Benign Prostatic Hyperplasia (BPH) in Men

Study Notes

BPH occurs in men over 50 years old, with 50% of men showing histological evidence by the age of 60.
Lower urinary tract symptoms (LUTS) associated with BPH include:
Voiding symptoms: hesitancy, poor flow, intermittent stream, and dribbling
Storage symptoms: frequency, nocturia, urgency, urge incontinence, and nocturnal incontinence
BPH is the most common cause of bladder outflow obstruction in men over 70 years old.

Acute retention in fit men without other causes (e.g., drugs, constipation, recent operation)
Chronic retention and renal impairment: residual urine of 200 mL or more, raised blood urea, hydroureter, or hydronephrosis
Complications of bladder outflow obstruction: stone, infection, and diverticulum formation
Haemorrhage: venous bleeding from a ruptured vein overlying the prostate may require prostatectomy
Elective prostatectomy for severe symptoms: increasing difficulty in micturition, frequency, and poor stream

Carcinoma of the prostate is the most common malignant tumor in men over 65 years old
Screening for prostate cancer involves measurement of PSA (prostate-specific antigen)
Local spread: locally advanced tumors tend to grow upwards to involve the seminal vesicles, bladder neck, and trigone
Spread by the bloodstream: particularly to bone, with the pelvic bones and lower lumbar vertebrae being the most frequently involved sites

Men are often asymptomatic, with detection occurring through opportunistic PSA testing
Cancer may be detected in men describing lower urinary tract symptoms or presenting with symptoms of metastatic disease
Clinical features: BOO, pelvic pain, haematuria, bone pain, malaise, ‘arthritis’, anaemia, pancytopenia, and renal failure

Treatment options depend on stage of disease, life expectancy, and patient preference
Prostate-specific antigen, digital rectal examination, and biopsy Gleason grade are used to predict pathological stage
Localized cancer can be treated by radical prostatectomy, radiation therapy, and active monitoring
Treatment of advanced disease is palliative, with hormone ablation being the first-line therapy

Acute prostatitis is common but underdiagnosed
Usual organisms responsible: Escherichia coli, Staphylococcus aureus, Staphylococcus albus, Streptococcus faecalis, Neisseria gonorrhoeae, or Chlamydia
Infection may be haematogenous from a distant focus or secondary to acute urinary infection