What Is An Enlarged Prostate
Many men will experience an enlarged prostate in their lifetime. Learn about the symptoms of an enlarged prostate, what causes it, and how to treat an enlarged prostate here.By the time you reach the age of 60, you have a 50/50 chance of having an enlarged prostate. When you blow out 85 candles on the birthday cake, the likelihood increases to 90%.
You might be wondering, If its so common, whats the big deal about having benign prostatic hyperplasia ?
Combination Therapy: Risk And Benefits
The benefits of combination therapy are clear however, side effects may be more likely. The potential interactions of both BPH medications with other health issues and medications are more complicated with combination therapy. Common side effects of combination therapy may include any of the issues from each drug class. These include, but are not limited to:
- Reduced sexual desire
What Is Benign Prostatic Hyperplasia
Benign prostatic hyperplasia is another name for enlargement of the prostate gland. BPH is common in men as they age, but it can health problems if its not treated.
What causes benign prostatic hyperplasia?
In most men, the prostate gland grows with age. Sometimes, this leads to enlargement at a level that causes urinary or kidney problems.
Top risk factors for benign prostatic hyperplasia include:
- Age: By age 60, a third of men experience some symptoms of prostate enlargement. By age 80, about half of men do.
- Family medical history: Men who have a father, grandfather or brother with an enlarged prostate are more likely to experience the condition as well.
- Diabetes and heart disease: People with diabetes, heart disease and those who use beta blocker medications may be at increased risk for enlarged prostate.
- Obesity: Being obese increases the risk of BPH.
What are the symptoms of benign prostatic hyperplasia?
Some cases of BPH are very mild, but for most people who experience the condition, symptoms get worse over time. Common BPH symptoms include:
- Frequent urination, including increased urgency and nighttime urination.
- Difficulty in starting urination.
- Weak urine stream or dribbling.
- Urine stream that starts and stops.
- Feeling that bladder isnt completely empty after urination.
- Increase in urinary tract infections.
How is benign prostatic hyperplasia diagnosed and treated?
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Appendix A: Search Strategy
Do All People With Bph Require Medication
A person may not need treatment for a mildly enlarged prostate that is not causing significant symptoms. In such cases, a person may need to visit a urologist for regular checkups and may need treatment only if the symptoms become problematic.
If the symptoms of BPH begin to bother a person, a doctor may prescribe medication to shrink the prostate or stop its growth. This may reduce associated symptoms such as:
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Overlapping Syndromes With Luts/bph
Recent epidemiologic and demographic evidence has demonstrated the overlap among LUTS/BPH and other symptom complexes such as erectile impotence, ejaculatory dysfunction, and overactive bladder.57 New data presented at the annual AUA meeting in 2007 suggest an overlap between LUTS/BPH and abdominal obesity, diabetes, and the metabolic syndrome .58,59 The biological plausibility of these associations is currently being explored. Primary care physicians treating diabetes, obesity, and other metabolic conditions should recognize that these patients may have co-existing and latent symptoms of LUTS/BPH.60 The primary care physician is in the ideal position to identify and treat these symptoms, if clinically indicated.
When Should I See A Doctor
Growth of this gland, which is just below the bladder, is typical. But problems when you pee arenât. Even if you donât think itâs a big deal, itâs worth getting checked out if you have common BPH symptoms, such as:
- Dribbling when you finish peeing
- A hard time starting a stream
- Having to pee a lot — 8 or more times a day
- Waking up several times a night to pee
- A weak urine stream or you pee in stops and starts
Some problems with urine flow can be more serious. See your doctor or go to the emergency room right away if you:
- Canât pee at all
- Feel intense pain or discomfort in your lower belly
- Have blood in your pee
- Keep needing to pee right away, it hurts to pee, and you have fever and chills
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Benign Enlarged Prostate: Which Medications Can Help
Drugs that help to empty the bladder can relieve symptoms caused by an enlarged prostate. They are often used if the symptoms are such a problem that it is hard to get by in everyday life without treatment.
