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Welcome back! In the last article, we discussed benign prostatic hyperplasia (BPH) and prostate cancer. In this article, we will dive deeper into the disease progression of BPH, how to reduce the risk of BPH disease progression, and the need for BPH-related surgery.
Figure 1: BPH vs normal prostate
Two types of mechanisms cause the main reasons behind BPH symptoms: static and dynamic mechanisms. Both of which are responsible for urinary flow resistance.
Static | Dynamic |
---|---|
Static mechanisms are when the hyperplastic prostatic tissue compresses the urethra causing urinary retention. |
The prostate gland is enriched with alpha-1 receptors. During dynamic mechanisms, all the alpha-1 receptors are activated via the adrenergic nervous system. Increased adrenergic nervous system activity and prostate smooth muscle tone increase resistance to urinary flow at the level of the bladder outlet. |
BPH is a progressive disorder that is not life-threatening but has a negative impact on a patient's life. Disease progression is when clinical symptoms of the disease intensify over time without any medical intervention. The disease progression in BPH includes:
Although BPH is a progressive disease, certain risk factors increase the chances of disease progression in some patients. The main risk factors for BPH progression are age, PSA level, and prostate volume.
Therefore, it is possible to identify a group of patients at higher risk of disease progression and start early preventive treatment for them [2,5].
Irritative symptoms | Obstructive symptoms |
Altered bladder sensations | Hesitancy |
Increased daytime frequency | Intermittency |
Nocturia | Decreased force of the stream |
Urgency incontinence | Splitting or spraying |
In mild cases, the patients' symptoms can be managed without medical intervention. Therefore, lifestyle modifications are highly recommended for these patients. They should reduce water intake at night or before going out and limit the consumption of alcohol and caffeinated beverages, as these can increase the urge to urinate [4].
Medical therapies include medications such as α1-blockers which relax prostate smooth muscles and 5-alpha-reductase inhibitors which reduce prostate size or combination of the two based on clinician's assessment. Furthermore, patients may be recommended surgical options for prostate size reduction or removal of part or in full prostate based on their clinical status. Surgical options are now available as daycare and through minimally invasive approaches [1].
With consequences such as AUR and the need for surgery, it is important to take into account the risk of BPH progression and implement treatment plans to reduce the risk of further disease progression. Hence, physicians must accurately and quickly identify the group of patients at high risk of disease progression and suggest treatment plans accordingly to avoid BPH disease progression among such groups [5]. Age, PSA levels, and prostate volume are the key risk factors for BPH progression.
Medication intervention represents an effective approach to mitigating the need for surgeries and the progression of diseases. Specifically, 5-α-reductase inhibitors have gained recognition for their capacity to improve the bothersome symptoms associated with benign prostatic hyperplasia (BPH), such as LUTS [6].
In conclusion, BPH is a progressive disease and certain patients are at high risk of experiencing disease progression. However, there are medical interventions such as finasteride available which are proven to decrease BPH disease progression when given at an early stage. Therefore, physicians must be able to identify patients with higher chances of progression and start immediate medical treatment to avoid the need for surgery.
List of Abbreviations
Abbreviation | Meaning |
---|---|
BPH | Benign Prostatic Hyperplasia |
AUR | Acute Urine Retention |
PSA | Prostate Specific Antigen |
LUTS | Lower Urinary Tract Symptoms |
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Unnikrishnan R, Almassi N, Fareed K. Benign prostatic hyperplasia: Evaluation and medical management in primary care. Cleve Clin J Med [Internet]. 2017 Jan 1 [cited 2024 Jan 1];84(1):53–64. Available from: https://www.ccjm.org/content/84/1/53
Emberton M, Andriole GL, De La Rosette J, Djavan B, Hoefner K, Vela Navarrete R, et al. Benign prostatic hyperplasia: a progressive disease of aging men. Urology. 2003 Feb 1;61(2):267–73. Available from https://www.goldjournal.net/article/S0090-4295(02)02371-3/abstract
MEDICAL MANAGEMENT OF SYMPTOMATIC BENIGN health technology assessment. [cited 2023 Sep 17]. Available from: https://www.moh.gov.my/moh/resources/auto%20download%20images/587f118ec4d43.pdf
Management of Non-neurogenic Male LUTS - DISEASE MANAGEMENT - Uroweb [Internet]. [cited 2024 Aug 8]. Available from: https://uroweb.org/guidelines/management-of-non-neurogenic-male-luts/chapter/disease-management
Roehrborn CG. Reducing the Risk of Benign Prostatic Hyperplasia Progression. Rev Urol [Internet]. 2002 [cited 2024 Jan 4];4(Suppl 5):S29. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1476011/
Kim EH, Brockman JA, Andriole GL. The use of 5-alpha reductase inhibitors in the treatment of benign prostatic hyperplasia. Asian J Urol [Internet]. 2018 Jan 1 [cited 2024 Jan 4];5(1):28. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5780290/#:~:text=Thus%2C%205%2Dalpha%20reductase%20inhibitors,of%20BPH%E2%80%94finasteride%20and%20dutasteride.
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