Why Men Get an Enlarged Prostate and How to Treat BPH Symptoms

Summary

In this episode of the Reena Malik MD podcast, Dr. Reena Malik, a urologist and pelvic surgeon, discusses Benign Prostatic Hyperplasia (BPH), a common condition affecting millions of men. She explains what BPH is, its symptoms, and the factors contributing to its development, including hormones, genetics, and inflammation. Dr. Malik also covers various treatment options, such as alpha blockers, 5-alpha reductase inhibitors, and lifestyle modifications, emphasizing the importance of managing BPH to improve quality of life.

Takeaways

• 😀 Benign Prostatic Hyperplasia (BPH) is a common condition where the prostate gland enlarges, affecting about 70% of men by age 60 and 80% by age 80.
• 💧 Symptoms of BPH include increased urinary frequency, urgency, nocturia (waking up to urinate), weak stream, hesitancy, intermittency, and post-void dribbling.
• 🚫 BPH is not cancer, and an enlarged prostate does not increase the risk of prostate cancer.
• 🔬 The causes of BPH are complex and can involve hormones like DHT, inflammation, genetics, and factors like metabolic syndrome and the sympathetic nervous system.
• 🏃‍♂️ Maintaining a healthy weight, staying active, and eating a diet rich in vegetables and lycopene can help reduce the risk of BPH.
• 💊 Supplements like saw palmetto, beta-sitosterol, and pygeum africanum have mixed evidence for effectiveness in treating BPH symptoms.
• 🚫 Certain medications, including antihistamines, decongestants, and some antidepressants, can worsen BPH symptoms.
• 💧 Behavioral changes such as monitoring fluid intake, reducing bladder irritants like caffeine and alcohol, and managing constipation can improve BPH symptoms.
• 💊 Medical treatments for BPH include alpha blockers (e.g., tamsulosin), 5-alpha reductase inhibitors (e.g., finasteride), and phosphodiesterase 5 inhibitors (e.g., tadalafil).
• ⚠️ Sexual side effects are a potential risk with 5-alpha reductase inhibitors, and they can also affect PSA levels used in prostate cancer screening.

Q & A

What is BPH and how common is it among men?

BPH, or benign prostatic hyperplasia, is an enlargement of the prostate gland. It is incredibly common, affecting about 70% of men by the age of 60 and 80% by the age of 80.

What are the typical symptoms of BPH?

Symptoms of BPH include increased urinary frequency, urgency, nocturia (waking up to urinate more than once at night), weak stream, hesitancy, intermittency, incomplete emptying, post-void dribbling, and sometimes urinary leakage.

Does an enlarged prostate always lead to symptoms, and how does the size correlate with symptom severity?

An enlarged prostate does not always result in symptoms, and the size of the enlargement does not always correlate with symptom severity. Some men may have a large prostate without bothersome symptoms, while others with a smaller prostate may experience significant symptoms.

How does BPH affect sleep and quality of life?

BPH can significantly impact sleep and quality of life, especially in patients who experience nocturia. Frequent nighttime urination can lead to fatigue and difficulty falling back asleep, which can affect daily functioning and overall well-being.

What is the role of hormones like DHT in the development of BPH?

DHT, or dihydrotestosterone, is a byproduct of testosterone that plays a significant role in prostate growth. Higher levels of DHT are often found in men with larger prostates, contributing to the development of BPH.

How does inflammation contribute to BPH?

Chronic low-grade inflammation in the prostate can promote growth by triggering the release of growth factors like epidermal growth factor, insulin-like growth factor, and transforming growth factor beta, leading to cell proliferation and prostate enlargement.

What is the relationship between genetics and the risk of developing BPH?

There is a hereditary component to BPH. Men with a close male relative, especially a father, who had BPH at a young age (before 60) may be at a higher risk of developing BPH themselves.

What lifestyle changes can help prevent or reduce the risk of BPH?

Maintaining a healthy weight, staying active, eating a diet rich in vegetables and lycopene-rich foods like tomatoes and watermelon, managing chronic conditions, and being mindful of medications that could worsen BPH symptoms can help prevent or reduce the risk of BPH.

What are some common supplements that are believed to help with BPH symptoms, and how effective are they?

Saw palmetto is the most studied supplement for BPH, but recent high-quality trials have not shown significant benefits over placebo. Other supplements like beta-sitosterol, Pygeum africanum, pumpkin seed extract, and stinging nettle have some evidence of symptom improvement, but the results are not consistent.

How do alpha blockers and 5-alpha reductase inhibitors work to treat BPH, and what are their potential side effects?

Alpha blockers, such as tamsulosin and alfuzosin, work by relaxing the prostate and bladder neck muscles to improve urine flow. 5-alpha reductase inhibitors, like finasteride and dutasteride, block the conversion of testosterone to DHT, shrinking the prostate. Side effects can include retrograde ejaculation, dizziness, and sexual side effects like decreased libido.

What is the role of phosphodiesterase 5 inhibitors in treating BPH, and how do they work?

Phosphodiesterase 5 inhibitors, such as tadalafil, work by relaxing smooth muscles to help with prostatic symptoms. They are particularly useful for men experiencing both erectile dysfunction and BPH, as they can help with both conditions.