ACADEMY PUBLIC POLICIES

VIDEO

The Male Genital-Urinary System and BPH

What is the relationship between BPH and PSA?

As mentioned, benign prostate tissue makes PSA, although not as much per gram as malignant prostate tissue. Therefore, as the prostate grows, the PSA level increases. An elevated PSA can therefore signify either an underlying prostate malignancy or benign growth of the prostate.

In men with a mild elevation of their PSA (4 to 10 ng/dl), approximately 25% of the biopsies will be positive for cancer, but 75% will not.

What other disorders can mimic BPH?

Other underlying disorders can mimic the symptoms of BPH. A neurogenic bladder, or bladder with impairment of its nerve supply, can cause a patient to void either frequently or infrequently depending on the nature of the neurologic problem. At times, a neurogenic bladder can cause the patient to be unable to urinate or go into urinary retention.

Diabetes mellitus can cause frequent urination, as many patients with diabetes make a greater volume of urine per 24 hours. With long-standing diabetes, bladder damage can occur that results in a decreased ability of the bladder to contract and therefore causes less frequent urination.

A urinary tract infection can cause urinary frequency and burning with urination. A urethral stricture or scar tissue in the urethra from old infections or trauma can cause a decrease in the urinary stream.

What damage can BPH cause?

One way to think of BPH is that it is causing increased resistance to the flow of urine out of the bladder. This can result in a transmission of back pressure to the bladder and ultimately to the kidneys. Men with long-standing prostatic obstruction and incomplete bladder emptying can form bladder stones, which can result in bleeding and infection. With significant and chronic prostatic obstruction, the bladder can be damaged and not contract well, much like if you chronically overinflated the inner tube of a tire.

Finally, some men with chronic prostatic obstruction can develop kidney damage known as azotemia because of the long-standing back pressure that is transmitted to the kidneys.

JN: Are there symptoms that a patient with BPH should be aware of that would signal the likelihood of his condition worsening to the point where he would experience acute urinary retention?

KL: Not necessarily, unfortunately, urinary retention can occur without warning.

JN: If BPH can cause increased resistance to the flow of urine from the bladder and transmission of back pressure to the bladder and ultimately to the kidneys, is there any way a patient would recognize symptoms that would signal him to know that his enlarged prostate was now starting to cause bladder and possible kidney problems? If undetected, could the kidney problems develop into renal failure?

KL: Symptoms cannot predict kidney problems and which men may be at risk for renal failure. A blood test called serum creatinine is the best way to assess kidney function.

Does nutrition have any impact on BPH?

For many years, it has been known that the prostate has the highest concentration of zinc of any organ in the body. Therefore, the conventional wisdom has said that zinc supplements are good for the prostate; however, very little objective evidence exists that zinc prevents either enlargement of the prostate or cancer of  the prostate. If zinc supplements are beneficial to the prostate, no one knows the optimal dose. Most multivitamin preparations available in any drugstore, however, contain variable amounts of zinc.

There has also been increasing interest in herbal therapy to treat benign enlargement of the prostate. Saw palmetto is the most popular herb used to treat BPH, and some studies have shown a benefit from saw palmetto.

Like zinc, however, no one knows what the optimal dose of saw palmetto. In general, nutrition and its impact on BPH have been understudied, and much more work needs to be done regarding the relationship between diet and prostate disease

Terms:

Neurogenic bladder - a bladder that has an abnormality in its nerve supply.

Diabetes mellitus - a disorder in which blood sugar (glucose) levels are abnormally high because the body does not produce enough insulin

Bladder stones - hard buildups of mineral that form in the urinary bladder.

Azotemia - increased serum creatinine which is a sign of kidney dysfunction.