Benign Prostatic Hyperplasia/Benign Prostatic Hyperplasia Treatment
During childhood, the prostate gland is quite small—just a little larger than a pencil eraser. Its growth and functioning are con-..trolled by the male hormone testosterone, which at puberty facili-tates not only prostate growth, but growth of sex organs and body hair, as well as change of voice. By the time a man reaches age twenty, his prostate gland has achieved full size. However, after age forty it begins to enlarge. This growth is hormone induced. While testosterone levels have begun to decline by this stage of life, production of one of its metabolites, dihydrotestosterone (DHT), increases.
The enzyme that converts testosterone to DHT is testosterone 5-alpha reductase. DHT levels increase within prostate cells as a result of increased activity of this enzyme, as well as a greater uptake of testosterone and a lower rate of breakdown and excretion of DHT. This increase is associated not only with prostate enlargement, but also with male pattern baldness, because 5-alpha reductase is partly concentrated in the scalp. The enzyme is also found in scrotal skin and in the testicles. It appears that the aging process brings on both the decline of testosterone production and the increased conversion of testosterone to DHT. An increase in this conversion is what gives rise to growth of tissue in the prostate gland.
Benign prostatic hyperplasia (BPH) is the nonmalignant en-largement of the prostate gland that primarily affects men over fifty. The incidence of the disorder increases with age. By age fifty, approximately 30 percent of all males in this country will begin to experience the symptoms of BPH. By age sixty, half will be affect-ed. Beyond the age of seventy; almost 80 percent of all males will develop the disorder. And, by age eighty, almost every man in the United States will have BPH. It is the main problem treated by urologists. Some consider it to be a natural consequence of aging. Prostate enlargement results in urethral constriction and the development of BPH symptoms, including weak stream of urine, dribbling, progressive frequency urgency, hesitancy and intermit-tence of urination. It’s a condition that can be painful. Men with prostate enlargement often have to get up three to five times a night to urinate. In 2 to 3 percent of BPH cases, urinary inconti-nence results from instability of the outer muscle layer of the blad-der, known as the detrusor muscle. Any man experiencing these symptoms is strongly urged to consult a physician for a definitive diagnosis.
If left untreated, the condition can result in complete blockage of the bladder outlet, causing uremia, or urine retention in the blood. Benign prostatic hyperplasia can lead to cancer. An estimated 20 percent of those with BPH will develop prostate cancer. While prostate cancer was relatively rare before 1900, it is increasingly prevalent today. Like BPH, it is most common in later years. Only 2 percent of all prostate cancers occur in men under fifty. (Testicular cancer, on the other hand, is most common in the younger age groups, primarily affecting those men between fifteen and thirty-four years of age.) In 1999 alone, 200,000 cases of prostate cancer were diagnosed, with thirty-eight deaths resulting from it.
Benign Prostatic Hyperplasia Treatment With Conventional Treatments Surgery
Conventional Treatments Surgery is the most commonly recommended treatment for BPH. There are three different surgical procedures, but transurethral resection of the prostate (TURP) is the surgery performed on 95 per- cent of all patients. Four hundred thousand of these procedures are done each year. In fact, it’s the most common surgery performed on men over sixtv-five. TURP involves removal Of the central Core of the gland to take pressure off the urethra.
A significant complication in this surgery is excessive absorption of irrigating fluid that causes what is known as TURP syndrome, characterized by nausea, vomiting, and mental confusion. Left untreated, TURP syndrome can lead to high blood pressure, heart failure, and seizures-I The surgery claims a 90-percent success rate. However, according to Dr. John Weinberg of Dartmouth Medical School, the death rate has been as high as percent (one death per fifty-six procedures), 8 percent are hospitalized within three months because Of complications, 5 percent (one out Of twenty) become impotent, and about 20 percent (one out Of five) will need another resection.
The drug considered to he most effective in controlling BPH symptoms acts by blocking the conversion of testosterone to DHT_ The drug firmsteride (Proscar) does this by inhibiting the enzyme testosterone 5-alpha reductase. Proscar has been on the market for only about three years. It works slowly, taking approximately three months to accomplish maximum shrinkage (about 28 percent). It must be taken indefinitely and, like most drugs, Proscar has sirable side effects. These can include impotence and decreased libido. The medication is also costly—several dollars per day. Even so, annual sales are expected to top $1 billion dollars this year. The cost Of hospital care and surgery for BPH in the United States is also Over $1 billion dollars per year. Fortunately, a less expensive, less invasive, safer, and more effective approach to BPH manage- ment may be found in nature’s pharmacy.