The prostate is a walnut-sized gland that is part of the male reproductive organs. As men age, prostate enlargement sets in, pressing on the urethra and causing various symptoms. Prostate enlargement that is not of pathological origin is also called benign prostatic hyperplasia or prostatic adenoma.
What is prostate enlargement?
Schematic diagram showing the anatomy of a healthy prostate and an enlarged prostate. Click to enlarge. Prostate enlargement is a benign enlargement of the prostate gland due to increasing proliferation of cellular material. Hyperplasia should be distinguished from hypertrophy (growth in cell size), although the terms are sometimes used in synchronicity in prostate enlargement. Prostate enlargement involves an increase in the number of stromal and epithelial cells, resulting in the formation of large, relatively discrete nodules in the area of the prostate surrounding the urethra. If large enough, the nodules press on the urethra, causing obstruction of normal urinary flow. Prostate enlargement leads to symptomatic urinary symptoms such as frequent urination, dysuria (pain when urinating), and an increased risk of urinary tract infections. Despite causing symptoms, prostate enlargement does not lead to cancer or an increased risk of cancer.
Causes
Increased tissue growth of the prostate begins around age 30. An estimated 50% of men have histologic evidence of prostate enlargement by age 50. By age 80, 40-50% of all men have clinically significant prostate enlargement. The cause of prostate enlargement is as yet unclear, therefore it is difficult to identify risk factors. However, it is assumed that the increasingly higher level of estrogen promotes a growth stimulus of female tissue in the posterior urethra. Another hypothesis is that prostate enlargement results from decreased production of dihydrotestosterone (DHT) with age. Other studies assume that prostate enlargement could be predisposed. According to this study, certain cells are activated later in life, signaling other cells in the gland to grow or become more sensitive to hormones.
Symptoms, complaints, and signs
Schematic diagram showing the anatomy of a healthy prostate and an enlarged prostate in prostate cancer. Click to enlarge. Prostate enlargement primarily affects urination. The most common symptom is the urge to urinate frequently at night. In addition, with an enlarged prostate, there is often an abrupt and strong urge to urinate. At the same time, urination also becomes more difficult: there is a weaker urine stream and often sufferers of prostate enlargement have the feeling that the bladder is not completely empty. In fact, men with prostate enlargement very often have residual urine in the bladder, which promotes the occurrence of bladder and urethral infections. In very rare cases, complete urinary retention occurs, endangering the kidneys. Urination itself often takes longer than usual for those affected. Occasionally, those affected have great difficulty even starting to urinate. Often, urine continues to drip after urination or incontinence symptoms occur. Sometimes there may be a reduced amount of ejaculation or even temporary erection problems. The symptoms that can occur as part of benign prostate enlargement are not necessarily dependent on the severity of the enlargement. Some men experience no symptoms or very mild symptoms despite a severely enlarged prostate.
Diagnosis and course
In the irritable stage of prostate enlargement, the first symptoms appear concerning the frequency of urination and bladder function. The second stage of prostatic enlargement is characterized by incomplete urinary retention and incipient organ failure. In the untreated final stage, bladder function fails completely, resulting in urine toxicity. Additional complications such as urinary tract infections and even kidney damage are possible. For a complete diagnosis of prostate enlargement, a rectal urological examination is first necessary.To rule out cancer as the cause of prostate enlargement, a protein-based PSA blood test or rectal ultrasound may be performed. If suspected, a biopsy of suspicious tissue is taken for microscopic examination. During cystoscopy, the physician inserts a small tube through the opening of the urethra into the penis under local anesthesia. This allows the inside of the urethra and bladder to be examined to determine the extent of prostate enlargement.
Complications
Changes in the prostate that are not treated promptly can be associated with a number of complications. Even benign enlargements can block the flow of urine. Because of the increased accumulation of urine in the bladder, the risk for bladder stones increases significantly, as do urinary tract infections and a number of more serious complications. Due to the permanently increased filling of the bladder and the associated increased pressure during urination, after some time there is a reactive growth of the bladder wall muscles. Due to the excessive muscle growth, the bladder wall may lose elasticity. In addition, collagen deposition in the tissue increases, which can result in the formation of pseudodiverticula, small bulges in the bladder wall. Urinary retention can cause urine to pass through the ureters into the renal pelvis. If this occurs over a long period of time, the kidneys are damaged, and in severe cases, kidney failure can occur. There is also a risk of uremia. Certain metabolic by-products such as creatinine, uric acid or urea must be excreted through the kidneys in the urine. If this does not happen or does not happen to a sufficient degree because the kidneys are damaged, these substances accumulate in the body, leading to symptoms of poisoning. Typical symptoms are nausea, vomiting and severe itching. Uremia that is left untreated can be fatal.
