What is an enlarged prostate? Why should you check?

Benign prostatic hyperplasia, medically known as benign prostatic hyperplasia (BPH), is a common urological condition in middle-aged and elderly men. As we age, the prostate tissue gradually grows, compressing the urethra and causing symptoms such as difficulty urinating. According to the Hong Kong Health Bureau, about 50% of men over 50 years of age experience symptoms of an enlarged prostate, and the prevalence in men over 80 years of age is as high as 90%.前列腺檢查

An enlarged prostate is not directly life-threatening, but it can seriously affect your quality of life. Without long-term treatment, it can lead to bladder dysfunction, urinary tract infections, and even kidney failure. Therefore, it is important to do it early not only to diagnose symptoms, but also to rule out serious diseases such as prostate cancer.

Common tests include digital anal examination, PSA test, and urine flow test, which can help doctors comprehensively assess prostate health and develop optimal treatment plans.

Common symptoms of benign prostatic hyperplasia

The symptoms of benign prostatic hyperplasia are mainly related to urinary dysfunction and can be divided into two categories: urinary retention symptoms and urinary symptoms.

• Symptoms of urinary retention: Including frequent urination (urinating more than 8 times during the day), nocturia (waking up at night to urinate more than 2 times), and urgency to urinate (sudden strong urge to urinate). These symptoms can have a serious impact on sleep quality and daily life.
• Symptoms of the urinary phase: Manifested as difficulty urinating, low and weak urine flow, interrupted urination, need to exert effort to urinate, etc. In severe cases, urinary retention may occur, which makes urination completely impossible.
• Symptoms after urination: Dirty urine, dripping urine after urination, etc., can cause complications such as bladder stones and hematuria if not treated for a long time.

It is important to note that the severity of BPH symptoms is not always proportional to the size of the prostate. Some patients have a significantly enlarged prostate and mild symptoms, while others have a slightly enlarged prostate and severe symptoms. Therefore, symptom assessment combined with professional diagnosis can be accurately diagnosed.

How to diagnose BPH

The diagnosis of benign prostatic hyperplasia requires a combination of different test methods, and the most common diagnostic process is:

Medical history and physical examination

The doctor will ask the patient in detail about the patient's urination status, duration of symptoms, medication history, etc. The International Prostate Symptom Score (IPSS) is a commonly used assessment tool that quantifies symptom severity through seven questions.

Digital anal examination

The doctor wears gloves, applies lubricant, and inserts a finger into the rectum to touch the size, shape, and texture of the prostate. This test allows you to determine in advance whether the prostate is enlarged or if there is a hard lump. The procedure may be a little uncomfortable, but it usually does not cause severe pain.

Regular urine tests

By testing the urine for leukocytes, red blood cells, proteins and other indicators, urinary tract infections, hematuria and other diseases that can cause similar symptoms are ruled out.

Prostate-specific antigen (PSA) test

PSA is a protein secreted by prostate cells, and normal values are usually less than 4 ng / ml. Both benign prostatic hyperplasia and prostate cancer can lead to an increase in PSA and should be determined in conjunction with other test results.

Urine flow test

Urine flow test is an important test for assessing urinary function. The patient should use special instruments to measure parameters such as maximum urine flow, average urine flow and voiding time. The normal maximum urinary flow rate is greater than 15 ml/s, and less than 10 ml/s indicates possible obstruction.

Residual urine volume measurement

The amount of urine remaining in the bladder after urinating is measured by ultrasound or catheterization. Residual urine volume greater than 100 ml indicates impaired bladder emptying.

imaging

Urine ultrasound measures the volume of the prostate and assesses the condition of the kidneys and bladder. Especially if prostate cancer is suspected, CT or MRI can be done if necessary.

Significance and precautions for each test

Understanding the clinical implications and precautions of each can help patients cooperate with the diagnosis.

What does a high PSA test indicate?

Possible causes of elevated PSA include an enlarged prostate, prostatitis, and prostate cancer. The Hong Kong Urological Association recommends that if your PSA is between 4 and 10 ng/ml, further testing is required. Above 10 ng/ml significantly increases the risk of prostate cancer. Cycling, sex, and finger-anal tests should be avoided 48 hours before the test, as they can cause a temporary rise in PSA.

Is a digital anal exam painful?

Most people experience only mild discomfort rather than severe pain. Relaxing your anal muscles before the exam can help reduce discomfort. Patients with hemorrhoids or anal fissures should inform their doctor in advance.

How is a urine flow test performed?

Drink about 500 ml of water 1 hour before the urine flow test to maintain proper urine craving. During the examination, you can urinate naturally in front of a special instrument in a private space. To get accurate results, try to urinate and relax as usual during the test.

Treatment options for benign prostatic hyperplasia

Treatment for BPH should be based on factors such as symptom severity, prostate size, and the patient's age.

Drug therapy

• α receptor blockers: for example, tamsulosin which can relax the muscles of the prostate and bladder neck and quickly improve urinary symptoms. Common side effects include dizziness and orthostatic hypotension.
• 5α reductase inhibitors: For example, finasteride can reduce the size of the prostate, but it must be taken for 3 to 6 months to be effective. Prolonged use can reduce PSA levels, which can affect prostate cancer screening.

Surgical treatment

• Transurethral Resection of the Prostate (TURP): Gold standard surgery for moderate to severe patients. The device is inserted through the urethra and removes some of the prostate tissue to improve urine flow.
• Laser surgeryFor example, green laser vaporization, less bleeding, faster recovery, suitable for the elderly and patients taking anticoagulants.

Other treatments

• Microwave hyperthermia: It destroys part of the prostate tissue with heat energy, so there is less trauma, but the long-term effect is not as good as surgery.
• High-Intensity Focused Ultrasound (HIFU): Precise resection of prostate tissue and preservation of surrounding structures have emerged as minimally invasive treatments.

How to prevent an enlarged prostate?

Although an enlarged prostate is strongly associated with aging, the following measures may help slow the onset of the disease or reduce symptoms:

• Healthy Eating: Eat plenty of tomatoes (including lycopene), cruciferous vegetables, and omega-3-rich fish. Limit your intake of red meat and high-fat dairy products.
• Discipline Exercises: At least 150 minutes of moderate-intensity exercise per week, such as brisk walking or swimming, can help maintain prostate health.
• Maintain ideal weight: Obesity increases the risk of prostate enlargement and BMI must be controlled between 18.5 and 23.
• Try not to hold urine: Holding urine for a long time can impair bladder function and worsen prostate symptoms.
• Periodic health checkupsMen over 50 should have annual examinations, such as a digital anal examination and PSA test. People with a family history should start screening as early as age 45.

Early detection, early treatment, and improved quality of life

An enlarged prostate is a common problem that affects the quality of life of middle-aged and older men. By understanding the typical symptoms and being proactive in prostate testing (e.g., urine flow test, PSA test), you can detect problems early and receive appropriate treatment. Modern treatments range from medications to minimally invasive surgeries, which can effectively improve symptoms. It is important not to delay treatment due to shyness or misunderstandings, communicate well with the urologist and choose the best diagnosis and treatment plan.

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