From the Guidelines
BPH (Benign Prostatic Hyperplasia) is a common condition in older men where the prostate gland enlarges, causing urinary symptoms, and the most effective treatment approach depends on symptom severity, prostate size, and overall health, as recommended by the American Urological Association guideline published in 2021 1.
Cause and Risk Factors
The exact cause of BPH is unknown, but it's related to hormonal changes as men age, particularly the increased activity of dihydrotestosterone (DHT) in the prostate 1. Risk factors include:
- Age (most common in men over 50)
- Family history
- Obesity
- Lack of exercise
- Diabetes
- Heart disease
Preventive Measures
To reduce the risk of developing BPH or alleviate its symptoms, the following preventive measures can be taken:
- Maintain a healthy weight
- Exercise regularly
- Eat a balanced diet rich in fruits and vegetables
- Limit alcohol and caffeine intake
- Practice pelvic floor exercises
Signs and Symptoms
Common signs and symptoms of BPH include:
- Frequent urination, especially at night
- Weak urine stream
- Difficulty starting urination
- Dribbling at the end of urination
- Inability to completely empty the bladder
- Urinary urgency
- Urinary retention
Treatment Options
Treatment for BPH depends on symptom severity, prostate size, and overall health, and may include:
- Watchful waiting for mild symptoms
- Medications:
- Alpha-blockers (e.g., tamsulosin, alfuzosin) to relax prostate muscles
- 5-alpha reductase inhibitors (e.g., finasteride, dutasteride) to shrink the prostate
- Combination therapy using both types of medications
- Minimally invasive procedures:
- Transurethral needle ablation (TUNA)
- Transurethral microwave therapy (TUMT)
- Surgical options:
- Transurethral resection of the prostate (TURP)
- Laser therapy
- Open prostatectomy (for very large prostates) According to the American Society of Clinical Oncology/American Urological Association 2008 clinical practice guideline, finasteride, a 5-alpha reductase inhibitor, demonstrates both efficacy and acceptable safety for treatment of LUTS due to BPH, and can reduce the size of the prostate, increase peak urinary flow rate, and reduce BPH symptoms 1. However, it is essential to consult a urologist for personalized advice, as early intervention can prevent complications like urinary tract infections, bladder stones, or kidney damage.
From the FDA Drug Label
The symptoms associated with benign prostatic hyperplasia (BPH) are related to bladder outlet obstruction, which is comprised of two underlying components: static and dynamic. The static component is related to an increase in prostate size caused, in part, by a proliferation of smooth muscle cells in the prostatic stroma The dynamic component is a function of an increase in smooth muscle tone in the prostate and bladder neck leading to constriction of the bladder outlet
The causes of Benign Prostatic Hyperplasia (BPH) include:
- Increase in prostate size caused by proliferation of smooth muscle cells in the prostatic stroma
- Increase in smooth muscle tone in the prostate and bladder neck
The risk factors for BPH are not explicitly stated in the provided drug labels.
Preventive measures for BPH are not explicitly stated in the provided drug labels.
The signs and symptoms of BPH include:
- Bladder outlet obstruction
- Increase in prostate size
- Increase in smooth muscle tone in the prostate and bladder neck
Treatment options for BPH include:
- Finasteride tablets to improve symptoms, reduce the risk of acute urinary retention, and reduce the risk of the need for surgery
- Combination of finasteride tablets and the alpha-blocker doxazosin to reduce the risk of symptomatic progression of BPH
- Tamsulosin Hydrochloride Capsules, an alpha 1 adrenoceptor blocking agent, to relax smooth muscles in the bladder neck and prostate, resulting in an improvement in urine flow rate and a reduction in symptoms of BPH 2, 2, 3
From the Research
Causes and Risk Factors
- Benign prostatic hyperplasia (BPH) is a nonmalignant adenomatous overgrowth of the periurethral prostate gland commonly seen in aging men 4
- The pathophysiology of lower urinary tract symptoms in men is the result of bladder outlet obstruction associated with prostate enlargement 4
- BPH can be defined as prostate adenoma/adenomata, causing a varying degree of bladder outlet obstruction (BOO), which may eventually cause harm to the patients 5
- Age is a significant risk factor, with up to 15% to 25% of men aged 50-65 years experiencing lower urinary tract symptoms (LUTS) 6
Preventive Measures
- There is no clear evidence on preventive measures for BPH, but understanding the differential diagnosis and ordering appropriate laboratory tests are essential in accurately identifying a BPH diagnosis 4
- Strategies to identify patients most at risk and guidelines directed towards long-term management, in addition to short-term treatment, may be useful in helping to prevent BPH progression 7
Signs and Symptoms
- Symptoms of BPH include urinary hesitancy, incomplete bladder emptying, dribbling or prolonged urination, nocturia, urinary urgency, and/or urge incontinence 4
- LUTS can also be due to various unrelated syndromes such as heart failure, urinary tract infections, and diabetes 6
- BPH can cause a sensation of not completely emptying the bladder, stop-start urination, straining to urinate, a need to urinate soon after voiding, and weak urinary stream 6
Treatment Options
- Management of BPH can be broken down into medical or pharmacological and surgical therapies 4
- Treatment can be planned according to the disease severity using a staging system that classifies severity according to the presence or absence of significant obstruction and bothersomeness of symptoms 5
- Evaluation of patients with BPH should include lower urinary tract symptoms evaluation with appropriate symptom scores, digital rectal examination, voiding charts, prostate-specific antigen and creatinine measurement, urinalysis, and imaging of the urinary tract 8