If you have to go to the toilet several times a night and constantly feel the urge to pee during the day too because your bladder no longer fully empties itself, various medications can help.
When deciding whether to take a certain medication, it is always a good idea to talk to your doctor about possible interactions with other drugs. Many older men who develop prostate problems are already taking medication for other conditions such as high blood pressure or chronic illnesses.
Medications For Erectile Dysfunction
If you are considering an erectile dysfunction medication, you dont have to worry if you are also on one of the 5alpha-reductase inhibitors for your BPH: The drugs can be taken together without adverse effects. However, if you are currently using, or considering, an alpha-1 blocker, you may want to take some precautions when adding one of the PDE-5 inhibitors.
Heres why: Because the PDE-5 inhibitors cause a system-wide drop in blood pressure, theoretically they can exacerbate the blood pressurelowering action of the nonselective alpha-1 blockers doxazosin and terazosin. This seems especially to be a problem when taking sildenafil and vardenafil tadalafil is a longer-acting PDE-5 inhibitor, and the risks are less clear.
As a result, some doctors recommend that if you are using a nonselective alpha-1 blocker for BPH, you should avoid taking an erectile dysfunction medication altogether. However, our panel of Harvard experts think the concerns are overblown. If you dont want to stop using a nonselective alpha-1 blocker for your BPH, you can make sure you take the PDE-5 inhibitor at different times of the day to avoid problems.
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Review Of Key Questions
AHRQ posted the key questions on the Effective Health Care Web site for public comment. The EPC refined and finalized the key questions after review of the public comments, and input from Key Informants and the Technical Expert Panel . This input is intended to ensure that the key questions are specific and relevant.
What You Can Do
- Make a list of your symptoms, including any that may seem unrelated to the reason for which you scheduled the appointment.
- Keep track of how often and when you urinate, whether you feel you’re completely emptying your bladder, and how much liquid you drink.
- Make a list of your key medical information, including other conditions you might have.
- Make a list of all medications, vitamins or supplements that you’re currently taking.
- Write down a list of questions to ask your doctor.
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Transurethral Incision Of The Prostate
A lighted scope is inserted into your urethra, and the surgeon makes one or two small cuts in the prostate gland making it easier for urine to pass through the urethra. This surgery might be an option if you have a small or moderately enlarged prostate gland, especially if you have health problems that make other surgeries too risky.
Phytotherapies: Risk And Benefits
The best research studies demonstrate that these BPH home remedies do not work. Lower safety and testing standards mean that you do not know exactly what you are taking. These treatments carry risks without any potential benefits. In addition, they may result in patients prolonging urgent treatment that could result in long-term health complications.
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C Data Abstraction And Data Management
Data fields to be extracted will include author, year of publication, sponsorship, setting, subject inclusion and exclusion criteria, intervention and control characteristics, sample size, follow-up duration, participant baseline age, race, and AUA/IPSS scores, and results of primary outcomes and adverse effects. Relevant data will be extracted into web-based extraction forms created in Microsoft Excel. Data will be analyzed in RevMan 5.3 software.19 Data will be extracted to evidence and outcomes tables by one investigator and reviewed and verified for accuracy by a second investigator.
F Grading The Strength Of Evidence For Major Comparisons And Outcomes
The overall strength of evidence for primary outcomes of KQ1 within each comparison will be evaluated based on five required domains: study limitations directness consistency precision and reporting bias.23 Based on study design and risk of bias, study limitations will be rated as low, medium, or high. Consistency among studies will be rated as consistent, inconsistent, or unknown/not applicable based on the whether intervention effects are similar in direction and magnitude, and statistical significance of all studies. Directness will be rated as either direct or indirect based on the need for indirect comparisons when inference requires observations across studies. That is, more than one step is needed to reach the conclusion. Precision will be rated as precise or imprecise based on the degree of certainty surrounding each effect estimate or qualitative finding. An imprecise estimate is one for which the confidence interval is wide enough to include clinically distinct conclusions based upon established noticeable differences when available. Other factors that may be considered in assessing strength of evidence include dose-response relationship, the presence of confounders, and strength of association.
