Benign Prostatic Hyperplasia (BPH) and Prostate

The Prostate is a male reproductive gland situated in front of rectum.below the bladder and surrounding the urethra. The name is derived from the Greek word prostates, literally translated as "one who stands before", "protector" or "guardian". It may be so called as its main function is to store and secrete an alkaline fluid during intercourse. The prostate also contains some smooth muscles that help expel semen during ejaculation.

The prostate gland in an adult male is slightly larger than a walnut and is palpable on per- rectal digital examination. It shows its first growth spurt at puberty- when it grows twice in size and then again starts growing at about 25 years of age and this growth continues throughout life. The growth of prostatic tissue is mainly regulated by Dehydrotestosterone [DHT], a metabolite of testosterone and to a smaller extent by testosterone as well as estrogen which is present in small quantities in all males.

The main diseases affecting the prostate are:

• Prostatitis
• Benign Prostatic Hyperplasia (BPH)
• and prostate cancer

Benign Prostatic Hyperplasia (BPH)

Even though the prostate continues to grow during most of a man's life, the enlargement doesn't usually cause problems until later in life.

BPH rarely shows any symptoms before the age of 40. But more than half of the men in their sixties and as much as 90 percent in their seventies and eighties have some symptoms of BPH.

The exact cause of BPH is not very well known and also the amount of enlargement is not directly proportional to the symptoms.

When the prostate gland enlarges, the outer capsule does not expand much, hence it starts putting pressure on the urethra. To begin with most of the problems are with the urinary system.

These can be:

• Increased frequency because there is a certain amount of urine retained in bladder at all times
• Urgency and leaking or dribbling
• Hesitancy and difficulty in passing urine increases as patient exerts pressure while urination
• Complete blockage of urination can occur

The condition is usually diagnosed during a routine digital rectal examination or if the patient approaches a doctor because of urinary problems.

The following tests are used to validate the diagnosis and confirm any need for surgery. After the preliminary tests, all patients may not need to undergo all of these tests.

1. Digital rectal examination is the cornerstone of reaching a diagnosis. By putting a gloved finger in the rectum, the surgeon can make out the size and the condition of the gland
2. Prostate specific antigen[PSA] is a blood test, primarily done to rule out cancer. It is also useful to monitor the progress and treatment response of prostate cancer.
3. Rectal ultrasound and prostate biopsy in case there is suspicion of prostate cancer
4. Urine flow studies and cystoscopy

Treatment Options

Men who have BPH with symptoms usually need some kind of treatment at some time. However, a number of researchers suggest regular checkups to watch for early problems. If the condition begins to pose a danger to the patient's health or causes a major inconvenience to him, treatment is usually recommended. Although the need for treatment is not usually urgent, doctors generally advise going ahead with treatment once the problems become bothersome or presents a health risk.

Types of treatment

The types of treatment that are most commonly used for BPH are:

1. Watchful Waiting
2. Lifestyle changes which help in minimizing urinary problemsrn
   • Do not hold back urine for long
   • Avoid rich and spicy food
   • Sit on a hard chair
   • Avoid very cold temperatures
   • Frequent intercourse is also beneficial
   • Emergency treatment for urinary retention
3. Medications and Antibiotics for urinary infection and alpha blockers
4. Anti DHT drugs which help in controlling growth of the prostate and sometimes shrink it
5. Some poly herbal formulations like Prosteez can relieve symptoms and delay or mitigate the need for surgery
6. Minimally invasive therapies like Transurethral microwave thermotherapy (TUMT), Transurethral Needle Ablation (TUNA), Water-induced thermotherapy, High-intensity focused ultrasound and prostate stents
7. Surgical options:- Most doctors recommend removal of the enlarged part of the prostate as the best long-term solution for patients with BPH. This involves removing that part of prostatic tissue which is pressing on the urethra Most commonly this is done by trans urethral route[TURP] which is less traumatic than open surgery and recovery is faster
8. It may take up to one year for complete recovery after prostate reduction procedures and since all of the tissue is not removed, some surveillance is required lifelong

Herbal Supplements for Benign Prostatic Hyperplasia (BPH)