency energythrough twin needles to burn away a well-definedregion of the enlarged 42
  44. 44. Treatmentprostate. Shields protect the urethra from heatdamage. The TUNA systemimproves urine flow and relieves symptoms withfewer side effects whencompared with transurethral resection of theprostate (TURP). Noincontinence or impotence has been observed. 43
  45. 45. TreatmentWater-induced thermotherapy. This therapy usesheated water to destroy excess tissue in theprostate. A cathetercontaining multiple shafts is positioned in theurethra so that atreatment balloon rests in the middle of theprostate. A computer 44
  46. 46. Treatmentcontrols the temperature of the water, which flowsinto the balloon andheats the surrounding prostate tissue. The systemfocuses the heat in aprecise region of the prostate. Surrounding tissuesin the urethra and 45
  47. 47. Treatmentbladder are protected. Destroyed tissue eitherescapes with urinethrough the urethra or is reabsorbed by the body.High-intensity focused ultrasound. The use ofultrasound waves to destroy prostate tissue is stillundergoing clinical 46
  48. 48. Treatmenttrials in the United States. The FDA has not yetapprovedhigh-intensity focused ultrasound.Surgical TreatmentMost doctors recommend removal of the enlargedpart of the 47
  49. 49. Treatmentprostate as the best long-term solution for patientswith BPH. Withsurgery for BPH, only the enlarged tissue that ispressing against theurethra is removed; the rest of the inside tissueand the outsidecapsule are left intact. Surgery usually relieves theobstruction and 48
  50. 50. Treatmentincomplete emptying caused by BPH. The followingsection describes thetypes of surgery that are used.Transurethral surgery. In this type ofsurgery, no external incision is needed. After givinganesthesia, the 49
  51. 51. Treatmentsurgeon reaches the prostate by inserting aninstrument through theurethra.A procedure called transurethral resection of theprostate(TURP) is used for 90 percent of all prostatesurgeries done for BPH. 50
  52. 52. TreatmentWith TURP, an instrument called a resectoscope isinserted through thepenis. The resectoscope, which is about 12 incheslong and 1/2 inch indiameter, contains a light, valves for controllingirrigating fluid, andan electrical loop that cuts tissue and seals bloodvessels. 51
  53. 53. TreatmentDuring the 90-minute operation, the surgeon usestheresectoscopes wire loop to remove theobstructing tissue one piece at atime. The pieces of tissue are carried by the fluidinto the bladderand then flushed out at the end of the operation. 52
  54. 54. TreatmentMost doctors suggest using TURP wheneverpossible.Transurethral procedures are less traumatic thanopen forms of surgeryand require a shorter recovery period. Onepossible side effect of TURPis retrograde, or backward, ejaculation. In thiscondition, semen flows 53
  55. 55. Treatmentbackward into the bladder during climax instead ofout the urethra.Another surgical procedure is called transurethralincision ofthe prostate (TUIP). Instead of removing tissue, aswith TURP, thisprocedure widens the urethra by making a fewsmall cuts in the bladder 54
  56. 56. Treatmentneck, where the urethra joins the bladder, and inthe prostate glanditself. Although some people believe that TUIPgives the same relief asTURP with less risk of side effects such asretrograde ejaculation, its 55
  57. 57. Treatmentadvantages and long-term side effects have notbeen clearly established.Open surgery. In the few cases when atransurethral procedure cannot be used, opensurgery, which requires anexternal incision, may be used. Open surgery isoften done when the 56
  58. 58. Treatmentgland is greatly enlarged, when there arecomplicating factors, or whenthe bladder has been damaged and needs to berepaired. The location ofthe enlargement within the gland and the patientsgeneral health helpthe surgeon decide which of the three openprocedures to use. 57
  59. 59. TreatmentWith all the open procedures, anesthesia is givenand anincision is made. Once the surgeon reaches theprostate capsule, he orshe scoops out the enlarged tissue from inside thegland.Laser surgery. In March 1996, the FDA approved 58
  60. 60. Treatmenta surgical procedure that employs side-firing laserfibers and Nd: YAGlasers to vaporize obstructing prostate tissue. Thedoctor passes thelaser fiber through the urethra into the prostateusing a cystoscope and 59
  61. 61. Treatmentthen delivers several bursts of energy lasting 30 to60 seconds. Thelaser energy destroys prostate tissue and causesshrinkage. As withTURP, laser surgery requires anesthesia and ahospital stay. Oneadvantage of laser surgery over TURP is that lasersurgery causes little 60
  62. 62. Treatmentblood loss. Laser surgery also allows for a quickerrecovery time. Butlaser surgery may not be effective on largerprostates. The long-termeffectiveness of laser surgery is not known.Newer procedures that use laser technology canbe performed on an outpatient basis. 61
  63. 63. TreatmentPhotoselective vaporization of the prostate (PVP).PVP uses a high-energy laser to destroy prostatetissue and seal the treated area.Interstitial laser coagulation. Unlike otherlaser procedures, interstitial laser coagulationplaces the tip of the 62
  64. 64. Treatmentfiberoptic probe directly into the prostate tissue todestroy it. 63
  65. 65. CausesThe cause of BPH is not well understood. Nodefinite information onrisk factors exists. For centuries, it has been knownthat BPH occursmainly in older men and that it doesnt develop inmen whose testes were 64
  66. 66. Causesremoved before puberty. For this reason, someresearchers believe thatfactors related to aging and the testes may spurthe development of BPH.Throughout their lives, men produce bothtestosterone, animportant male hormone, and small amounts ofestrogen, a female hormone. 65
  67. 67. CausesAs men age, the amount of active testosterone inthe blood decreases,leaving a higher proportion of estrogen. Studiesdone on animals havesuggested that BPH may occur because the higheramount of estrogen 66
  68. 68. Causeswithin the gland increases the activity ofsubstances that promote cellgrowth.Another theory focuses on dihydrotestosterone(DHT), asubstance derived from testosterone in theprostate, which may help 67
  69. 69. Causescontrol its growth. Most animals lose their abilityto produce DHT asthey age. However, some research has indicatedthat even with a drop inthe bloods testosterone level, older men continueto produce and 68
  70. 70. Causesaccumulate high levels of DHT in the prostate. Thisaccumulation of DHTmay encourage the growth of cells. Scientists havealso noted that menwho do not produce DHT do not develop BPH.Some researchers suggest that BPH may developas a result of 69
  71. 71. Causes"instructions" given to cells early in life. Accordingto this theory,BPH occurs because cells in one section of thegland follow theseinstructions and "reawaken" later in life. These"reawakened" cells then 70
  72. 72. Causesdeliver signals to other cells in the gland,instructing them to growor making them more sensitive to hormones thatinfluence growth. 71