Benign Prostatic Hyperplasia: Diagnosis and Treatment

Diagnosis

A DRE will typically detect prostate enlargement. The surface of the prostate should be smooth and is usually symmetrical; induration suggests malignancy. Prostate biopsy, ultrasound, and/or the prostate-specific antigen (PSA) blood test help rule out malignancy and confirm a diagnosis of BPH. Other tests are available to evaluate bladder and urethral function.

Treatment

The purpose of BPH treatment is to improve the patient's quality of life.

Observation alone ("watchful waiting") is appropriate if symptoms are mild.

Medical treatment includes use of alpha-adrenergic antagonists, such as, prazosin, terazosin, doxazosin, tamsulosin, and alfuzosin, which relax smooth muscle. Tamsulosin and alfuzosin cause fewer adverse side effects than other medications.⁶ When moderate or greater prostate enlargement exists, administration of 5-alpha-reductase inhibitors, such as finasteride, blocks the conversion of testosterone to dihydrotestosterone. A combination of an alpha-adrenergic antagonist and finasteride appears to improve long-term outcomes.⁷

Plant extracts from saw palmetto (Serenoa repens), the American dwarf palm, and Pygeum africanum (an African plum tree) have shown efficacy in treating symptoms, although their mechanism(s) of action is not yet clear.^8,9

Surgical options for severe symptoms include transurethral resection of the prostate (TURP), transurethral incision of the prostate, "open" prostatectomy, laser photoselective vaporization, interstitial laser therapy, microwave therapy, radiofrequency therapy, and intraurethral stenting, among others.