ERECTILE DYSFUNCTION - Andrology Australia

28 Pages·2014·1.29 MB·English

Prostate
Enlargement
Contents
At A Glance 04
The Prostate 06
Prostate Enlargement – BPH 10
Symptoms 12
– DATE REVIEWED: DECEMBER 2017 (5TH EDITION)
© Healthy Male (Andrology Australia) 2004
Causes and Prevention 16
Health information in this booklet describes PROSTATE
Diagnosis 17
ENLARGEMENT. Diagnosis and treatment options are
described to help men and their families understand the health
problem, make men aware of the available treatment options,
and to help make talking with their doctor easier. Treatment 22
The information contained in this booklet is based on up-to-
date medical evidence. It has been provided for educational
Lifestyle and Relationships 40
purposes only. It is not intended to take the place of a clinical
diagnosis or medical advice from a fully qualified health
professional. Healthy Male urges readers to seek the services
of a qualified health professional for any personal health Support 42
concerns.
Although the information in this booklet has been carefully
Glossary 44
reviewed, Healthy Male does not take any responsibility for
any person using the information or advice available in this
booklet. Information is given on the understanding that users
take responsibility for checking the relevance and accuracy of Expert Reviewer 47
the information.
Healthy Male is supported by funding from the Australian
Government Department of Health and is administered by
Monash University.
At A Glance
or other symptoms described as You should talk with your doctor
‘irritative’. Obstructive symptoms and think carefully about the
include a delay or straining when risks and benefits before making
starting to urinate, and slow or a decision, jointly with the doctor,
dribbling flow of urine. Irritative about whether to have treatment,
symptoms include urgent or or the type of treatment.
frequent urination during the day
What is prostate enlargement
and night. BPH may also cause
other symptoms. Can I do anything to prevent
(benign prostatic hyperplasia or BPH)?
BPH?
BPH is a benign (non-cancerous) enlargement or growth How is BPH diagnosed? As there are no known causes
of BPH there are no known ways
of the prostate gland. As the prostate surrounds the top If you have urinary symptoms, a to prevent it. However, lifestyle
part of the urethra, enlargement of the prostate makes doctor may do a number of things changes may help to stop the
to find the cause, including: taking symptoms of BPH getting worse
the urethra narrower and puts pressure on the base of the a medical history and description of and may even help to improve
bladder. Narrowing of the urethra can affect the passing symptoms, a physical examination, symptoms.
blood or urine tests, and sometimes
of urine in a number of ways. BPH is not usually life-
biopsy or ultrasound. These tests
threatening but symptoms can have a major effect on are used to find out the type of
prostate disease (to check if it is
quality of life.
BPH, prostate cancer or prostatitis).
BPH is more likely to be the cause
of urinary problems than prostate
cancer.
How common is BPH? What are the symptoms
of BPH?
BPH is the most common prostate
How is BPH treated?
disease. BPH usually starts after A number of men with BPH do not
the age of 40 years and is more have many or any symptoms. If you have LUTS linked with
common in older men; it affects The men who do have BPH BPH, when deciding on the best
nearly all men at some time in symptoms usually notice changes treatment it’s important to think
their lives. Some men do not have to their urination because BPH about how much the symptoms
any symptoms even though their affects the part of the prostate that are bothersome or affect your
prostate has grown larger. BPH surrounds the top part of the urethra. quality of life. In some cases of BPH,
usually becomes more of a problem when the symptoms are mild, no
over time, with symptoms getting LUTS (lower urinary tract treatment may be the best option.
worse if they are not treated. symptoms) is a common term Oral medicines (tablets) can help
used to describe a range of urinary men with moderate symptoms.
symptoms. LUTS linked to BPH Surgery is an option for men whose
include a group of symptoms BPH symptoms are severe and have
described as ‘obstructive’ and/ a major negative effect on their
quality of life.
