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DISEASE BACKGROUNDER

EMBARGOED: 12:01AM AEDT, TUESDAY, OCTOBER 29, 2024

​

About benign prostatic hyperplasia (BPH) or

an enlarged prostate

​

  • Benign prostatic hyperplasia (BPH) also known as an enlarged prostate, is a common urological condition affecting older men1,2 that involves a non-cancerous enlargement of the prostate gland and expansion of the surrounding tissues.3,4  

  • While a healthy prostate resembles the size of a walnut, an enlarged prostate can grow to the size of a lemon.2

  • Though the causes of an enlarged prostate are multifactorial,5 age-related prostate changes associated with metabolic disturbances, changes in hormone balance and chronic inflammation can cause an enlarged prostate.6

  • Many men with an enlarged prostate  and the associated side effects wait until symptoms become significantly bothersome before seeking medical attention.7

​

Signs and symptoms

​​

  • The need to urinate frequently – a common symptom of an enlarged prostate  – can result from obstruction, or blockage, of the bladder, which is caused by enlargement of the prostate.4

  • This enlargement leads to the compression of the urethra, reducing the flow of urine from the bladder and sometimes blocking it entirely.8 

  • Urinary frequency can be as often as every one to two hours, and often occurs throughout the night.4

  • An enlarged prostate can result in lower urinary
    tract symptoms (LUTS), such as:    9-11

    • inability to completely empty the bladder
      when urinating;

    • poor urine flow;

    • an urgent need to pass urine;

    • difficulty starting and ending urination;

    • getting up at night to pass urine; and

    • passing urine more or less often than usual.

  • Some studies estimate that 90 per cent of men
    between the ages of 45 and 80 suffer from some type of LUTS.    5

  • The prevalence and severity of LUTS in ageing men can be progressive and is an important diagnosis in the care of patients and the welfare of society.5

  • LUTS associated with an enlarged prostate are often accompanied by sexual dysfunction, including ED and ejaculatory problems. Interest in sexual intercourse declines as the severity of LUTS increase.7

  • Symptoms left untreated may also lead to urinary tract infections, kidney stones and kidney damage.10

​

Risk factors and causes

​​​

  • The underlying mechanism of a benign enlargement of the prostate and surrounding tissues is yet to be determined and is a highly complex and debated topic. However, metabolic, hormonal and inflammatory factors are known to contribute to development of the condition.12,13

  • Non-modifiable risk factors (factors not in your control) include age and genetics.14

    • Age: an enlarged prostate is present in 50 to 60 per cent of men in their 60s, and 80 to 90 per cent of those aged 70+ years.15

    • Genetics: Evidence suggests genetics plays a role in an enlarged prostate, noting some forms of the disease can be inherited.14

  • Modifiable (factors you have control over) risk factors include:4,14

    • Obesity or a higher body mass index (BMI)

    • Metabolic syndromes e.g. diabetes, high blood pressure and high cholesterol levels;16

    • Cardiovascular (a group of disorders of the heart and blood vessel) disease;

    • Smoking;16

    • Sedentary lifestyle;

    • Poor diet;

    • Inflammation; and

    • Sex hormone imbalances.17

  • An enlarged prostate is a result of hyperplasia (increase in the number of cells resulting in an enlargement) of both epithelial (covers all body surfaces) and stromal (gives support and structure) tissues of the prostate gland.12,18

​

​Prevalence
 

  • Our ageing population is fuelling the global burden of BPH. There were 94 million cases of men living with an enlarged prostate worldwide in 2019, compared with 51.1 million cases in 2000.1

  • Enlarged prostate cases have more than doubled in Australia over the past approximately 20 years, from 271,000 recorded cases in 2000 to 476,000 recorded cases in 2019.1 

  • However, it is estimated an enlarged prostate affects more than 2.8 million men aged 50+ in Australia [based on a population of 26.6 million Australians].*19-21

  • Around half of Australian men over 50 years of age, and more than 8 in 10 men over

  • 80 years of age have some symptoms of an enlarged prostate.10

  • It is estimated that one in two men will have an enlarged prostate by the age of 50.2

​​​

​*According to the Australian Bureau of Statistics, males represent 49.3% of the Australian population [26.6 million]. Estimate has been calculated on the number of men aged over 50 [approx. 4.576 million].

