Enlargement of the prostate is known asbenign prostatic hyperplasia (BPH) or non-cancerous. 
It is not spoken of hypertrophy (increase of volume), but of hyperplasia because it is caused by a rapid multiplication of cells in the central part of the gland.

The prostate is an organ that is located below the bladder and involves the urethra (the channel through which urine passes). 
Due to this position , urinary symptoms occur in the case of hyperplasia. 
Prostate hyperplasia involves the central part of the organ, around the urethra, while the prostate tumor occurs on the outside.

The prostate is responsible for producing a fluid known as prostatic fluid. 
This pure fluid serves to neutralize the acidity of the vaginal tract which would otherwise cause the destruction of the semen before reaching the egg for fertilization.

Prostate Size

  1. The normal size of the prostate is 4 X 3 X 2 cm,
  2. The weight of the gland is approximately 30-40 grams.

In childhood, this gland is the size of a pea. 
Over time, it begins to grow at a gradual pace. 
With the onset of puberty, growth intensifies and at the age of 25 the gland grows to the size of a chestnut or a nut.

For most men, the prostate continues to grow until it causes pressure on the bladder and urethra . 
This interferes with the normal flow of urine.

Weight of prostate

Age Prostate
20 years 20g
From 30 to 50 years 30g
Over 70 years 60g

In young men under 30 years (for example, 20 or 25 years) prostate hyperplasia rarely occurs. 
The period ranging from 40 to 50 years is considered the period of prostate growth. 
The main reasons for prostatic hyperplasia in the juvenile population are still unknown. 
Although there is no solid evidence, there are some credible assumptions.

Causes of enlarged prostate

In the elderly the enlargement of the prostate (also known as benign prostatic hyperplasia) is a frequent illness. 
Aging can cause inflammation and obstruction of small arteries . 
The consequence is ischemia and oxidative stress that create a favorable environment for the development of benign prostatic hyperplasia. 
Source : Role of inflammation in benign prostatic hyperplasia. – Chughtai B, Lee R, Te A, Kaplan S-Rev Urol. 2011; 13 (3): 147-50

Hormones
In some cases, the prostate can develop a greater sensitivity to the hormones, causing an increase. 
Hormone levels in patients with enlarged prostate and in normal patients are similar.

Dihydrotestosterone
The pituitary releases the hormone LH, which stimulates the testes to turn testosterone into dihydrotestosterone (DT). 
This binds to the R protein, ie the receptor on the cell membrane. 
From here it enters the nucleus and stimulates the synthesis of proteins. 
This is the origin of prostatic proliferation.

With age, some changes in the body promote prostatic hyperplasia:

  1. A progressive increase of DT;
  2. A progressive decrease in the catabolism of DT, so that this hormone remains active in the blood for longer;
  3. An increase in dietary and non-food 17-ß-estradiol, which is converted to DT. The flesh is rich in this substance;
  4. An increase in the R protein, i.e., the DT receptor.

Genetics and inheritance
A genetic link to prostatic hyperplasia in men younger than 60 years has been studied in recent years. 
Research shows it is a hereditary disease. 
The genetic factor increases the risk of developing moderate or severe urinary symptoms in elderly men by 72%. 
Source : Benign Prostatic Hyperplasia and Male Lower Urinary Tract Symptoms: Epidemiology and Risk Factors. – Parsons JK – Curr Bladder Dysfunct Rep. 2010 Dec; 5 (4): 212-218.

Growth
factors Several growth factors and the corresponding receptors were identified:

  1. In the prostate epithelium,
  2. In the connective tissue of support.

These can stimulate or inhibit cell growth and differentiation processes (acquisition of specific characteristics). 
Among the growth factors there are:

  1. Epidermal growth factor,
  2. Fibroblast growth factor,
  3. Transforming growth factor beta.

Activation of these growth factors may stimulate the growth of connective tissue cells and tissue remodeling. The consequence is enlarged prostate.

