In most men, around the age of 40, the prostate, which was about 20 g by then, starts to grow again. This growth is benign and is medically called benign prostatic hyperplasia (BPH) to describe the tissue changes only. This benign prostatic hyperplasia gradually leads to benign prostatic enlargement (BPE).
The exact cause of prostate enlargement is not clear. Today, however, we know that there is not just one reason to blame, but several reasons at once. One of the main reasons for this is the change in the hormone balance in the male organism with age, especially testosterone and estrogen. Both hormones promote prostate enlargement. In addition, inflammatory processes may be involved.
However, as the prostate continues to grow, it can narrow the urethra so much that urination problems occur. About one in two men over the age of 50 is affected by BPH, with about one in three having clinical symptoms. About 80% of people over 70 have BPH and almost half of them have clinical symptoms. If BPE is caught early, medication can be given or surgery can be postponed.
Causes of Prostate Enlargement
Despite great efforts by researchers, the exact cause of benign prostate enlargement is still not fully understood.
Hormones seem to play an important role. There is evidence that dihydrotestosterone, which is formed from the male sex hormone testosterone, plays a role in the development of benign prostatic hyperplasia.
Apparently, there is also a family predisposition to the disease: If close relatives already have cases of benign prostate enlargement, your risk of developing the disease increases.
The role of metabolic syndrome is controversial. Doctors call metabolic syndrome a combination of morbid obesity (obesity), diabetes mellitus, lipid metabolism disorders (high cholesterol or LDL levels) and high blood pressure. One study showed that prostate growth was faster in patients with metabolic syndrome. In contrast, another study found no association between benign prostatic hyperplasia and metabolic syndrome.
Whether benign prostate enlargement is associated with various dietary factors is the subject of research. Special dietary rules cannot be derived at this point.
Microscopic examination of prostate tissue in patients with prostate enlargement almost always showed inflammatory changes, although there did not appear to be any link with a bacterial infection. Researchers therefore suspect that malfunctions of the immune system may also contribute to the development of benign prostatic hyperplasia.
Symptoms of Prostate Enlargement
An enlarged prostate usually causes problems emptying the bladder (“urinating”) and storing water in the bladder (“water retention”).
Bladder Disorder
Affected men have difficulty initiating urination. Urine flow may weaken. It takes longer than usual to urinate. Urine may also drip from the urethra after urination. Sometimes it takes more than one attempt to empty the bladder completely. Even after urinating, there is often a feeling that there is still a small amount of urine in the bladder (residual urine sensation).
Urine Storage Disorders
Those affected have to go to the toilet frequently, sometimes at short intervals and often at night. The sudden strong urge to urinate (nuisance incontinence) combined with unwanted urine leakage is often particularly stressful for those affected.
If there is always residual urine in the bladder, germs can settle there more easily, which increases the risk of urinary tract infections or bladder stones. About a third of affected men also suffer from erection problems, even more from difficulties with ejaculation; many experience a significant reduction in ejaculate volume.
If there is acute urinary retention, the affected person can no longer empty the bladder despite it being full and feels a clear urge to urinate. An overstretched bladder can cause severe pain. As an emergency measure, the doctor should drain the urine using a thin plastic tube (catheter).
However, in many patients acute urinary retention does not occur, instead the bladder is overstretched and residual urine is gradually and unrecognized (chronic urinary retention). The result is overflow incontinence. Urine retention can continue up to the ureters and kidneys and permanently damage them.
Prostate Enlargement Treatment Methods
Patients should explain even the slightest complaints to their doctor and seek advice on individualized treatment.
Under certain circumstances, it may be justified not to start any treatment (controlled waiting). For example, if the patient has only very few symptoms and the ultrasound examination shows that there is (almost) no urine left in the bladder after urinating (a small amount of residual urine). However, this wait-and-see approach must be discussed with a doctor and carried out under regular medical supervision. This is the only way to recognize in time when therapy is needed.
A number of classes of substances are available for the drug treatment of lower urinary tract symptoms associated with prostate enlargement. Traditionally, doctors in Turkey prescribe herbal medicines (phytopharmaceuticals). In addition, α1-receptor blockers and 5-alpha-reductase inhibitors have proven their efficacy in many studies. In addition, there are new active ingredients and active ingredient combinations aimed at treating existing diseases, for example symptoms of prostate enlargement as well as erectile dysfunction (“impotence”). All of the active ingredients present represent the gold standard in the treatment of mild to moderate complaints.
Surgical Treatment
If there are specific problems with benign prostate enlargement, the doctor will usually recommend an operation. These issues include, but are not limited to:
- Recurrent urinary retention despite drug therapy
- Frequent urinary tract infections
- Impairment of kidney function
- The appearance of visible blood in the urine
- Formation of bladder stones
Today, many patients take medication over a longer period of time that relieves the symptoms of an enlarged prostate without slowing the growth of the gland. If the prostate has reached a volume that makes surgery necessary, those affected are usually older and suffer from comorbidities – which can make surgery more risky. At least for this reason, doctors are focusing on developing new and less stressful (minimally invasive) surgical techniques to improve existing surgical procedures. The focus is currently on the use of different laser systems and modifications of classical methods that promise less blood loss during the operation.
Every surgical technique has advantages and possible disadvantages. Patients should seek detailed advice from their doctor to find the most suitable procedure for them individually.
Early Diagnosis in Prostate Enlargement
There is no reliable protection against prostate enlargement in old age. Early diagnosis is therefore important. An examination as part of a cancer early detection program can also contribute to this. Health insurance companies pay for an early detection test once a year for men over 45. In addition to taking a medical history, this includes examination of the pubic area and external genitalia, as well as palpation of the prostate through the rectum.
