Impact and Management of Benign Prostatic Hyperplasia (BPH)

Benign prostatic hyperplasia (BPH), characterized by prostate enlargement, affects 50% of men in their 50s and 80% of men over the age of 70.¹ Left untreated, BPH causes a considerable reduction in quality of life and requires extensive medical intervention.

Causes and Risk Factors

BPH develops when noncancerous cells proliferate and increase the overall size of the prostate.² Exact causes are unclear, however, hormonal mechanisms are known to play a large role in the pathophysiology of the condition. Higher levels of androgens and lower levels of estrogens promote enlargement of the gland.³

Although the causes of BPH have not been clearly identified, certain factors are known to increase risk, such as:⁴

• Age: The prostate growth rate for older men is 2.0% to 2.5% per year
• Diet: Red meat, fat, dairy products, bread, poultry, and starch can potentially increase the risk of BPH
• Physical activity: Exercise decreases the risk of BPH by up to 25%
• Alcohol: Daily alcohol consumption can reduce BPH risk by up to 35%
• Metabolic syndrome: Obesity, diabetes, hypertension, and high cholesterol have all been linked to BPH
• Inflammation: Prostate enlargement can be brought on by histological inflammation, which also plays a role in the development of prostate cancer
• Genetics: There may be a direct correlation between BPH and genetics, specifically for larger prostates in younger men

Symptoms and Signs

Common side effects of BPH include erectile dysfunction (ED) and lower urinary tract symptoms (LUTS) that result from compression of the urethra, and these include:⁵

• Urinary retention
• Urinary frequency
• Incomplete bladder emptying
• Urgency
• Nocturia
• Intermittency

If prostate enlargement is not treated early, LUTS can turn into chronic high-pressure urinary retention (a life-threatening medical emergency) and permanently impair the contractility of the primary muscle in the bladder wall.⁶ Patients are also at an elevated risk for urinary tract infections, kidney stones, and damage to the bladder and kidneys.⁷

Although BPH is noncancerous, the repercussions of leaving the condition untreated can be severe. It is important to prioritize regular prostate checks in order to prevent the life-altering and potentially fatal side effects of prostate enlargement.

Diagnosis & Treatment

Diagnosing BPH involves routine assessments of urinary function in men over the age of 50, including a thorough patient history, rectal exam, and testing PSA levels — a prostate cancer biomarker that can also diagnose BPH.⁸

Patients with mild BPH, you may wish to take a “watchful waiting” approach to closely monitor symptoms without any medical intervention.⁹ For those with bothersome symptoms or moderate to severe BPH, the following medications are commonly prescribed:¹⁰

• Alpha blockers: Relax the prostate muscles
• Phosphodiesterase inhibitors: Improve urine flow
• Alpha-reductase inhibitors: Block the hormone DHT to prevent prostate growth
• Clinical implications

BPH may not be a malignant condition, but it can create serious issues for men’s sexual, physical, and emotional health. Being keenly aware of how BPH and LUTS are linked to ED is crucial, as they share risk factors and similar pathophysiological mechanisms.¹¹ Additionally, ED can be brought on by both BPH and the therapies used to treat it.¹² Therefore, it is important male patients are closely monitored for any signs of prostate enlargement, as the impacts of BPH can affect every aspect of life.

Learn more about how MediSuite makes treating the symptoms of urologic conditions easier and less expensive for patients.

Sources:

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2. Benign Prostate Hyperplasia. (n.d.). Mount Sinai. https://www.mountsinai.org/care/urology/services/mens-health/bph 
3. Ho, C.K.M. & Habib, F.K. (2011). Estrogen and androgen signaling in the pathogenesis of BPH. Nature Reviews Urology 8, 29-41. 
4. Lim, K.B. (2017). Epidemiology of clinical benign prostatic hyperplasia. Asian Journal of Urology 4(3), 148-151. 
5. Andriole, G.L. (2022). Benign Prostatic Hyperplasia (BPH). Merck Manual. https://www.merckmanuals.com/professional/genitourinary-disorders/benign-prostate-disease/benign-prostatic-hyperplasia-bph?query=Benign%20Prostatic%20Hyperplasia%20(BPH) 
6. Ng, M. & Baradhi, K.M. (2022). Benign Prostatic Hyperplasia. In StatPearls [Internet]. Retrieved October 20, 2022, from https://pubmed.ncbi.nlm.nih.gov/32644346/ 
7. Prostate Enlargement (Benign Prostatic Hyperplasia). (n.d.). National Institute of Diabetes and Digestive and Kidney Diseases. https://www.niddk.nih.gov/health-information/urologic-diseases/prostate-problems/prostate-enlargement-benign-prostatic-hyperplasia 
8. Tanguay, S., Awde, M., Brock, G., Casey, R., Kozak, J., Lee, J., Nickel, J.C., Saad, F. (2009). Diagnosis and management of benign prostatic hyperplasia in primary care. Canadian Urological Association Journal 3(3-S2), S92-S100.
9. Wigyul, J. & Babayan, R.K. (2009). Watchful waiting in benign prostatic hyperplasia. Current Opinion in Urology 19(1), 3-6. 
10. Benign Prostatic Hyperplasia. (n.d.). Cleveland Clinic. https://my.clevelandclinic.org/health/diseases/9100-benign-prostatic-hyperplasia#management-and-treatment 
11. Calogero, A.E., Burgio, G., Condorelli, R.A., Cannarella, R., La Vignera, S. (2018). Epidemiology and risk factors of lower urinary tract symptoms/benign prostatic hyperplasia and erectile dysfunction. The Aging Male 22(1), 12-19.
12. Gandhi, J., Weissbart, S.J., Smith, N.L., Kaplan, S.A., Dagur, G., Zumbo, A., Joshi, G., Khan, S.A. (2017). The impact and management of sexual dysfunction secondary to pharmacological therapy of benign prostatic hyperplasia. Translational Andrology and Urology 6(2), 295-304.