04 05
1
6
7
2 8 12
11
The Prostate 3
9
1 9
9 6
1
46
7 10
2 8 12 7
2 8 12 5
11
What is the prostate? 33 11 1 Bladder
2 Vas deferens
The prostate is a small but important gland (organ) 99 3 Urethra
in the male reproductive system. The main role of 44 1100 4 Penis
the prostate is to make fluid that protects and 5 5 Scrotum
gives nutrients to sperm. The prostate makes about Bladder 5
6 Seminal Vesicle
ofrnoem t hthired poef ntihse a flt uoirdg tahsamt i(ss eexjaucaul lcalitmeda x(r)e.leased) BPrlaodstdaePEtrirjcao cgsutlaalanttidcos rgyl adnudcsts 21 231BVBVUalaalrsaeds dtd ddhdeeereafrfreerreennss 87 RPreocsttuamte gland
The prostate is made up of a number of small EjaculaUtroertyh draucts 3 4UPreentihsra 9 Epididymis
glands surrounded by supporting tissue called the UrethrEaxternal sphincter muscle 4 5PeScnriostum 10 Testicle
stroma (the tissue or supporting framework of an E(pxetlevrinc(Sa pfllt eorsolopvmrhi ciman fl cu(oitsneoctrrle e mmrss)uupsseccrlsleee sd) 5 67SRSceercomttiunumaml Vesicle 11 Cowper’s gland
organ). The small glands in the prostate make the Stromab e(itnwteeresnp eprrsoesdta tic glands) 6 8SPermositnaatel Vgleasnidcle 12 Ejaculatory duct
fluid. The prostate is surrounded by pelvic floor betweePnr opsrtoasttiact dicu gcltands) 7 9REepcitduidmymis
muscles, which contract during ejaculation to ProstaItnicte druncatl sphincter 810PrToessttiacltee gland
help move the fluid into the urethra. Inte9rnaDl estprhuisnocrt emruscle 91121EpCEjioadwciudpleyarmt’so rigysla dnudct
9 Detrusor muscle 10 Testicle
Where is the prostate? Cross-section of the prostate gland T1h1eC mowalpee rr’es pgrlaondductive system
12 Ejaculatory duct
The male reproductive system is made up of
many organs, glands and ducts (tubes). Some of muscles support the bladder and the bowel and
these are on the outside of the body, such as the surround the urinary tract and rectum (back
penis and the testicles inside the scrotum sac. passage).
Other organs and tubes are internal, including the
The prostate is located near the rectum. Growth
epididymis, vas deferens, seminal vesicles and the
of the prostate can be checked by a digital
prostate gland.
rectal examination (DRE) where a doctor places
In young men the prostate is about the size of a a gloved finger into the rectum to check the size,
walnut, but it gets bigger with age. The prostate sits shape and feel of the prostate.
underneath the bladder, and surrounds the top part
of the urethra. Urine passes through the urethra on What does the prostate do?
its way from the bladder to the penis.
The prostate gland makes fluid that forms a
The prostate rests on the pelvic floor muscles major part of semen (mixture of sperm and fluid).
that stretch from one side of the pelvis to the The fluid from the prostate helps the sperm flow
other, and run from the tailbone at the back to along the ducts (tubes) of the male reproductive
the pelvic bone at the front. The pelvic floor system.
06 07
The Prostate
Childhood Puberty
1-10 years 11-20 years
1.4g 10.8g
The pelvic floor Sperm are made in the testes and then pass
muscles help to stop along the highly coiled epididymis, through the
urine leaking from vas deferens to the prostate. The prostate gland Adult Later Life
the bladder and other glands (the seminal vesicles and 21-50 years 71-80 years
Cowper’s gland) make the fluid that mixes with
18.1g 30.9g
the sperm. Semen then travels along the urethra
to the tip of the penis where it is ejaculated
(released) at orgasm.
To stop semen flowing backwards into the
bladder during ejaculation, an internal sphincter
(muscle) at the base of the bladder and the top
Weight of the prostate at different ages
of the prostate closes. An external sphincter (a
pelvic floor muscle) at the end of the prostate
relaxes to release the fluid from the prostate into
the urethra. What is prostate disease?
Prostate disease is any medical problem that
affects the prostate gland. Common prostate
How does the prostate gland change
problems include:
with age?
The male sex hormone testosterone makes the • benign prostatic hyperplasia or hypertrophy
prostate grow in size. As men get older, the prostate (BPH): a benign (non-cancerous) enlargement
grows larger. At puberty, testosterone levels in boys of the prostate gland
start to increase and the prostate grows to about
• prostatitis: inflammation of the prostate
eight times its size. It continues to grow, doubling
gland, sometimes because of infection
in size between the ages of 21 and 50 years, and
almost doubles again in size between the ages
• prostate cancer: a problem where cells within
of 50 and 80 years. The reasons for this ongoing
the prostate grow and divide abnormally so
growth are not fully understood.
that a tumour forms.
Most of the growth of the prostate happens in the
Only prostate cancer and the uncommon condition
central part of the prostate. There is an increase
acute bacterial prostatitis can be life-threatening.
in both the number of the smaller glands in the
However, both inflammation and enlargement of
prostate, and the stroma.
the prostate can be very painful and have a major
effect on quality of life.
