An enlarged prostate, or benign prostatic hyperplasia (BPH), is a pathological increase in the volume of the prostate gland, which is associated with abnormal proliferation of its cells. This disease is typical for men over 50 years of age and can lead to significant urinary dysfunction, which negatively affects the patient's quality of life. BPH is a non-cancerous condition, but requires careful examination and treatment due to possible complications and concomitant diseases. The main mechanism of BPH pathogenesis is associated with hormonal changes that occur in a man's body with age, in particular, with an increase in the level of dihydrotestosterone, which plays an important role in stimulating cellular proliferation in the prostate gland.
History of the disease and interesting historical facts
Benign prostatic hyperplasia has been known to medicine for centuries. The first mentions of symptoms associated with an enlarged prostate are found in ancient Egyptian medical texts dating back to the 3rd millennium BC. In the Middle Ages, urinary problems in men became a subject of study and discussion among doctors and surgeons. Interestingly, in the 17th century, doctors were aware of what they called “watery disease,” which may in fact be associated with symptoms caused by an enlarged prostate.
Modern research aimed at identifying the causes and mechanisms of BPH development began to actively develop only in the 20th century. In the 1930s, the important contribution of androgens, including testosterone and its metabolite dihydrotestosterone, to the pathogenesis of this disease was established. Over the next decades, various treatment methods were proposed, both conservative and surgical, which significantly improved the quality of life of patients with this pathology.
Epidemiology
BPH is one of the most common diseases among older men. According to statistics, the incidence of this disease increases with age. About 50% men aged 50 years and about 80% men over 80 years experience various symptoms associated with an enlarged prostate. Overall, the World Health Organization estimates that more than 300 million men worldwide suffer from BPH. One of the largest epidemiological studies showed that men with hypertension have a 15-20% increased risk of developing BPH.
An important aspect of the epidemiology is the geographical variation of the disease: a study showed that men from East Asian countries suffer from BPH less frequently than men from North America and Europe. This may be due to differences in diet, lifestyle and genetic predisposition. The influence of environmental factors such as pollution levels on the development of the disease is also taken into account.
Genetic predisposition to this disease
Genetic predisposition to benign prostatic hyperplasia is being studied more and more deeply. Having a family history of the disease significantly increases the risk of its development. Studies have shown that men whose father or brothers suffered from BPH have a 2-3 times higher chance of developing the disease.
Important genes involved in the pathogenesis of BPH include AR (androgen receptor gene), which is responsible for tissue sensitivity to androgens, and other genes associated with cell proliferation and apoptosis. The discovery of mutations in these genes and their impact on testosterone and its derivatives in the human body makes it possible to develop more targeted treatment approaches.
In addition, studies have shown that certain gene polymorphisms associated with inflammatory processes in the prostate gland can also contribute to the development of hyperplasia. Thus, further study of genetic predisposition will improve diagnostic and treatment methods for this disease.
Risk factors for the development of this disease
There are many risk factors that contribute to the development of benign prostatic hyperplasia. The main ones include:
- Age: Age is the most significant risk factor; the likelihood of prostate enlargement increases after age 40.
- Hormonal changes: Increased levels of androgens such as testosterone and dihydrotestosterone lead to greater prostate enlargement.
- Family history: Having close relatives with BPH increases the likelihood of developing the disease.
- Indulge in fatty foods: Research shows that high saturated fat intake may increase the risk of disease.
- Obesity: Being overweight is associated with hormonal imbalances, which can contribute to prostate enlargement.
- Diabetes mellitus: Type 2 diabetes, especially in the presence of concomitant obesity, is associated with an increased risk of developing BPH.
In addition to the above factors, it is important to consider the role of chronic inflammatory processes in the prostate gland, as well as the influence of environmental and chemical factors. For example, a 2020 study also confirmed the link between the effects of chemical pollutants on the walls of the prostate gland and the development of benign hyperplasia.
Diagnosis of this disease
Diagnosis of benign prostatic hyperplasia involves a comprehensive approach that begins with anamnesis and clinical examination. Important symptoms include:
- frequent urination, especially at night (nocturia);
- weakening of the urine stream and the inability to completely empty the bladder;
- painful sensations when urinating;
- feeling of incomplete urination.