​​

Diagnosis & management​

​​​

  • The evaluation and management of an enlarged
    prostate is complicated by several factors;
    namely, the normal prostate varies in size and
    there is not a defined relationship between the
    size of the prostate and the severity of the
    symptoms.    7

  • Blood, urine tests or an ultrasound to examine
    the urinary tract are commonly used to diagnose
    an enlarged prostate.    10

  • A prostate symptom score questionnaire is a
    simple and readily accessible method for diagnosing an enlarged prostate. It is used to determine if a man has mild, moderate or severe symptoms.    8  

  • An enlarged prostate can be diagnosed through a rectal (anal) examination to determine the size and shape of the prostate.10

​

Simple lifestyle modifications may suffice to manage mild enlarged prostate  symptoms, such as:22

  • Reducing diuretics (caffeine, alcohol);

  • Minimising bladder irritants (consumption of spicy and acidic foods);

  • Not drinking fluids at night;

  • Addressing constipation issues; and

  • Bladder training and pelvic floor exercises.

​

Impact on quality of life

​

  • Most men living with an enlarged prostate
    experience a reduced quality of life due to
    bothersome symptoms. Symptoms of an
    enlarged prostate can compromise day-to-day
    life and routines.    23-25

  • Lower urinary tract symptoms associated with an
    enlarged prostate have also been linked to
    depression, anxiety and stress.    25

  • Living with an enlarged prostate can also affect
    the quality of life of a partner or spouse, and
    take a toll on a relationship.    26

  • Nearly half (46 per cent) of partners experience disturbed sleep due to being regularly woken by their partner’s urination disorder; 37 per cent of women reported problems with sexual function as a result of their partner’s disorder; and 17 per cent cited being unable to take a long trip with their affected partner without regular toilet stops.26

​

Treatment options

​

  • An enlarged prostate is treatable and men living with the condition should seek professional advice. Varying treatment options are available, depending on the size of the prostate and severity of symptoms.27

  • Some of the most common barriers to seeking treatment for an enlarged prostate  include embarrassment, waiting for the condition to go away on its own, considering it to be an inevitable part of ageing and a fear of surgery.28

  • For some, an insufficient understanding of the severity, slow progression of symptoms and negative attitudes towards seeking treatment contribute to delayed treatment.29

  • Level of bother and invasiveness, recovery time, duration of treatment, sexual function preservation, risk of adverse events and out of pocket costs are key factors for patients when choosing a treatment option. Patients also have different preferences when considering the balance between effectiveness and safety.30

  • In 2021-22 it was estimated that roughly 24,000 men underwent treatment for an enlarged prostate in public and private hospitals.27,31

  • The different treatment options available for an enlarged prostate vary in the degree of invasiveness. Symptoms may be treated by lifestyle changes, medication or surgery.32

  • Surgical procedures to treat an enlarged prostate include:33

    • Transurethral resection of the prostate (TURP)

    • Photoselective vaporisation of the prostate (PVP)

    • Holmium laser enucleation of the prostate (HoLEP)

  • Minimally invasive techniques to treat an enlarged prostate include:33

    • Water vapor therapy

    • Prostatic urethral lift

  • ​TURP is the most common procedure used for an enlarged prostate in Australia, but minimally invasive techniques are becoming more common.33

  • There are two main medications that can help with symptoms of an enlarged prostate symptoms: alpha blockers and 5 alpha reductase inhibitors. Alpha-blockers and 5-Alpha reductase inhibitors have different functions.

    • 5-Alpha Reductase Inhibitors: Designed to stop the growth or shrink the prostate by lowering production of the hormone DHT (a male sex hormone).3

    • Alpha-Blockers: Help to relax the muscles in the bladder and prostate, allowing urine to flow more freely.35

  • These can be prescribed together, which is commonly known as combination therapy.8,36

  • For men whose quality of life is significantly affected by an enlarged prostate, minimally invasive treatments are available for consideration. Such treatments include water vapour therapy, where steam is injected directly into the prostate tissue to reduce problematic tissue overgrowth, to relieve symptoms and obstructions.37,38

  • Water vapour therapy is a simple and short procedure, taking less than ten minutes to complete, with most patients discharged on the same day.39

​​

​ends#

​

For more information, please contact Kirsten Bruce & Sam Jacobs, VIVA! Communications

M          0401 717 566 | 0422 654 404

W          02 9968 3741 | 1604

E            kirstenbruce@vivacommunications.com.au| sam@vivacommunications.com.au

 

References

  1. Awedew AF, Han H, Abbasi B, Abbasi-Kangevari M, Ahmed MB, Almidani O, et al. The global, regional, and national burden of benign prostatic hyperplasia in 204 countries and territories from 2000 to 2019: a systematic analysis for the Global Burden of Disease Study 2019. The Lancet Healthy Longevity. 2022;3(11):e754-e76.