08 09
NORMAL
Normal BHP
NORMAL
Prostate Enlargement-BPH
BPH
BPH is a benign What is BPH?
(non-cancerous) Bladder
BPH refers to benign prostatic hyperplasia
enlargement or
(increase in the number of cells) or hypertrophy Prostate gland
growth of the
(increase in the size of cells).
prostate gland NORMAL BPH Urethra
BPH is a benign (non-cancerous) enlargement
or growth of the prostate gland. As the
prostate surrounds the top part of the urethra,
enlargement of the prostate makes the urethra Cross-section of a healthy prostate gland compared to a prostate with BPH
narrower and puts pressure on the base of the Bladder
bladder. Narrowing of the urethra can affect the
passing of urine in a number of ways. What is the diffePrreonsctea tbee gtwlaenedn BPH is not usually
hyperplasia and Uhryeptehrrtarophy? life-threatening but
BPH is not usually life-threatening but symptoms symptoms can have
can have a major effect on quality of life. Hyperplasia is an increase in the number of a major effect on
cells; hypertrophy is an increase in the size of quality of life
cells. Both terms are used to describe BPH but
BPH
How common is BPH? hyperplasia is more often used.
BPH is the most common prostate disease. BPH
usually starts after the age of 40 years and is
more common in older men; it affects nearly all
men at some time in their lives. Some men do not Bladder
have any symptoms even though their prostate
has grown larger. BPH usually becomes more of a Prostate gland
problem over time, with symptoms getting worse
Urethra
if they are not treated.
In an Australian study, one in seven men aged
over 40 years reported a diagnosis of prostate
disease. About two out of three men over the age
of 40 with prostate disease have treatment.
10 11
Symptoms
SYMPTOMS OF BPH
Lower urinary - Hesitancy – a longer than usual wait for the stream of
tract symptoms – urine to begin
obstructive or voiding - Weak and poorly directed stream of urine
symptoms
- Straining to urinate
What are the symptoms of BPH?
- Dribbling after urination has finished or an irregular
A number of men with BPH may not have many stream
or any symptoms. The men who do have BPH - Urinary retention – not all the urine is passed from the
symptoms usually notice changes to their bladder causing a need to urinate more often
urination because BPH affects the part of the - Overflow or paradoxical incontinence – urine overflows
prostate that surrounds the top part of the from a full bladder uncontrollably even though normal
urethra. urination cannot be started
LUTS (lower urinary tract symptoms) is a Lower urinary tract - Urgency – an urgent feeling of needing to urinate
common term used to describe a range of urinary symptoms –irritative - Frequency – a short time between needing to urinate
or storage symptoms
symptoms. LUTS linked to BPH include a group of - Nocturia – a need to pass urine two or more times during
symptoms described as ‘obstructive’ and/or other the night
symptoms described as ‘irritative’.
Other symptoms - Perineal pain – pain in the perineum (the area between
BPH may also cause other symptoms. (see Table: the scrotum and the anus)
Symptoms of BPH)
- Dysuria – painful urination
- Haematuria – blood in the urine
12 13
Symptoms
When should I see a doctor if I have It is important to
urinary problems? talk to your doctor
about any urinary
See a doctor if you notice any changes to symptoms so they
urination, particularly if the symptoms are can investigate the
affecting your quality of life or interfering with problem, discuss the
What are lower urinary tract symptoms normal daily activities. possibility of prostate
disease or prostate
(LUTS)? Many people think that urinary symptoms in men
cancer, and make a
are a sign of prostate cancer. This is not true.
LUTS (lower urinary tract symptoms) is a term correct diagnosis
Prostate cancer may sometimes be present with
used to describe a range of symptoms related
urinary symptoms but most often the symptoms
to problems of the lower urinary tract in men
are caused by BPH or other problems.
and women. LUTS in men can have many causes
and one of the common causes is BPH. Other If needed, the doctor may refer you to a urologist
causes include changes in the bladder or urinary (specialist doctor). A urologist specialises in
tract, some medicines, infection, an irritable or diseases of the urinary tract in men and women,
overactive bladder and neurological disease. and the genital organs in men.
LUTS are broadly grouped into voiding
(obstructive) symptoms or storage (irritative)
symptoms (see Table: Symptoms of BPH). A
man may have mainly voiding symptoms, mainly
storage symptoms, or a combination of both.
LUTS can be described as mild, moderate or
severe, depending on how much the symptoms
affect a man’s quality of life, that is how
‘bothersome’ the symptoms are. Other issues not
directly related to the urinary problems may make
the symptoms more bothersome. For example,
restricted physical movement because of age or
other health problems can make it more difficult
to get to the toilet in time.