Based on these elements, we will assess the overall strength of evidence for each comparison and outcome as:23
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Efficacy And Side Effects Of Drugs Commonly Used For The Treatment Of Lower Urinary Tract Symptoms Associated With Benign Prostatic Hyperplasia
- 1Department of Urology, The Second Affiliated Hospital of Nanchang University, Nanchang, China
- 2Medical Department of Graduate School, Nanchang University, Nanchang, China
- 3Department of Clinical Medicine, Xi’an Jiao Tong University Health Science Center, Xi’an, China
- 4Department of Pathology, Jiangxi Provincial People’s Hospital Affiliated to Nanchang University, Nanchang, China
- 5Institute of Clinical Medicine, Jiangxi Provincial People’s Hospital Affiliated to Nanchang University, Nanchang, China
- 6Department of Ultrasound, The First Affiliated Hospital of Nanchang University, Nanchang, China
Figure 1 How Bph Medications Work
A. As the prostate gland enlarges, it constricts the urethra, which carries urine out of the body, and may expand up into the bladder itself. This not only impedes urinary tract functioning, but also reduces the volume of urine the bladder can hold.
B. Alpha-1 blockers attach to certain receptors in the muscle walls much as a key fits into a lock. By blocking alpha-1 receptors, alpha-1 blockers prevent insertion of the chemical keys that signal a muscle to contract. The muscles relax and urine flows more freely.
C. The 5alpha-reductase inhibitors have a different mechanism of action: They neutralize 5alpha reductase, the enzyme that initiates conversion of testosterone into dihydrotestosterone, or DHT, the form of the hormone that is usable in the prostate. By blocking the action of the chief male hormone responsible for growth of the prostate, these drugs eventually cause the prostate to shrink.
The alpha-1 blockers are classed into two groups. The selective agents, alfuzosin , silodosin , and tamsulosin , work primarily on the tissues of the urinary tract. The nonselective agents, doxazosin and terazosin , affect both the urinary tract and other tissues elsewhere in the body. The 5alpha-reductase inhibitors, which include dutasteride and finasteride , act directly on the prostate.
Other medications are in development , but are not yet available. So for now, youll have to weigh the relative risks and benefits of alpha-1 blockers and 5alpha-reductase inhibitors.
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Why Atenolol And No Other Beta
As noted in the study, patients were mostly taking either Metoprolol, Carvedilol, and Atenolol. Each is formulated differently from the others, with slightly different effects. Metropolol and Carvedilol help prevent death in people with heart failure, and both improve the chances of surviving a heart attack. They also have the ability to lower blood pressure if other first-choice medications dont work, but Metropolol does not seem as effective as Carvedilol, and may also raise blood sugar levels.
Atenolol is also prescribed for cardiac problems like angina, and as a way to improve heart attacks survival. It differs from the other two drugs because its action works nearly twice as long per oral dose. The researchers who conducted the study hypothesize that Atenolols ability to linger in the body gives it extra time to discourage opportunistic cancer cells from developing new blood vessels .
Another study worth noting is a retrospective analysis of nearly 40,000 men with advanced castration-resistant PCa who were treated through the Veterans Administration . Based on research evidence suggesting beta-blockers discourage angiogenesis in mice with in metastatic tumors, the purpose was to explore the survival benefit, if any, for humans taking Metropolol, the only beta-blocker used in the study. After adjusting for all variables, beta-blocker use was not linked with reduced mortality.
