Q: My husband wakes up several times during the night complaining about the need to urinate. Sometimes he urgently has to go, but then he can't. He's embarrassed about this problem and doesn't know what to do.
I've heard about men suffering from enlarged prostates. Would you explain what this means exactly and what treatments are available?
-- S.E., Brooklyn
A: Benign prostatic hyperplasia (BPH) is the non-cancerous growth of prostate gland cells. It is the most common non-cancerous tumor in men. BPH is a frequent condition for men over age 50, and the majority of men over the age of 70 will have some BPH.
The prostate gland is formed around the upper part of the urethra (the tube running from the bladder to the end of the penis). Any significant increase in prostate size or contraction of prostate tissue narrows the urethra. The pressure of the prostate makes it more difficult to start urination, and the bladder may not empty completely. Incomplete emptying makes the bladder fill up faster and require more frequent urination.
The cause of BPH is unknown but may be associated with changes in hormone levels as a result of aging. Although some dietary supplements are thought to help keep the BPH in check, diet is not thought to be a cause.
A number of treatment options are available for BPH, including surgery and medications. Although the surgery is typically easy and can be done on an outpatient basis, there is a high rate of complications, including impotence and urinary incontinence. Because the prostate grows very slowly, many man, especially older ones, may decide to live with the symptoms or try medications.
Several new drugs relax smooth muscles at the bladder outlet. In a recent study, two of the most commonly prescribed drugs for improving urine flow were tested. The researchers found that men taking doxazosin had significant improvement, while those taking finasteride didn't. But a more recent study showed that finasteride decreased the risk of prostate cancer.
Of the dietary supplements used for BPH, saw palmetto seems to be the most popular and promising, although the mechanism by which it improves urinary symptoms remains unknown. Many in the medical community feel that additional studies using standardized preparations of saw palmetto and other herbal and dietary supplements, such as zinc, are needed to determine their effectiveness and safety in the treatment of BPH.
BPH is not cancerous, and a man with BPH doesn't have a higher risk of developing cancer of the prostate. But the symptoms of BPH will motivate someone to get examined sooner, so that cancer may be found earlier.
Part of this examination is doing a PSA test, which is also a screening test for prostate cancer. Unfortunately, both BPH and cancer of the prostate can cause an elevation PSA. But cancer causes higher absolute levels, and PSA typically increases much faster over a shorter time.
Another part of the exam is the digital rectal exam, in which it's determined if the prostate is enlarged. Additional medical studies such as MRI or ultrasound may be recommended. If your husband has not had a medical evaluation concerning his nighttime urination, I strongly recommend that he get one.