A common, noncancerous tumor called benign prostatic hyperplasia (BPH) is characterized by uncontrolled growth in the deep, mucosal glands in the prostate and by proliferation of some of the nearby stroma cells. About 50% of men at age 50 and 80% of men at age 70 develop BPH.
Enlargement of the prostate and contraction of its smooth musculature constrict the prostatic urethra, making micturition difficult. BPH can lead to urinary retention, continual dribbling of urine, urinary tract infections, and the formation of kidney stones.
Diagnosis of BPH begins with inquiries about the patient’s urinary symptoms—whether he is hesitant to urinate, has a weak stream, must strain to urinate, feels that his bladder does not empty fully, has increased urinary frequency and urgency, and must urinate often at night.
Next, to determine whether the prostate is enlarged, the physician performs a digital rectal exam; a finger inserted into the anal canal can feel the prostate because it lies just anterior to the rectum (as shown in Figure 1).
FIGURE 1 Reproductive organs of the male, sagittal view. A portion of the pubis is shown in three-dimensional view to illustrate the position of the ductus deferens as it enters the pelvic cavity.
The physician may also order a blood test to check the levels of PSA (which are only mildly elevated in BPH; generally less so than in prostate cancer).
Treatment for BPH begins with drugs that inhibit the production or action of testosterone, which the tumor cells depend on, or drugs that relax the prostate’s smooth muscle. If such treatment does not increase ease of urination, the prostate is either removed in a surgical procedure called transurethral prostatectomy or destroyed by heat from a microwave device or an electrode inserted into the urethra.