Key facts
- Non-malignant enlargement of the prostate gland
- Commonly seen in older men
- Commonest cause of lower urinary tract symptoms (LUTS) in older men
Risk factors
- Age: around 50% of 50-year-old men will have evidence of BPH and 30% will have symptoms. Around 80% of 80-year-old men have evidence of BPH
- Ethnicity: black > white > Asian
Symptoms
BPH typically presents with lower urinary tract symptoms (LUTS), which may be categorised into: FUN WISE Dribble: Frequency, Urgency, Nocturia, Weak stream, Intermittent urinary flow, Straining, Empting incompletion
- Storage symptoms (irritative): Frequency, urgency, nocturia
- Voiding symptoms (obstructive): Weak stream, intermittent urinary flow, straining, emptying incompletion
- Post-micturition: dribbling
- Complications: urinary tract infection, retention, obstructive uropathy
Signs
- On DRE: smooth enlarged prostate
Investigation
- International Prostate Symptom Score (IPSS) to assess severity
- DRE and PSA to rule out malignancy
- Renal function
- Urine analysis in all patient
- Urodynamics: Urine flowmetry and pressure
- If concern over malignancy
- Transrectal ultrasound ± guided biopsy
Management
Conservative
- Watchful waiting
Medical management
Recommended for those with LUTS and affecting QoL
- Alpha-1 antagonists e.g. tamsulosin, alfuzosin, doxazosin
- decrease smooth muscle tone (prostate and bladder)
- considered first-line, improve symptoms in around 70% of men
- SE: dizziness, postural hypotension, dry mouth, depression
- 5 alpha-reductase inhibitors e.g. finasteride
- Block the conversion of testosterone to dihydrotestosterone (DHT), which is known to induce BPH
- Unlike alpha-1 antagonists causes a reduction in prostate volume and hence may slow disease progression. This however takes time and symptoms may not improve for 6 months. They may also decrease PSA concentrations by up to 50%
- SE:erectile dysfunction, reduced libido, ejaculation problems, gynaecomastia
Surgical management
- Indication: Failed medical therapy, worsening QoL
- Transurethral Resection of Prostate (TURP)- gold standard
- Open retropubic prostectomy- for large gland
- Transurethral incision in the prostate (TUIP)- causes less destruction and reduced sexual dysfunction
- Laser Prostectomy
- Microwave thermotherpay ablation of the prostate