Benign Prostatic Hyperplasia

Benign Prostatic Hyperplasia (BHP) is incredibly common. My pathology textbook says that BHP is found in:

• 20% of 40-year-old men
• 60% of 60-year-old men
• 90% of 70-year-old men

Consider those rates of incidence carefully. How old are you? How old is your father? What are the odds that someone you know has BHP?

Accordingly, when was the last time that you heard anything about BHP? If you’re anything like me before I came to medical school, you may have never heard of it. Subjectively then, it’s easy to appreciate that men’s health issues are under-discussed, and need more attention.

BHP is non-cancerous enlargement of the prostate gland. Compare the pictures below:

The left shows a normal prostate. The right is a prostate with BHP. If you recall the normal prostate anatomy that was discussed in an earlier post, you’ll remember that the urethra travels directly through the prostate gland, carrying urine from the bladder to the exterior. When the prostate becomes enlarged in BHP, the urethra can become compressed and narrowed.

The symptoms of BHP are exactly what you might expect for a narrowed urethra: difficulty voiding, slow stream, frequency of voiding, nocturia (needing to wake up in the night to void), and urgency. There can also be an increased risk for bladder infections.

BHP is treated in a few different ways, depending on the severity:

• Lifestyle changes: reducing fluid intake (particularly before bedtime), developing a voiding schedule, and avoiding diuretics like coffee and alcohol.
• Medication: some drugs can relax the smooth muscle of the bladder and urethra for some relief of symptoms
• Surgery: removal of the prostate and reconstruction of the urethra will permanently relieve BHP. But it comes at a cost: the vas deferens joins with the urethra in the prostate, and so men undergoing this surgery will be rendered infertile.

There’s good evidence to suggest that BHP is induced by androgens (male hormones) like testosterone. Androgens bind to receptors in the prostate gland, signalling it to grow and expand. It’s a signalling/response process that takes a long time, hence why the incidence of BHP increases with age, and why most men will get BHP if they live long enough.