Q: What are the symptoms for an enlarged prostate?

A: Prostate enlargement (benign prostate hyperlasia or BPH) is one of the most common conditions affecting the aging male. This condition occurs in 50 percent of men by age 60 and 90 percent by the ninth decade of life.

The development of BPH is associated with an increase of stroma and epithelial cells (the cells that make up the prostate gland). This leads to an increase in the size and weight of the prostate, which leads to anatomic changes of the urethra (the tube through which urine travels as it passes from the bladder) and the bladder. These changes lead to lower urinary tract symptoms (LUTS) such as reduced stream, hesitancy, straining to urinate, as well as storage symptoms. Storage symptoms might include frequency, nocturia (waking at night to urinate) and incontinence (loss of urine). These symptoms are often combined with extreme urgency or desire to urinate. Also, blood in the urine, urinary tract infection and problems with sexual function can occur as a result of prostate enlargement. Other causes of these problems must be ruled out.

The signs and symptoms are rarely life threatening, yet the degree to which these symptoms become bothersome or worrisome to the patient and disruptive to daily activities usually provides the basis for his decision to seek medical care. The recent Multinational Survey of the Aging Male determined that although 90 percent of all men surveyed had some degree of LUTS, only 19 percent sought medical help for their urinary problems and only 11 percent received any type of medical or surgical intervention.

Before a physician can decide on the treatment for an individual's symptoms of enlarged prostate, he or she should evaluate the patient's symptoms and general physical status to help determine what methods of treatment would be most beneficial to the patient. Although prostate enlargement does not cause or lead to prostate, bladder or kidney cancers, their diagnosis must be eliminated before treating the prostate enlargement. There are multiple diagnostic tools available such as blood tests, radiological testing and cystoscopy, which assist in providing the physician with an accurate assessment. If intervention is necessary, then a decision is made whether medication can adequately treat the patients' symptoms or more aggressive surgical intervention is necessary.

Patients seek treatment for relief of symptoms anticipating improvement in their quality of life as well as their medical status. Consequently, the treating urologist should involve the patient in all of the decision-making process. Fortunately, today there are multiple options available to the patient and the urologist to improve the patient's comfort and well-being.

Leonard A. Stept, M.D.
Urology