Wednesday, October 8, 2008

Prostate Enlargement (Benign Prostatic Hyperplasia)

About the prostate gland

The prostate lies below the bladder, the sac that stores the urine in the body,and surrounds part of the urethra, the 'tube' through which the urine passes from the bladder to the outside world.
The prostate is one of three glands necessary for reproduction. The fluid it produces provides about 15 percent of the total volume of the semen.
The exact function of the fluid produced by the prostate remains largely unknown, although it is believed to promote the survival of sperm cells by reducing the acidity within the vagina.

The prostate gland consists of about 50 small glandular lobes, which are drained by smaller branched tubes and ducts. The ducts empty into the part of the urethra that passes through the prostate gland.
The prostate gland is surrounded by a lining called the capsule

What Is Benign Prostatic Hyperplasia?

Benign prostatic hyperplasia (BPH) stands for benign prostatic hyperplasia which means a noncancerous enlargement of the prostate gland.
"Benign" refers to the fact that the growth is noncancerous.
The term "prostatic" refers to the prostate gland.

"Hyperplasia" describes a condition in which the number of cells in an organ increases, leading to an overall increase in size of the prostate.

The prostate gland is an acorn-shaped gland located in a man's pelvic region. It lies below the bladder, the sac that stores the urine, in the body, and surrounds part of the urethra, the "tube" through which the urine passes from the bladder to the outside world.

An enlarged prostate gland is a common condition, affecting the lifestyles and, to some degree, the health of many men over the age of 60. It can play havoc on a man's ability to urinate with ease and, in some cases, can lead to serious medical complications.
However, the condition is not cancerous. And there are many methods to improve the flow of urine if it does become obstructed by an enlarging prostate.

Enlargement in the size of the prostate:
Is the result of an increase in the number of cells in the prostate gland
May occur at different locations within the prostate and give rise to different prostate shapes

How Common Is BPH?
The prostate gland normally increases in size as men age. This does not usually create a urinary flow problem for men under 40 years of age.
After age 40, however, the prevalence of BPH rises sharply.
The incidence of BPH is at least 50 percent for all men at the age of 50.
The incidence of BPH rises to at least 80 percent of all men in their eighth decade of life. However, only about 25 percent of men will actually be treated for BPH by the age of 80.
Only about 50 percent of men with an enlarged prostate gland have a condition in which there is some degree of obstruction of the bladder outlet.

What Causes The Prostate To Enlarge?
Growth in the size of the prostate gland is related to:
Normal Prostate Growth During Life
The first growth phase is completed before or at birth, when the average prostate weighs about 1.5 grams.
The second growth phase occurs early during puberty, when the weight of the prostate gland increases to around 11 grams.
The third growth phase occurs during the mid-20s, when the weight of the prostate gland increases to approximately 18 grams.
There is another apparent growth phase that begins when a man is in his 50s.
By the time a man is in his 70s, the prostate gland has reached a maximum weight of 31 grams.

Therefore, throughout a man's lifetime, the prostate gland normally increases in weight about 21 times, compared to its birth weight.
Although the prostate gland grows during much of a man's life, urinary flow problems usually appear only after the age of 50 as a consequence of the final growth phase.

Sex Hormone Changes That Occur With Aging

There is some evidence to suggest that this relative increase in circulating estrogen may strengthen the effect of the testosterone derivative DHT, which promotes cell growth in the prostate gland and is formed when testosterone is acted upon by a specific enzyme. As a consequence of estrogen and DHT acting together, cell growth and glandular enlargement are promoted.

What Are The Symptoms?
Although symptoms of an enlarged prostate gland may vary among individuals, the most common ones involve problems with passing urine.
A stream of urine that is hesitant before starting, weak in force, or intermittently interrupted while flowing can indicate an enlarged prostate gland. Dribbling, with one drop or less a second, may persist for 10 to 20 seconds or more at the end of urination.

There may be an urgency to urinate, or urine may leak at an inappropriate time. Some men feel as if their bladder, is not completely empty; other may feel a sudden, urgent need to urinate.
Increased number of urinations, which is especially apparent at night and cause two or more nightly trips to the bathroom. This symptom results in interrupted and inadequate sleep.

About 80 percent of the time, these symptoms are caused by BPH, but they can also be the result of other conditions, such as prostate cancer that should be carefully diagnosed by a urologist.
The size of the prostate gland does not always correlate with the degree of urinary obstruction. Smaller prostate glands may cause more obstruction to the flow of urine than much larger ones.

