Enlarged Prostate
By Rear Adm. Joyce Johnson

My doctor told me my prostate is enlarged and that I have benign prostatic hypertrophy. Does this mean I have cancer? What treatment should I have?

First, "benign" means that it is not cancer. Hypertrophy or hyperplasia means there is an increase in tissue growth, which is normal.

When men age, their prostate typically enlarges — a condition called benign prostatic hypertrophy, benign prostatic hyperplasia, or BPH. About half of all men over age 60 have some signs of BPH.

When the prostate is enlarged, it compresses the urethra, the tube that delivers urine from the body. Men with BPH often have signs indicating obstruction, such as difficulty initiating urination, a dribbling stream, frequent urination (especially at night), feeling that the bladder is never empty, and urinary tract infections.

BPH usually is detected from a patient's history and a medical exam. An enlarged prostate can be felt during a digital rectal examination. A urinalysis can check for infection or bleeding. A PSA (prostate-specific antigen) test can screen for cancer. Other tests may include a cystoscopy, where a tube with a scope is inserted into the urethra to view the prostate and bladder. A urogram checks the bladder's ability to empty itself. An ultrasound assesses the kidneys and bladder.

Once BPH has been detected, treatment depends on the symptoms. Minimal symptoms require no specific treatment, and "watchful waiting" may be advised.

Surgery is another option. There are many procedures; transurethral resection of the prostate is most common. Under anesthesia, a fiber-optic tube guides the surgeon through the urethra to remove excess tissue. A simpler procedure, generally limited to men with small prostates with minimal obstruction, is the transurethral incision. A new procedure, the transurethral needle ablation, uses radio frequency energy to destroy excess tissue. The most invasive procedure is the open prostatectomy, where the obstructing inner part of the prostate is surgically removed. Only 5 percent of patients with BPH have open prostatectomy.

Patients with minimal symptoms or with other conditions that make surgery too risky may be treated with medication to shrink the prostate or relax the prostate muscles.

For information on BPH, contact the American Foundation of Urologic Disease at (800) 242-2383 or the Department of Defense's Center for Prostate Disease Research. Both can be accessed on the Web through TROA's links page, www.troa.org/magazine/links.asp.

Rear Adm. Joyce Johnson, D.O., M.A., is director, health and safety, U.S. Coast Guard, and assistant surgeon general, U.S. Public Health Service.