Benign Prostatic Hyperplasia: Overview and Risk Factors
Benign prostatic hyperplasia (BPH) is an overgrowth of prostate cells. It is the most common benign tumor in men. It is not a cancer, but it can cause significant discomfort.
The risk of BPH increases with age, rising from 8 percent in the third decade of life, to 40 to 50 percent in the fifth decade, to greater than 90 percent in the ninth decade. BPH involves many factors, including testosterone, estrogen, and other hormones, but its specific causes are not yet entirely clear.
The most common symptom is obstruction of urine flow, which may result in dribbling, the feeling of having to urinate constantly, and the need to urinate several times during the night.
Risk Factors
The following factors are associated with increased risk of BPH:
- Age: BPH occurs more commonly with advancing age.
- Family history
- Obesity: Obesity, particularly abdominal obesity, may increase risk for BPH.
- Physical inactivity: The Health Professionals Study and Massachusetts Male Aging Study found lower levels of physical activity to be associated with increased risk for BPH.
Diagnosis
- The evaluation will begin with a medical history and a physical examination. During the examination, a digital rectal exam will typically detect prostate enlargement.
- Blood testing to measure prostate-specific antigen levels is usually performed.
- Prostate biopsy and/or ultrasound may be recommended to help rule out cancer and confirm a diagnosis of BPH.
Treatment
The purpose of BPH treatment is to improve the patient's quality of life.
- Observation alone ("watchful waiting") is appropriate if symptoms are mild.
- Medical treatment includes use of alpha-blockers (e.g., prazosin, terazosin and doxazosin) and 5-alpha-reductase inhibitors (e.g., finasteride). A combination of an alpha-blocker and finasteride appears to work best.
- Plant extracts from saw palmetto (Serenoa repens), the American dwarf palm, and Pygeum africanum (an African plum tree) have been shown to be effective in treating symptoms, although their mechanisms of action are not yet clear.
- Surgery may be recommended to treat severe symptoms.
Benign Prostatic Hyperplasia: Nutritional Considerations
Research studies have examined the relationship between dietary factors and the risk of BPH. The following factors are associated with reduced risk in epidemiologic studies:
- Limiting or avoiding animal products and vegetable oils: Several studies have implicated high total meat and animal product (particularly beef and dairy products) intake in BPH. The Health Professionals Follow-Up Study found that higher intakes of total protein, animal protein, polyunsaturated fatty acids, and vegetable oils were all associated with BPH.
- Soy product intake: Epidemiologic evidence shows that Asian men have a lower risk for prostate disease than their Western counterparts; the difference appears to be associated in part with higher intake of isoflavones found in Asian foods, particularly soy products.
- Lower energy intake: Some studies have shown an association between higher caloric intake and a greater risk for BPH. The Health Professionals Follow-Up Study reported a 50 percent increase in risk for BPH in men who took in the most calories compared with men who ate the fewest, as well as a 70 percent higher risk for moderate-to-severe symptoms in men consuming the most calories.