Inflammation
At the level of the immune system, inflammation can:

  1. Causing the release of cytokines,
  2. Increase the concentration of growth factors.

The consequence is the excessive proliferation of prostatic cells. 
Source : The role of chronic prostatic inflammation in the pathogenesis and progression of benign prostatic hyperplasia (BPH). – Gandaglia G, Briganti A, Gontero P, Mondaini N, Novara G, Salonia A, Sciarra A, Montorsi F – BJU Int. 2013 Aug; 112 (4): 432-41.

Metabolic Syndrome, Lifestyle, and Obesity
Prostate volume is significantly higher in men:

  1. With metabolic syndrome,
  2. Obese,
  3. With low levels of HDL (“good”) cholesterol in the blood.

Among the most believed theories, lifestyle and unnatural eating.

According to natural medicine , eating can cause prostate problems. 
According to the blood type diet , foods can be:

  1. Harmful – can cause symptoms and illness,
  2. Neutrals – usually do not cause health problems,
  3. Beneficial – they are tolerated and can help heal.

The effect depends on the blood group of the individual. 
One food can be harmful to one person and beneficial to another. 
For example:

  • People with type 0 blood can eat red meat, but can get sick if they eat fruit,
  • People with type A blood do not tolerate red meat and beer,
  • A person with type B blood can develop diseases eating tomatoes and hazelnuts,

The blood type diet found a link between prostatic hyperplasia and consumption of milk and dairy products . 
People who develop bloated prostate or  prostate cancer  regularly eat one of these foods:

  1. Cheese
  2. Creamy desserts,
  3. Pizza,
  4. Milk.

In the past, few people have suffered from prostate problems, but since when most people regularly eat dairy products, prostate diseases have increased dramatically. 
We must avoid the excesses of any food, because even the most harmless can cause symptoms if ingested:

  1. In large quantities,
  2. Every day.

For example, you can eat 3 walnuts a day without problems, but more than 10 walnuts a day can be harmful.

 

Increased prostate risk factors

Among the risk factors are:

  1. Type II diabetes
  2. Sexual abstinence,
  3. Coito interrupted,
  4. The constipation  may be due to hard feces and dried to accumulate in the colon, because the person can not evacuate. 
    The colon increased due to the presence of feces can cause a pressure on the prostate that creates difficulty in urinating. In this case, after the evacuation, the person noticed more ease in urinating and greater flow.

 


Symptoms of prostatic hyperplasia

  1. Reduced urine flow,
  2. Intermittent flow of urine,
  3. Sudden need to urinate,
  4. Frequent urination ,
  5. Urinary retention,
  6. Drip following urination,
  7. Burning during and after urination ,
  8. Incontinence .

Description of symptoms

The symptoms of enlarged prostate develop gradually.

  • When enlargement of the prostate presses the urethra, it can cause partial urinary obstruction . This causes the first symptom of enlarged prostate, ie the difficulty in starting to urinate. Usually the person has to strive to urinate properly.
  • The enlarged prostate leaves the urine stream weak and causes it to start and stop frequently.
  • Even after the person has urinated, involuntary loss of urine drops may occur .
  • The prostate can continue to grow even more, leaving the urethra tighter. To counter this problem, the bladder may perform a greater effort to push the urine  out of the body. 
    The strong contraction could make the bladder more sensitive and could signal to the brain that it is full, even when it contains only a small amount of urine. 
    This causes frequent urination (frequent urination ) – another characteristic symptom of enlarged prostate. 
    This symptom is accompanied by a sudden urge to urinate , especially at night ( Nocturia ).
  • In some people with enlarged prostate, the urethra can become so tight that the bladder does not empty completely and there remains a little urine inside. This causes a feeling of incomplete evacuation .
  • Among the consequences of an enlarged prostate there is also  incontinence .
  • In case of acute prostatitis, the patient may also have fever , abdominal painand back pain .
  • The blood in the urine is not usually caused by BPH, it is more likely that the cause is a tumor.