Rationale For Developing Alpha 1 Subtype Selective Blockers For Bph
Three subtypes of the alpha 1 adrenoceptor have been cloned and pharmacologically characterized. Lepor and associates demonstrated that the predominant alpha 1 adrenoceptor subtype in the human prostate was the alpha 1a subtype.27 Subsequent studies by the same group using both autoradiography28 and immunohistochemistry29 localized the alpha 1a subtype to the prostatic stroma. Functional studies demonstrated that the alpha 1a subtype mediated human prostate contraction.30
If one assumes that the efficacy of alpha blockers is mediated by prostate smooth-muscle relaxation, then there would be a compelling reason to develop alpha 1a subtype selective inhibitors for the treatment of BPH. Presumably, some of the adverse events associated with non-selective alpha 1 blockade are mediated by the alpha 1b and alpha 1d adrenoceptor subtypes. These adverse events would be minimized or eliminated by administrating an alpha 1a selective antagonist. There is now abundant evidence that alpha 1 blockers relieve LUTS via mechanisms unrelated to prostate smooth-muscle relaxation.4 Therefore, it is conceivable that an alpha 1a subtype selective antagonist would retain its modest impact on relieving BOO while failing to relieve LUTS if the therapeutic effect on LUTS is mediated by alpha 1b or alpha 1d subtypes. The developments of several alpha 1a subtype selective antagonists were terminated due to lack of any clinical advantage.
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When To See A Doctor
If you’re having urinary problems, discuss them with your doctor. Even if you don’t find urinary symptoms bothersome, it’s important to identify or rule out any underlying causes. Untreated, urinary problems might lead to obstruction of the urinary tract.
If you’re unable to pass any urine, seek immediate medical attention.
How Is Prostate Enlargement Diagnosed
It’s usually problems with urination that bring patients to a urologist. Diagnosis typically involves a digital rectal examination and lab work that includes urine and blood tests. A prostate-specific antigen blood test checks for elevated levels of an enzyme released by the prostate. Higher levels generally suggest some type of problem with the prostate, although levels can also be high due to recent surgery or an infection. Additional assessment can involve image tests, a urine flow study, and a special procedure done with a lighted scope that provides a better view of the prostate . In some cases, a prostate biopsy is done to rule out cancer.
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Cautions With Other Medicines
There are some medicines that may interfere with the way that beta blockers, including beta blocker eyedrops, work.
Tell your doctor if you’re taking:
- other medicines for high blood pressure. The combination with beta blockers can sometimes lower your blood pressure too much. This may make you feel dizzy or faint
- other medicines for an irregular heartbeat such as amiodarone or flecainide
- other medicines that can lower your blood pressure. These include some antidepressants, nitrates , baclofen , medicines for an enlarged prostate gland like tamsulosin, or Parkinson’s disease medicines such as levodopa
- medicines for asthma or chronic obstructive pulmonary disease
- medicines for diabetes, particularly insulin beta blockers may make it more difficult to recognise the warning signs of low blood sugar
- medicines to treat nose or sinus congestion, or other cold remedies
- medicines for allergies, such as ephedrine, noradrenaline or adrenaline
- non-steroidal anti-inflammatory medicines , such as ibuprofen. These medicines may increase your blood pressure, so it’s best to keep them to a minimum
Assessment Of Lower Urinary Tract Symptoms
LUTS includes urinary storage and voiding symptoms. The storage and voiding symptoms are best captured and quantified using self-administered symptom questionnaires that assess the individual patients symptoms. The American Urological Association Symptoms Index and the International Prostate Symptom Index Score are the most widely used instruments to capture severity of LUTS.9 Both instruments capture 7 symptoms: emptying the bladder, urinary frequency, interrupted urinary stream, postponing of urination, weak stream, straining to initiate urination, and nocturia. The total score for both ranges between 0 and 35. Scores of 07, 818, and 19, respectively, designate mild, moderate, and severe symptoms.10 The IPSS has an additional question that assesses quality of life and is scored separately on a scale of 0 to 6, with 6 representing the poorest quality.
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