Benign Pathology of the Prostate

Benign prostatic enlargementis a non-cancerous enlargement of the prostate gland. It is also referred to as Benign Prostatic Hyperplasia (BPH).The prostate is a walnut-sized gland that forms part of the male reproductive system. The gland is made of two lobes, or regions, enclosed by an outer layer of tissue. The prostate is located in front of the rectum and just below the bladder, where urine is stored. The prostate also surrounds the urethra, the canal through which urine passes out of the body. The main role of the prostate is to produce semen, the milky fluid that transports sperm during ejaculation.

Benign prostatic enlargement rarely causes symptoms before age 40, but more than half of men in their sixties and in their seventies and eighties have some symptoms of BPH.

Many symptoms of BPH stem from obstruction of the urethra and gradual loss of bladder function, which results in incomplete emptying of the bladder. The symptoms of BPH vary, but the most common ones involve changes or problems with urination, such as:

• A hesitant, interrupted, weak stream
• Urgency and leaking or dribbling
• More frequent urination, especially at night

You may first notice symptoms of BPH yourself, or your doctor may find that your prostate is enlarged during a routine check-up. Some tests your doctor may order can include the following:

• Digital Rectal Examination (DRE)
  In this examination the doctor inserts a gloved finger into the rectum and feels the part of the prostate next to the rectum. This examination gives the doctor a general idea of the size and condition of the gland.
• Prostate-Specific Antigen (PSA) Blood Test
  To rule out cancer as a cause of urinary symptoms, your doctor may recommend a PSA blood test. PSA, a protein produced by prostate cells, is frequently present at elevated levels in the blood of men who have prostate cancer.
• Rectal Ultrasound and Prostate Biopsy
  In this procedure, a probe inserted in the rectum directs sound waves at the prostate. The echo patterns of the sound waves form an image of the prostate gland on a display screen. To determine whether an abnormal-looking area is indeed a tumour, the doctor can use the probe and the ultrasound images to guide a biopsy needle to the suspected tumour. The needle collects a few pieces of prostate tissue for examination with a microscope.
• Urine Flow Study
  Your doctor may ask you to urinate into a special device that measures how quickly the urine is flowing. A reduced flow often suggests BPH.
• Cystoscopy
  In this examination, the doctor inserts a small tube through the opening of the urethra in the penis. This test allows the doctor to determine the size of the gland and identify the location and degree of the obstruction.

Treatment

Conservative treatment measures to treat BPH are always considered first before invasive measures such as surgery. Medications are the most common treatment method for controlling symptoms of BPH. There are a number of medications approved for the treatment of BPH symptoms. Some prevent growth of the prostate while others actually shrink the prostate gland. Other drugs may be prescribed to improve urine flow and reduce bladder outlet obstruction. Your doctor will discuss the various drugs available to treat your particular situation.

Nonsurgical Treatment Measures are minimally invasive treatments to reduce the size of the prostate gland and enlarge the urethra to make voiding easier.

Many doctors recommend removal of the enlarged part of the prostate as the best long-term solution for patients with severe BPH. With surgery for BPH, only the enlarged tissue that is pressing against the urethra is removed; the rest of the inside tissue and the outside capsule are left intact. Surgery usually relieves the obstruction and incomplete bladder emptying caused by BPH.

The most common surgery performed for BPH is Transurethral Resection of the Prostate or TURP surgery. With TURP, an instrument called a resectoscope is inserted through the penis so there are no incisions made in the skin. Transurethral procedures are less traumatic than “open” surgeries that require a long abdominal incision. The main side effect of TURP is retrograde, or backward, ejaculation. In this condition, semen flows backward into the bladder during climax instead of out the urethra causing infertility. If you plan on having children, you need to discuss alternative options with your surgeon.