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BPH - Symptoms and Treatment

At 50 years of age and over, one man in five will suffer from a prostate related problem. So just what happens at this time of life? Let's take a look.

After about 50, the prostate often begins to enlarge: the cells multiply to form a benign tumor, known as an adenoma. This is normally known simply as BPH, a shortened form of Benign Prostatic Hyperplasia or Benign Prostatic Hypertrophy. BPH develops in the central region of the prostate.

This hypertrophy extends through all three prostatic tissues - glandular (adenoma), fibrous (fibroid), and muscular (myoma) – resulting in what is known as adenofibromyoma. This is in fact similar to uterine fibroids found in women.

BPH is not cancerous and does not become cancerous.

It is nevertheless still possible to find some cancerous cells inside a prostatic adenoma. The two diseases are therefore related, although under no circumstances will adenoma transform into cancer.

In the western, industrialized world, BPH develops in about 10% of men of 30 years old and above, reaching 50% of men between the ages of 50 and 80. On the other hand, BPH is rarely found in Asia.

Causes of BPH

The origins of BPH aren't precisely known. However the involvement of male hormones (androgens) is indisputable, since BPH never arises in men castrated before reaching puberty, and castration can also cause regression of pre-existing BPH. However, although there are several paths of investigation, the precise involvement of androgens is still unknown.

Inside BPH cells are found increased concentrations of dihydrotestosterone (DHT) originating from the transformation of testosterone under the influence of the enzyme 5-alpha-reductase. From a certain age, DHT favorizes increased cellular development, leading to hypertropy of the prostate gland.

Other studies claim female hormones (estrogens) as the cause, but a single hormonal hypothesis on its own can't explain everything.

Growth Factors

Linked to the male androgen hormones, growth factors, called IGF (insulin-like growth factors), also seem to play an important role. They are secreted by certain prostate cells and work particularly on the multiplication, determination and survival of the cells. Several growth factors exist although we still don't know how the come to deregulate men over a certain age.

A Link with Sexual Activity?

Contrary to what one sometimes thinks, there is no link between an enlarged prostate and the frequence of sexual activity. For centuries prostate problems were linked with a dissolute sexual life (just as with venerial disease). These are simply "old wives tales".

The Progress of BPH

BPH begins at the microscopic level, gradually becoming macroscopic and palpable to a rectal examination. The size of BPH increases at a regular pace and can double in volume in about 10 years. But it's important to note that there is no direct link between the size of the prostate and the presence (or intensity) of urinary problems. In other words, just because you have an enlarged prostate, it doesn't follow that you will also suffer with urinary problems.

A large number of BPHs arise without obvious symptoms. It's possible to have a prostate only slightly enlarged, about 20-30g, which causes severe problems. The reverse is also true – a very large prostate of say 300g might cause minimum trouble.

The Onset of Urinary Problems

Urinary problems tend to be variable, with periods of major discomfort and then apparent sudden relief. But in general problems tend to increase as the years pass.

Problems also vary with diet, what you drink, physical activity, and the seasons. Problems tend to be greater during Autumn and Winter.

BPH - Not Really an Illness

Prostatic adenoma arises with age. So long as the prostate, even a large one, remain supple, all that's required is regular surveillance.

Between 50 and 60 years of age, surveying is recommended every two years. Above 60, this is recommended annually. These tests enable the development of the adenoma to be followed and to detect any potential complications early on. They also permit the detection of any prostatic cancer at an early stage.

Such surveillance is recommended for men even with very mild symptoms without any particular impact on their lives. In such cases it is possible to simply live with it, whilst respecting certain simple hygiene rules. This certainly isn't a "treatment", it's simply learning to live in harmony with a few little urinary problems.


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