Benign prostatic hyperplasia (BPH), is the term for an enlarged prostate gland.

The prostate is a walnut sized gland located beneath the bladder sitting in front of the rectum in men. It is made up of two types of tissue, epithelial cells that form glands interspersed with smooth muscle cells. Surrounding this is a fibrous tissue layer called the prostatic capsule. The urethra (tube that transports urine and semen out the body) passes from the base of the bladder through the prostate to the tip of the penis. The exact role the prostate plays in human physiology is not entirely known, however, it certainly plays a major part in sexual function and fertility.

Approximately 25 to 30% of the volume of the semen comes from the prostate, 60 to 65% of the fluid from the seminal vesicle (two organs attached to the prostate) and very small portion from the testicles (where the sperm is produced). The prostate also secretes many enzymes, one of which is called prostate specific antigen, or PSA. Also secreted in high concentrations is zinc.

Causes of BPH
Benign prostatic hyperplasia is probably a normal part of the aging process in men. It is caused by changes in hormone balance and cell growth. It is difficult to determine the exact incidence and prevalence of BPH because research groups often use different criteria to define the condition. According to the National Institutes of Health, benign prostatic hyperplasia affects more than 50% of men over the age of 60 and as many as 90% of men over the age of 70. Dr. Scott Kahn specializes in diagnosis and treatment of BPH. He sees patients in the Poughkeepsie, Rhinebeck, and Fishkill locations.

How does BPH occur?
The prostate enlarges by the hyperplasic growth of the prostatic smooth muscle and epithelial cells that surround the urethra. The growth of these cells forms discreet nodules that surround the urethra. As these nodules continue to enlarge, the urethra becomes compressed and squeezed resulting in inhibited urine flow. Why some men develop BPH and others don't is not clear. Prostate growth begins at approximately age 30 and continues thereafter. By age 50, 50% of men have microscopic evidence of BPH and 75% show signs by age 80. About 50% of these patients develop the clinical symptoms of BPH.

Symptoms of BPH
As BPH progresses men begin to experience a hesitant, slow urine stream, straining to void, frequent urination, sensation of incomplete bladder emptying, overactive bladder symptoms (urgency, frequency, urgency incontinence) and nocturia (getting up to urinate). If the disease goes untreated, the patient can develop complications such recurrent gross blood in the urine, recurrent urinary infections, bladder stones, kidney failure and urinary retention (the inability to pass urine).

Although some of the signs of BPH and prostate cancer are the same, having BPH does not seem to increase the chances of developing prostate cancer. The National Cancer Institute and the American Cancer Society recommend that all men over the age 50 have their serum PSA tested once a year to screen for prostate cancer. A man who has BPH may also have undetected prostate cancer at the same time, or may develop prostate cancer in the future. As a general rule, patients with an elevated PSA, prostate cancer should be ruled out before initiating treatment for BPH.