Laboratory tests include a complete blood count, a biochemical blood test, and a prostate-specific antigen (PSA) level, which helps rule out prostate cancer. Radiological tests, such as ultrasound, can show the size and structure of the prostate gland, as well as the presence of residual urine in the bladder.
Additional tests may include magnetic resonance imaging (MRI) and urodynamic studies. Differential diagnosis includes ruling out prostate cancer, other genitourinary diseases, and infections that may cause similar symptoms.
Treatment
Treatment of benign prostatic hyperplasia can be conservative or surgical, depending on the severity of symptoms and the general condition of the patient. At the beginning of treatment, pharmacological measures are most often used, which may include the following groups of drugs:
- α-blockers (eg, terazosin and tamsulosin) help relax the smooth muscles of the bladder neck and prostate;
- 5α-reductase inhibitors (dutasteride and finasteride) slow the progression of the disease by reducing the size of the prostate;
- Herbal medicine: Herbal preparations such as saw palmetto extract may help reduce symptoms of the disease.
In cases where conservative therapy is not effective enough, surgical interventions may be recommended. Surgical treatment options include transurethral resection of the prostate (TURP) or laser therapy. These methods can reduce the size of the gland and eliminate symptoms associated with urinary dysfunction.
Additionally, there has been a recent increase in interest in minimally invasive treatments, such as focal ablation. Regardless of the treatment method chosen, regular monitoring of the patient's condition and adjustment of therapy, if necessary, remains important.
List of medications used to treat this disease
The main groups of drugs used to treat benign prostatic hyperplasia:
- α-blockers:
- Tamsulosin
- Doxazosin
- Terazosin
- 5α-reductase inhibitors:
- Finasteride
- dutasteride
- Phytopreparations:
- Saw Palmetto Extract
- Pumpkin Seed Extract
It should also be taken into account that the choice of specific drugs and their dosage should be determined by the attending physician depending on the individual characteristics of the patient and the severity of symptoms.
Disease monitoring
Monitoring the condition of a patient with benign prostatic hyperplasia is an important aspect of patient management. Regular examinations should be performed to assess the dynamics of the disease, identify possible complications and adequately adjust treatment.
The patient should undergo a general urine analysis, determination of the PSA level, and assessment of the prostate volume using ultrasound, as well as an assessment of symptoms using the IPSS (International Prostate Symptom Score) scale. The prognosis of the disease is favorable in most cases, especially with timely diagnosis and treatment. However, if left untreated, complications such as acute urinary retention, urinary tract infections, and the development of chronic renal failure are possible.
Age-related features of the disease
Age is one of the key factors in the development of benign prostatic hyperplasia. The disease usually progresses with age. At the age of 40-50 years, the risk of its development increases, and upon reaching 60-70 years, this pathology can be observed in more than 80% men.
In younger men, BPH is less common and may be related to genetic factors or endocrine dysfunction. In this age group, the emphasis should be on early diagnosis and monitoring of possible symptoms. In older men, due to age-related changes in prostate tissue and hormonal imbalances, more careful monitoring and an individualized approach to treatment are necessary.
Questions and Answers
- What are the main symptoms of an enlarged prostate? The main symptoms include increased frequency of urination, weak urine stream, difficulty urinating, and a feeling of incomplete bladder emptying.
- What age group of men are most often diagnosed with BPH? BPH is most often diagnosed in men over 50 years of age, with the risk of developing the disease increasing with each decade of life.
- How can benign prostatic hyperplasia be diagnosed? For diagnosis, clinical symptoms, laboratory tests (blood test for PSA) and ultrasound diagnostics are used.
- What are the treatments for BPH? Treatment methods can be both conservative (drug therapy) and surgical (TURP, laser therapy).
- Can BPH be prevented? There is no complete prevention of the disease, but a healthy lifestyle, proper nutrition and regular medical examinations can reduce the risk of developing the disease.
Dr. Oleg Korzhikov emphasizes in his recommendations that it is important for men not to ignore symptoms related to urination and to consult a doctor at the first signs. He also advises paying special attention to hormonal balance and lifestyle, including physical activity and healthy eating. An important aspect is regular monitoring of health and establishing communication with the attending physician to choose the optimal treatment strategy.