Most people may assume that the prostate is related to the severity of the symptoms. 
Studies have revealed that some men with a greatly enlarged prostate have minimal urinary symptoms. 
However, some people with a slight enlargement have the worst symptoms. 
Source : Pathophysiology of benign prostate enlargement and lower urinary tract symptoms: Current concepts – Cheng-Ling Lee and Hann-Chorng Kuo – Ci Ji Yi Xue Za Zhi. 2017 Apr-Jun; 29 (2): 79-83.

In addition, it has been noted that about half of men with this disease have such irritating symptoms that they sought a doctor. There are men whose symptoms show a gradual reduction and improve over time. 
Many men are concerned about having an erectile dysfunction , but hyperplasia does not affect erection or libido . 
Riding bicycle causes inflammation because the person is sitting for hours on the bike. The consequence is difficulty in urinating, but it does not promote hyperplasia.

 

Complications of enlarged prostate

Enlarged prostate that is not treated can cause:

  1. Urinary Tract Infections ,
  2. Stones in the bladder,
  3. In rare cases damage to the kidneys.

Because of these complications, the affected person may experience other symptoms than those mentioned above.

 

Diagnosis of prostatic hyperplasia

Prostate Examination
The prostate is located in front of the rectum, so the easiest way to explore the prostate is to insert a finger into the rectum. 
Prostate exploration is indicated:

  1. In people over 50,
  2. When the doctor suspects a prostate disease.

The holding is performed with the index finger, the patient is on his back with his legs flexed and away. 
The doctor should evaluate the presence of hemorrhoids . 
Palpation is uncomfortable and may stimulate urination, but it is not painful if the patient does not have a prostatic inflammation. 
Rectal examination results 
Your doctor may find:

  1. An enlarged prostate ,
  2. Of the nodules that may indicate a neoplasia,
  3. painful area in case of infection ( prostatitis ).

The presence of hard nodules or sunken regions is considered abnormal. 
Soon, the doctor can prescribe more tests. 
However, most of the nodules that are felt during rectal exploration are calcificationsand do not have an evil meaning. 
In addition to methods for direct measurement of the prostate, blood tests are performed to:

  1. Check the amount of a special protein produced by the prostate (PSA).
  2. Measure creatinine (serum creatinine concentration), which is higher than normal in the event of kidney malfunction.

There are other types of tests:

Prostate specific antigen (PSA) test : Prostate specific antigen (PSA) is a protein produced by the prostate. In diseases such as prostate cancer and prostatitis, the level of PSA is high. 
Therefore, it is an important parameter to know the pathological conditions of the prostate. 
However,

  1. PSA values ​​are not a reliable indicator,
  2. The importance of this data depends on the results of other examinations.

Transrectal echography : In this procedure, a device that emits sound waves (known as TRUS) is inserted into the rectum. Therefore a gel is applied on the  ultrasound probe which is covered by a sheath. 
From the reflected sound waves, an image of the prostate is created. 
suprapubic ultrasonography (through the abdomen) does not show clear images such as trans-rectal.

Urofluxometry – This test is used to assess urine flow, showing the amount of urine emitted in one second.

cystoscopy is a test used to visualize the inner surface of the bladder. 
This test is useful for understanding the severity of the obstruction:

  • From the urethra,
  • From the lap of the bladder.

Prostate biopsy

This is an endoscopic examination in which the doctor inserts a rigid and flexible tube (cystoscope) into the bladder through the opening of the urethra into the penis.

Prostate biopsy : If a patient’s digital rectal examination reveals abnormalities and PSA is high then a biopsy is performed to confirm a suspected diagnosis. 
A sample of prostatic tissue to be analyzed in the laboratory is collected with the aid of a transrectal ultrasound (TRUS).

 

 

 

 

 

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