14 15
Causes and Prevention Diagnosis
The causes of What causes BPH? How is BPH diagnosed? Urination problems
BPH are not are not a usual
The causes of BPH are not well understood. Some If you have urinary symptoms, a doctor may do a
well understood. symptom of
research shows that there may be genetic links, number of things to find the cause:
Older age and the prostate cancer
as sons of men diagnosed with BPH are more
male hormone
likely to develop prostate disease. • a full personal and family medical history and
testosterone are
description of symptoms
linked with BPH
Older age and the male sex hormone testosterone
but may not be the are linked with BPH but may not be the cause. It is • a physical examination
cause
known that BPH only happens when testosterone,
• blood tests and sometimes biopsy or
which is made in the testes, is present. An enlarged
ultrasound – to find out the type of prostate
prostate becomes smaller after castration (the
disease (to check if it is BPH, prostate cancer
testes are surgically removed). However, castration
or prostatitis).
is not recommended as a treatment for BPH.
Testosterone is an important hormone in men for
BPH is more likely to be the cause of urinary
muscle strength and general health and well-being.
problems than prostate cancer.
Can I do anything to prevent BPH?
What happens when a medical history
As there are no known causes of BPH there are is taken?
no known ways to prevent it. However, lifestyle
Doctors will often take a detailed personal and
changes may help to stop the symptoms of BPH
family medical history in order to diagnose the
getting worse and may even help to improve
problem. Keeping a ‘voiding diary’ may also be
symptoms.
helpful. This is where the details of voids (passing
Reducing caffeine and alcohol intake (these urine) over a period of one to three, or even up
substances can irritate the bladder), avoiding to seven days are recorded. The amount of urine
constipation (straining to pass stools can affect emptied from the bladder, the time of each visit
pelvic floor muscles, which are important for both to the toilet and the fluid intake should be noted,
bowel and bladder control), reducing body weight, as it may be useful information for the doctor.
and good control of diabetes and blood pressure
The doctor may ask for details of any prescription
may be helpful. Stopping smoking and increasing
and non-prescription medicines you are taking
exercise levels may also help symptoms.
for other problems.
16 17
Diagnosis
Other problems can also cause changes in the Note that a normal
shape and feel of the prostate. For example, PSA level does not
in a condition called ‘chronic granulomatous rule out prostate
prostatitis’ the prostate may feel hard, is not disease, especially
tender when touched and can be irregular in prostate cancer,
shape when felt by a doctor, similar to a prostate which can still be
gland with cancer. present even with
Are the urinary symptoms bothersome?
a normal PSA test
The doctor may ask about how much the
symptoms limit your daily living and activities, Are blood tests needed to diagnose BPH?
and affect your quality of life and well-being (this
A blood test to measure the level of prostate
may be checked or scored using a questionnaire).
specific antigen (PSA) in the blood is often done
This information will help the doctor understand
for prostate disease. PSA is a protein made in the
how much the urinary symptoms bother you, and
prostate gland and low levels of PSA are normally
the best way to manage them.
present in the blood. A high PSA level in the
blood almost always means there is something
happening in the prostate.
What happens in a physical examination?
A digital rectal examination (DRE) is the main A PSA test is mostly used as a marker of prostate
part of a physical examination when checking cancer risk, but BPH can also raise PSA levels two
for prostate disease. The doctor places a gloved to three times higher than normal. However, the
finger into the rectum (back passage) to check higher the PSA level, the greater the chance that
the size, shape and feel of the prostate. prostate cancer is present.
• If BPH is present, the doctor may feel an Other blood tests (such as urea, creatinine and
enlarged prostate gland that tends to feel glucose) may also be done to check whether the
smooth, firm and elastic. kidneys are working normally.
• If prostatitis is present, the prostate may
feel slightly larger than normal, tender, What other tests for BPH might be done?
firm and warm
To find out more about the problem, doctors
sometimes do other tests.
• If prostate cancer is present, the prostate
gland may be larger than normal and its
Urine tests check for signs of infection or cancer
shape and hardness may be uneven. However,
in the urinary tract or kidneys.
a prostate gland with cancer may also feel
normal. Urinary tract ultrasound checks the health of the
kidneys and can also show how well the bladder
is emptying. Using sound waves, an ultrasound
takes images or pictures by painlessly moving a
special instrument across the stomach. It is safe
and no anaesthetic or incisions (cuts) are needed.
18 19