What is the prostate?
The prostate is a small gland, roughly the size of a walnut, located in the pelvis of men. It is situated below the bladder and surrounds the first part of the male urethra. The role of the prostate is to produce a fluid that is ejaculated in the semen which assists in fertility.
The prostate normally increases in size with age, and the growth is dependent on testosterone which is produced by the testicles. Greater than 50% of men aged over sixty-five years will have lower urinary tract symptoms (LUTS), but not all of these are caused by benign prostatic hyperplasia. Other causes of LUTS include bladder overactivity, prostatitis and pelvic floor dysfunction. Not all men who have benign prostatic hyperplasia will have bothersome voiding symptoms, and sometimes men with normal sized prostates can have LUTS. It is important to diagnose the cause of LUTS, as the treatment for each cause is different.
Benign Prostatic Hyperplasia
This is a condition caused by enlargement of the central part of the prostate, which compresses the urethra and causes obstruction to the flow of urine. BPH is a different condition to prostate cancer, and does not turn into prostate cancer. Men who present with voiding difficulties are more likely to have BPH than prostate cancer.
The common symptoms suggestive of BPH include obstructive/voiding symptoms (ie: hesitancy/straining, weak stream, intermittency, feelings of incomplete bladder emptying and post micturition dribbling) and irritative/storage symptoms (ie: frequency, urgency and nocturia). The diagnosis of BPH is often made following a history, physical examination and basic investigations arranged by a General Practitioner or Urologist. A physical examination should include a digital rectal examination to assess the size and consistency of the prostate. A urine test should be done to exclude infection and haematuria (blood in the urine). Other investigations which may help in the work up of BPH include a PSA blood test (if there are concerns about prostate cancer), a voiding diary, uroflowometry and a renal tract ultrasound.