What is BPH?

The term BPH or an "enlarged prostate" is commonplace, but what exactly is it?

BPH is an acronym for Benign Prostatic Hyperplasia:

• benign - noncancerous
• prostatic - in prostate
• hyperplasia - multiplication of cells

In BPH, the prostate cells increase in number and are packed closer together. This causes enlargement of the prostate gland and closes the urethra through which urine passes between the bladder and penis.
 

Left - normal prostate             Right - prostate with BPH
Source Wikimedia Commons and NCI

BPH starts early and insidiously, usually in the 40's with an incidence proportional to age.  That means that a 50 year old man has about a 50% chance of having BPH.  Therefore, in general, BPH is an issue of when it will happen rather than if it will happen.

 
Why is BPH a problem?

As the prostate enlarges it closes the voiding channel.  This can cause urinary symptoms including frequency, urgency, hesitancy, feelings of incomplete emptying, nighttime urination.  BPH can also cause urinary tract infections, urinary retention, hematuria, and even kidney damage.

Please see this prior blog post for more info on urinary symptoms.

Therefore, BPH can affect a man's physical health and quality of life.

What causes BPH?

One significant factor in prostate growth is the male hormone testosterone, or more specifically dihydrotestosterone (DHT).  DHT goes into prostate cells and causes an increase in cell multiplication.  Though male hormones are a big factor, medical science has not identified all the factors that are involved in prostate hyperplasia.  Identifying other mechanisms for this disease process are breakthroughs waiting to happen.

Talking about prostate health at NP conference tomorrow

No rest for the weary.
After just coming back from the ACPE Annual Meeting in San Francisco, I have a talk about prostate health at the 19th Annual Northeast Regional Nurse Practitioner Conference tomorrow afternoon (5/3 at 2:30pm).

Here's a brief on the talk from the conference brochure:

"SEMINAR 12:

PROSTATE HEALTH SCREENING/

PROSTATE HEALTH

Ronald Yap, MD

The issues and recommendations related to this topic continue to evolve.

During this session, we will discuss two common issues affecting the aging male:

prostate enlargement (BPH) and prostate cancer screening. We will review current national guidelines. Up to date research, management options and controversies will be discussed."

It will be a jam packed talk.  Last year, I talked about BPH alone and took up the entire time.

Given the recent stories regarding screening involving Warren Buffett's prostate cancer, USPSTF guidelines, and evolving clinical studies, adding the prostate cancer screening part will hopefully clear up some confusion about this issue. 

I have the talk as a .ppt file and have thought about putting some videos up with my lecture material on You Tube at some point in the future.  If this is something you'd like to see please comment.

Describing your urinary symptoms to your doctor

The urologic system can be quite a mystery to many people.  When you see your doctor for urinary issues, it can be difficult to find the right words to describe your symptoms.

In this post, I'll review some symptom terminology so that you can communicate more effectively with your healthcare provider.

"Urias":

• dysuria - pain with urination
• hematuria - blood in the urine
• nocturia - night time urination
• pneumaturia - passage of air with urination

Leakage:

• urge incontinence - urinary leakage due to feeling like you need to urinate and not making it to the bathroom in time
• stress incontinence - urinary leakage due to coughing, straining, laughing, or other strenuous activities

Symptoms:

• frequency - how often you urinate
• urgency - how rushed you feel when you feel the need to urinate
• hesitancy - a difficult to start urinary stream
• intermittency - starting and stopping stream
• retention - sense of incomplete emptying after urination

Knowing a few buzz words can really expedite your visit and let your doctor know how empowered you are about your urologic health!

Prostate Pal Mobile App

With the mobile technology revolution in full swing, I believe that this is an opportunity for healthcare to harness this energy to further empower patients, facilitate doctor/patient relations, and improve the efficacy of care.

Since I'm a urologist, I naturally think about such things within my realm of expertise.
For men, prostate disorders impact millions of men throughout the world.  In an effort to marry mobile healthcare (mHealth) with these interests, I came up with Prostate Pal.

Prostate Pal is a free app.  By free, I mean the real free - no in app purchases, "liteware",  or banner ads. By releasing the app in such a manner, the goal was to give men worldwide the ability to track their urologic health.

It's available on Apple and Android platforms:

Prostate Pal for Apple Devices

Prostate Pal for Android

The app consists of three parts:

• Bladder Diary - This is used to track fluid intake, urine output, urinary leakage, and incontinence pad changes.  The information that is logged will help your healthcare assess your urinary health and response to therapy.  Containers to measure output can be purchased at your local drug store.
• AUA Symptom Score - This is a questionnaire produced by the American Urological Association. It has been validated with numerous medical studies.  The list of questions are used to help men and women in conjunction with their healthcare providers assess their urinary symptoms and response to therapy.
• PSA Tracker - Prostate specific antigen or PSA is a blood test that is used to screen for prostate cancer and monitor response to prostate cancer therapy.  The tracker has a table and graph format.

Prostate Pal Home Screen

I first came up with the idea in early 2010.  Initially, I tried to program it myself with the Apple Software Development Kit.  However, the programming was too time intensive as well as too complex for me to fully implement my vision for the app.

Thankfully, two things happened that allowed the app to come together.  First, I received funding from the LeBaron Foundation and Concord Hospital Trust for the project.  Second, I ran into Cameron Banga and Mike Phelps from 9Magnets, LLC - an app development company. They did a great job executing the app and it was first released in January of 2011!

In other posts I'll talk about the further development of the app and stuff that happened after the release, It's been a pretty crazy ride since I thought about this app in my living room on a cold, New Hampshire winter night!

How is the Prostate Examined?

The prostate is felt or "palpated" via digital rectal exam or "DRE". 

See figure below:

Source: Wikimedia Commons and NCI

In this cutaway side view, the doctor's finger is in the rectum and digitally examining the prostate gland.

When your doctor does a DRE he or she is assessing several attributes regarding your prostate:

• Size - How big is the gland?
• Symmetry - Is one side or "lobe" different in size compared to the other one?
• Contour - Are there any lumps or "nodules" within the gland?
• Consistency - Are there any firm areas within the prostate?

A well trained clinician can detect all these factors pretty quickly from the exam.  If an abnormality is found the patient may be offered a prostate biopsy to determine whether or not the prostate harbors cancer.

As a urologist, I believe that when a patient elects to be screened for prostate cancer a digital rectal exam should be part of the process.  Though screening for prostate cancer is a controversial issue, much of the attention has been around PSA testing alone with little acknowledgement of the utility of the DRE.

The DRE is also helpful in assessing the prostate for other conditions such as benign enlargement of the gland or "BPH" or prostatitis.

What exactly is the prostate anyway?

Let's start with basics:

The prostate is a sexual gland located between a man's bladder and penis.  It is located in the pelvis behind the pubic bone (bone you can feel just above the penis) and in front of the rectum.

Check out the figure below:

Source: Wikimedia Commons and NCI

This shows a cutaway side view or "sagittal" view of the male pelvic area.  The prostate is located in the boxed area.










This is a closer view of the prostate and the seminal vesicles which store the semen created by the prostate.








The main purpose of the prostate is to create semen.  Semen is the vehicle for sperm transport to the female reproductive system. The semen is also critical in helping the sperm become active within the female reproductive tract, a process called capacitation.

So hopefully this post has shed some light on what it is and where it is.  I'll do another post next on how the prostate is examined.