How Severe Are Your Symptoms?
With the use of the following "symptom index" developed by the American Urological Association (AUA), a distinction can be made between symptoms.
To take the test, record the most appropriate number in each row or line.
Add the sum of the seven numbers you recorded. The ratings are as follows:
Mild (0-7 points)
Moderate (8-19 points)
Severe (20-35 points).
This symptom index can be used during the initial diagnosis and as a record of improvement following treatment.

Blood Tests
Generally, the urologist will test your blood to assess kidney function and the level of prostate specific antigen (PSA).
PSA is a protein present in the normal prostate gland, as well as in enlarged prostates (BPH) or those in any stage of prostate cancer. A high PSA in the blood serves as a chemical marker for BPH as well as prostate cancer.
If your PSA is elevated, your urologist may recommend a transrectal ultrasound examination and a biopsy to distinguish between the two possibilities of prostate enlargement and prostate cancer

Digital Rectal Exam (DRE)
After putting on a lubricated glove, the physician gently inserts a finger through the anus into the rectum and assesses the size and hardness of the prostate gland. This exam is done when prostate enlargement is suspected or as part of an annual physical examination.

Urinary Flow Rate Study
This technique, which is used to detect an obstruction of the urethra, and bladder neck, is widely used in the diagnosis of BPH. In the simplest form of this study, a recording is made of the flow rate during urination, into a special device.
However, while a urinary flow rate study can indicate an obstruction, it cannot provide a definitive diagnosis of BPH. Many other variables affect flow, including a weak bladder, contraction.

Intravenous Pyelography (IVP)
This test is performed only in cases complicated by a finding such as blood in the urine, Following intravenous injection of a dye, an x-ray of the urinary tract is made. Because the presence of the dye makes the urine visible on x-ray, the point of obstruction or narrowing of the urinary tract can be identified.

An instrument called a cystoscope is inserted through the urethral opening of the penis and visually guided through the urethra to the bladder. This test can be performed in the doctor's office, using a local anesthetic. During cystoscopy, an assessment is made of the size of the prostate gland, the degree of urinary tract obstruction, and its precise location.

What Are The Treatment Options?
The effectiveness of the various treatments for BPH is determined by:
1. How well the urine flow has improved
2. A reduction in the number of times or the need to pass urine

In general, the results from
surgical treatments have been significantly better than those from medical treatments.
Your doctor can help you determine which treatment option is best for you.

Medical Treatments
Medical treatments for BPH include:
Watchful waiting. This simply involves careful monitoring, rather than active treatment. This method is elected by most people who have mild to moderate symptoms.

Because up to one-third of all mild cases clear up spontaneously, the strategy of watchful waiting is a prudent course for many individuals. Over 40 percent of men with mild to moderate symptoms have experienced improvement with this method of management.

Alpha blocker. DOXAZOSIN – Cardura, ORAL 1 mg given once daily in the a.m. or p.m.

Benign Prostatic Hyperplasia

DOXAZOSIN – Cardura, ORAL, 1-8 mg once daily
. The initial dosage of CARDURA is 1 mg, given once daily in the a.m. or p.m. Depending on the individual patient's urodynamics and BPH symptomatology, dosage may then be increased to 2 mg and thereafter to 4 mg and 8 mg once daily, the maximum recommended dose for BPH. The recommended titration interval is 1-2 weeks. Blood pressure should be evaluated routinely in these patients.
These are drugs that can inhibit the contraction of the smooth muscle of the prostate gland, and bladder neck, and, in this way, improve the urinary flow rate. About 75 percent of individuals who choose alpha blocker therapy have experienced an improvement in the symptoms of BPH, particularly relief from the symptoms of urinary frequency and urgency

Finasteride (Proscar®), 5 mg tab / once daily.

This drug inhibits production of DHT, the hormone that is thought to cause prostate enlargement, by inhibiting the enzyme 5-alpha reductase. As a result of this, the prostate gland shrinks in size, alleviating the symptoms of BPH.
It can take six months to experience the full effects of this drug. About two-thirds of individuals who choose finasteride therapy will experience an improvement in the symptoms of BPH. On average, the size of their prostates shrunk about 30 percent.
Sometimes, finasteride is used in conjunction with an alpha blocker.

Herbal treatment for enlarged Prostate.

A great combination for prostate issues with:

Gotu kola, or Pagaga eat raw or as juice
Lycopene, Tomato Paste any time with any food
Pumpkin seeds freely use
Saw palmetto
Stinging nettle tablets or cap
Wild yam root juice 2 tab /day
Zinc tab 25 mg /day