  2. Understanding Prostate Changes and Conditions: National Cancer Institute 2024 [Available from: https://www.cancer.gov/types/prostate/understanding-prostate-changes#:~:text=The%20prostate%20is%20part%20of,the%20size%20of%20a%20lemon].

  3. Franco JVA, Tesolin P, Jung JH. Update on the management of benign prostatic hyperplasia and the role of minimally invasive procedures. Prostate Int. 2023;11(1):1-7.

  4. Benign prostate hyperplasia (BPH): Urology Care Foundation; 2023 [Available from: https://www.urologyhealth.org/urology-a-z/b/benign-prostatic-hyperplasia-(bph).

  5. Sandhu JS, Bixler BR, Dahm P, Goueli R, Kirkby E, Stoffel JT, et al. Management of Lower Urinary Tract Symptoms Attributed to Benign Prostatic Hyperplasia (BPH): AUA Guideline Amendment 2023. Journal of Urology. 2024;211(1):11-9.

  6. Kim EH, Larson JA, Andriole GL. Management of Benign Prostatic Hyperplasia. Annu Rev Med. 2016;67:137-51.

  7. Bruskewitz RC. Quality of life and sexual function in patients with benign prostatic hyperplasia. Rev Urol. 2003;5(2):72-80.

  8. Ng M, Leslie SW, Baradhi KM. Benign Prostatic Hyperplasia.  StatPearls. Treasure Island (FL)2024.

  9. Lokeshwar SD, Harper BT, Webb E, Jordan A, Dykes TA, Neal DE, Jr., et al. Epidemiology and treatment modalities for the management of benign prostatic hyperplasia. Transl Androl Urol. 2019;8(5):529-39.

  10. Benign prostate hypertrophy: healthdirect;  [Available from: https://www.healthdirect.gov.au/benign-prostate-hypertrophy].

  11. Lepor H. Pathophysiology of lower urinary tract symptoms in the aging male population. Rev Urol. 2005;7 Suppl 7(Suppl 7):S3-s11.

  12. Eric Chung ML, Michael Gillman, Chris Love, Darren Katz, Graham Neilsen. Urological Society of Australia and New Zealand (USANZ) and Australasian Chapter of Sexual Health Medicine (AChSHM) for the Royal Australasian College of Physicians (RACP) clinical guidelines on the management of erectile dysfunction. Med J Aust. 2022;217(6):318-24.

  13. Da Silva MHA, De Souza DB. Current evidence for the involvement of sex steroid receptors and sex hormones in benign prostatic hyperplasia. Res Rep Urol. 2019;11:1-8.

  14. Patel ND, Parsons JK. Epidemiology and etiology of benign prostatic hyperplasia and bladder outlet obstruction. Indian J Urol. 2014;30(2):170-6.

  15. Launer BM, McVary KT, Ricke WA, Lloyd GL. The rising worldwide impact of benign prostatic hyperplasia. BJU Int. 2021;127(6):722-8.

  16. Li J, Peng L, Cao D, Gou H, Li Y, Wei Q. The association between metabolic syndrome and benign prostatic hyperplasia: a systematic review and meta-analysis. The Aging Male. 2020;23(5):1388-99.

  17. Asiedu B, Anang Y, Nyarko A, Doku DA, Amoah BY, Santa S, et al. The role of sex steroid hormones in benign prostatic hyperplasia. The Aging Male. 2017;20(1):17-22.

  18. Liu TT, Thomas S, McLean DT, Roldan-Alzate A, Hernando D, Ricke EA, et al. Prostate enlargement and altered urinary function are part of the aging process. Aging (Albany NY). 2019;11(9):2653-69.

  19. Profile of Australia's population: Australian Government - Australia Institute of Health and Welfare; 2024 [Available from: https://www.aihw.gov.au/reports/australias-health/profile-of-australias-population].

  20. Population: Australian Bureau of Statistics; 2024 [Available from: https://www.abs.gov.au/statistics/people/population#:~:text=The%202021%20Census%20counted%2025%2C422%2C788,age%20of%2039%20years%20old.

  21. Management of Lower Urinary Tract Symptoms Attributed to Benign Prostatic Hyperplasia: AUA Guideline: American Urogoical Assoication 2023 [Available from: https://www.auanet.org/guidelines-and-quality/guidelines/benign-prostatic-hyperplasia-(bph)-guideline].

