Benign prostatic hyperplasia is the most common pathology of the genitourinary system in men after age 50, manifesting as urination disorders. Below — the definition, the mechanism of age-related gland enlargement, symptoms, the difference from prostate cancer, examinations, and signs that should not be ignored.
1. Definition: the prostate and benign hyperplasia
The prostate gland (prostate) is a small gland below the bladder. It produces fluid for semen and controls the flow of urine from the bladder into the urethra. An enlarged gland presses on the urethra, which explains urination disorders.
Benign prostatic hyperplasia (BPH, prostate adenoma) is the growth of glandular tissue around the urethra. The growth takes the form of one or several nodules: they gradually enlarge, compress the channel, and make urination difficult.
2. Why the gland enlarges with age
The leading factor is age-related changes in hormonal regulation. A decrease in testosterone production and its increased conversion to dihydrotestosterone under the action of 5-alpha-reductase leads to accumulation of the more active hormone in the prostate and stimulation of epithelial cell growth. At the same time, aromatase activity in stromal cells increases, which stimulates stromal growth.
The modern theory adds an imbalance of growth factors: a predominance of epidermal and keratinocyte factors and fibroblast growth factor-2 over transforming growth factor β, which suppresses prostate cell growth. The risk is increased by cases of BPH in the family and inflammatory diseases of the prostate. Sexual activity does not affect the frequency of hyperplasia.
| Age | Frequency |
|---|---|
| 40–49 years | 11.3 % |
| from 50 years | 25 % |
| 60–70 years | 50 % |
| 90 years | about 90 % |
In Ukraine in 2013, the prevalence of BPH was 1132.9 per 100 thousand adult male population; among men aged 50–60 the pathology was detected in approximately 20 %, 60–70 years — in 75 %, 90 years — in 88 % of cases.
3. Symptoms of impaired urination
The main group of signs is urination disorders. They develop gradually and may intensify with age.
- difficulty starting urination, the need to strain;
- weak urine stream, interruption, longer bladder emptying;
- a feeling of incomplete bladder emptying;
- urine dribbling after finishing urination;
- frequent or urgent urges, including at night.
The mechanism is twofold: the nodules compress the urethra, and activation of alpha-adrenoreceptors of the bladder neck and changes in the detrusor add irritation symptoms.
4. How BPH differs from prostate cancer
These are different processes: benign growth of glandular and stromal tissue without metastasis, and malignant growth. According to available data, an enlarged prostate is not caused by prostate cancer and does not increase the risk of its occurrence.
The practical conclusion is different: similar urination disorders are sometimes caused by more serious conditions, in particular prostate cancer. Therefore such symptoms require examination rather than observation — early detection makes treatment simpler.
5. Diagnosis: examination, PSA, ultrasound
The first stage is asking about the frequency of urination and its characteristics, examination of the abdomen and penis, and a digital rectal examination to assess the size of the prostate. The patient may be asked to keep records for at least 3 days of the amount of fluid drunk and the frequency and volume of urination.
The laboratory minimum is a urine sample test and a blood test for PSA. If needed, the doctor refers to a specialist at a hospital for uroflowmetry (urination into a device that measures the flow), bladder ultrasound, or cystoscopy — examination of the bladder with a camera. Treatment is not always needed: the doctor determines the scope and appropriateness of interventions after examination.
6. When to see a doctor
Routinely to a family doctor or urologist — if there is difficulty urinating or more frequent urges.
Do not wait for a scheduled appointment: blood in the urine (pink, red, or brown), pain during urination, inability to urinate — an urgent consultation with a doctor is needed.
Call 103 or 112 if the condition is life-threatening: confusion, severe drowsiness, inability to speak, suspected stroke or heart attack. Complete urinary retention with severe pain or worsening of the condition is also a reason for an emergency call.
The material is for reference and does not replace consultation with a doctor.
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This content is for reference and does not replace a doctor's consultation. Medical disclaimer