Benign prostatic enlargement is a noncancerous, benign enlargement of the prostate. It usually occurs in men over the age of 50. It is extremely rare under the age of 40.

According to the American Urology Association, 50% of men between the ages of 50-60 and 90% of men over the age of 80 have BPH and related complaints.

What are the complaints?
difficulty urinating
Constant feeling of urination
Frequent urination, especially at night
Intermittent, forced urination, feeling of incomplete ejaculation
Drops of urine at the end of urination
Diagnosis

In the diagnosis of BPH, the patient’s history, physical examination and some tests are used.

Prostate examination

It is done rectally (anus) with a finger. The size of the prostate is evaluated, if there is a suspicion of cancer, a research is done for it.

Blood tests

PSA: If the blood values ​​are high, cancer should be considered primarily, but it can also increase in inflammatory diseases of the prostate.

Kidney function tests (Urea and creatinine): If kidney functions deteriorate in the advanced stages of prostate growth, urea and creatinine values ​​increase. In these cases, surgery is absolutely necessary.

Ultrasonography (USG)

Bladder, prostate and kidneys are evaluated with USG

Multiparametric MRI (MPMR)

Prostate multiparametric MRI helps in the differentiation of cancer. If cancer is suspected in MPMR, a biopsy should be taken to rule out cancer.

Determination of residual urine in the bladder

In normal people, there should be no urine left in the bladder after urinating, if there is urine and this value is above 100-150 cc, it is significant and surgery is required.

uroflowmetry

This test measures urine flow. If it is below certain values, prostate-related urinary difficulty should be suspected.

What are the treatment options?

* Medical treatment (drug therapy)
* Herbal treatment
* Surgical treatment

Medical treatment (drug therapy)

Alpha blocker: For this purpose, alpha blocker group drugs for prostate are widely used all over the world. This group of drugs are mainly:

Alfuzosin (Uroxatral)
Doxazosin (Cardura)
Prazosin (Minipress)
Silodosin (Rapaflo)
Tamsulosin (Flomax)
Terazosin (Hytrin)

The main side effects of these are: dizziness, headache, fatigue, low blood pressure and retrograde ejaculation (semen mixed with urine, semen does not come out after intercourse).

5-alpha reductase inhibitors: This group of drugs is effective by lowering the serum testosterone (male hormone) level. They are effective in large prostates (40 g and above), they are not effective in small prostates. PSA levels decrease if used for a long time. However, these also have sexual side effects:

Erectile dysfunction (impotence)
Decreased sexual desire
Decreased amount of semen
Retrograde ejaculation
There are 2 drugs in this group that are used for this purpose in the market!
Finasteride (Propecia, Proscar)
Dutasteride (Avodart)

Phosphodiesterase-5 inhibitors (Phosphodiesterase-5 Inhibitors): This group of drugs is the viagra group drugs used in the treatment of erectile dysfunction (impotence, sexual insufficiency). It provides a partial recovery in patients with prostate, and also helps in the treatment of impotence if there is one.

Prof. Dr. Emin ÖZBEK

Urology Specialist