When should you see a doctor?
Because prostate enlargement may indicate another serious condition, it should always be evaluated by a physician. Only early diagnosis and treatment can prevent further symptoms and complications. The earlier the disease is diagnosed and treated, the higher the probability of a positive course of the disease. The doctor should be consulted in the case of prostate enlargement if the affected person has to go to the toilet very frequently during the night without having drunk much. Erectile dysfunction can also be a sign of prostate enlargement and should be examined by a doctor if it occurs regularly and without any particular reason. It is not uncommon for patients to show incontinence as well, and the kidneys can also be damaged. The symptoms of prostate enlargement can vary in severity and can significantly limit the life of the affected person. The diagnosis of prostate enlargement can be made by a urologist. However, further treatment requires the involvement of other specialists. Whether prostate enlargement leads to a reduced life expectancy of the affected person depends largely on the exact cause of the disease, so that here no general prediction is possible.
Treatment and therapy
Treatment measures should be taken as early as the first symptoms in order to curb the progression of prostate enlargement. Most of these minimally invasive treatments apply heat to the affected tissue pressing on the bladder. If symptoms are severe and heat treatments are unsuccessful, surgery should be considered. In addition to naturopathic medicinal herbal teas made from nettle, willowherb or buds of quaking aspen, prostate enlargement can also be treated with medication. The natural hormones finasteride and dutasteride stop prostate enlargement. So-called alpha-blockers such as terazosin, doxazosin, tamsulosin or alfuzosin can treat symptoms of prostate enlargement. However, side effects such as dizziness, fatigue, and lightheadedness are to be expected. The discomfort of prostate enlargement can be relieved with red light and sitz baths or warm moist compresses. In addition, to counteract blood stasis in the prostate, regular sexual intercourse or masturbation is an effective therapy.
Prevention
Prostate enlargement is part of the aging process in men. In principle, a light diet rich in vitamins and carbohydrates and low in protein is recommended for prevention.Fat, meat and beer should be renounced in favor of non-carbonated drinks and fruit. A valuable alternative to chips are pumpkin seeds, which inhibit the growth of proliferating prostate tissue. Avoidance should also be made of sitting for too long, hypothermia or forcible suppression of the urge to urinate.
Aftercare
In cases of prostate enlargement due to the formation of a carcinoma, surgical treatment and the associated removal of the affected tissue usually occurs. This is also done in some cases of benign prostate enlargement. After such treatment, regular examinations by the treating physician are of great importance. This is to detect the possible occurrence of further tumors after the treatment at an early stage. In the case of a previous operation, follow-up care of the wound must also be carried out. The treating physician takes care here that there is no infection of the wound and that there is little scarring. If the scarring is severe, additional surgery may be required. The disease and treatment of the prostate can also lead to impaired sexual function and incontinence. This can lead to psychological problems in patients. Therefore, therapy as well as a cure, which is often covered by the statutory health insurance, are advisable to ease the patient’s situation. Self-help groups and other counseling centers at the clinics can also be used. Any incontinence that may occur can be improved by special pelvic floor exercises.
What you can do yourself
Prostate enlargement is a mostly benign condition that is not always operated on immediately, but is also amenable to self-help by the patient. Some measures with which the patient can help himself in everyday life are compiled here below. The first step is to make the urge to urinate, which most patients perceive as a recurring symptom, more bearable. This is often achieved by patients drinking the recommended amount, but not before certain occasions, such as bedtime or a social engagement, in order to be as free as possible from the urge to urinate for these times. Another way to help yourself is to avoid diuretic drinks. Dehydrating beverages are also more likely to be avoided. Especially coffee, tea and alcohol are on the list of unfavorable drinks. After urinating, it is recommended to try again to empty the bladder after a short break. Subsequent urine is then also deposited and the pause before the next urination is significantly prolonged. Bladder training is also very useful. It is also used, for example, in irritable bladder to train the bladder to tolerate larger amounts of filling. In this way, it is also possible to better control the urge to urinate. Over-the-counter medications, such as those containing pumpkin extracts, also make this possible.
