A common, noncancerous tumor called benign prostatic hyperplasia (BPH) is characterized by uncontrolled
growth in the deep, mucosal glands in the prostate and by proliferation of some
of the nearby stroma cells. About 50% of men at age 50 and 80% of men at age 70
develop BPH.
Enlargement of the prostate and contraction of its smooth
musculature constrict the prostatic urethra, making micturition difficult. BPH
can lead to urinary retention, continual dribbling of urine, urinary tract infections,
and the formation of kidney stones.
Diagnosis of BPH begins with inquiries about the patient’s urinary
symptoms—whether he is hesitant to urinate, has a weak stream, must strain to
urinate, feels that his bladder does not empty fully, has increased urinary
frequency and urgency, and must urinate often at night.
Next, to determine whether the prostate is enlarged, the physician
performs a digital rectal exam; a finger inserted into the anal
canal can feel the prostate because it lies just anterior to the rectum (as
shown in Figure 1).
FIGURE 1 Reproductive organs of the
male, sagittal view. A portion of the pubis is shown in three-dimensional view to
illustrate the position of the ductus deferens as it enters the pelvic cavity.
The physician may also order a blood test to check the levels of
PSA (which are only mildly elevated in BPH; generally less so than in prostate cancer).
Treatment for BPH begins with drugs that inhibit the production or
action of testosterone, which the tumor cells depend on, or drugs that relax
the prostate’s smooth muscle. If such treatment does not increase ease of
urination, the prostate is either removed in a surgical procedure called transurethral prostatectomy or destroyed by heat from a
microwave device or an electrode inserted into the urethra.