  22. Jiwrajka M, Yaxley W, Perera M, Roberts M, Dunglison N, Yaxley J, et al. Review and update of benign prostatic hyperplasia in general practice. Australian Journal for General Practitioners. 2018;47:471-5.

  23. Chughtai B, Rojanasarot S, Neeser K, Gultyaev D, Fu S, Bhattacharyya SK, et al. A comprehensive analysis of clinical, quality of life, and cost-effectiveness outcomes of key treatment options for benign prostatic hyperplasia. PLoS One. 2022;17(4):e0266824.

  24. Pinto JD, He HG, Chan SW, Wang W. Health-related quality of life and psychological well-being in men with benign prostatic hyperplasia: An integrative review. Jpn J Nurs Sci. 2016;13(3):309-23.

  25. Park S, Lee KS, Choi M, Lee M. Factors associated with quality of life in patients with benign prostatic hyperplasia, 2009-2016. Medicine (Baltimore). 2022;101(36):e30091.

  26. Shvartzman P, Borkan JM, Stoliar L, Peleg A, Nakar S, Nir G, et al. Second-hand prostatism: effects of prostatic symptoms on spouses' quality of life, daily routines and family relationships. Fam Pract. 2001;18(6):610-3.

  27. Morton A, Williams M, Perera M, Teloken PE, Donato P, Ranasinghe S, et al. Management of benign prostatic hyperplasia in the 21st century: temporal trends in Australian population-based data. BJU Int. 2020;126 Suppl 1:18-26.

  28. Ertel P, Adalig B, Demircan I, Lartey B, Manyak MJ. Understanding patient and physician perceptions of benign prostatic hyperplasia in Asia Pacific, Latin America and the Commonwealth of Independent States: the Prostate Research on Behaviour and Education (PROBE) II survey. Int J Clin Pract. 2016;70(10):870-80.

  29. Zou H, Jiang D-x, Zhao W-y, Yang J-h, Jia H-h, Zhang L-l. Factors associated with patient delay for older adults with benign prostatic hyperplasia: A descriptive qualitative study. Geriatric Nursing. 2022;46:178-83.

  30. Public Summary Document - Application No. 1697 – Review of Different Minimally Invasive Therapeutic Approaches for the Management of Patients with Benign Prostatic Hyperplasia (BPH) 2022.

  31. Admitted patient care NMDS 2021–22: Australian Government - Australian Institute of Health and Welfare - Meteor Metadata Online Registry [Available from: https://meteor.aihw.gov.au/content/728439.

  32. Prostate enlargement: Healthy Male [Available from: https://healthymale.org.au/mens-health/prostate-enlargement.

  33. Patel RM, Bariol S. National trends in surgical therapy for benign prostatic hyperplasia in Australia. ANZ J Surg. 2019;89(4):345-9.

  34. Wojcik M, Dennison D. Photoselective vaporization of the prostate in ambulatory surgery. Aorn j. 2006;83(2):330-4, 7-40, 43-5; quiz 47-50.

  35. Prostate Enlargement (Benign Prostatic Hyperplasia): National Institute of Diabetes and Digestive and Kidney Disease [Available from: https://www.niddk.nih.gov/health-information/urologic-diseases/prostate-problems/prostate-enlargement-benign-prostatic-hyperplasia.

  36. O'Quin C, White KL, Campbell JR, Myers SH, Patil S, Chandler D, et al. Pharmacological Approaches in Managing Symptomatic Relief of Benign Prostatic Hyperplasia: A Comprehensive Review. Cureus. 2023;15(12):e51314.

  37. Water vapor therapy: Boston Scientific [Available from: https://www.treatmybph.com.au/treatment-options/water-vapor-therapy.html.

  38. McVary KT, Rogers T, Roehrborn CG. Rezūm Water Vapor Thermal Therapy for Lower Urinary Tract Symptoms Associated With Benign Prostatic Hyperplasia: 4-Year Results From Randomized Controlled Study. Urology. 2019;126:171-9.

  39. McVary KT, Gittelman MC, Goldberg KA, Patel K, Shore ND, Levin RM, et al. Final 5-Year Outcomes of the Multicenter Randomized Sham-Controlled Trial of a Water Vapor Thermal Therapy for Treatment of Moderate to Severe Lower Urinary Tract Symptoms Secondary to Benign Prostatic Hyperplasia. J Urol. 2021;206(3):715-24.

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