Understanding Prostate Disease All There Is to Know Every man is worried about prostate diseasewith good reason. More than half of all men over the age of 50 have at least one prostate problem! With today's technology, more men are being diagnosed with prostate problems than ever before. Yet few men have the latest information or practical understanding of the various forms of prostate disease. Understanding Prostate Disease solves that problem. A complete prostate reference book, it explains such diverse conditions as prostatitis, benign prostatic hyperplasia (BPH), and prostate cancer, and discusses every aspect of prostate disease and how to deal with it. Written by the renowned People's Medical SocietyAmerica's largest nonprofit consumer health advocacy organizationUnderstanding Prostate Disease is the only book you'll need to be fully informed and empowered. In clear, easy-to-understand language, Understanding Prostate Disease goes well beyond the basic condition descriptions. You'll learn:
- The most common and important prostate problem symptoms
- When to consult a doctorand the best type of doctor to see
- Everything you need to know about prostate screening tests. Are they accurate? (You may be surprised by what is revealed.)
- The most effective treatments. What works? What doesn't? And what's effective at your age?
- How to prevent prostate problems
- Which alternative and complementary therapies are most effective
- Ways to make sure your health insurance covers your treatmentand what to do if they say no
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People's Medical Society
Understanding Prostate Disease
- 3 -
All About Benign Prostatic Hyperplasia
BENIGN PROSTATIC HYPERPLASIA (BPH) MEANS DIFFERENT THINGS to different people.To health professionals, benign prostatic hyperplasia is a noncancerous enlargementof the prostate gland. (In medical lingo, the term hyperplasia refers to anincrease in the number of normal cells in an organ or tissue, so that the organ ortissue grows in size.)
To men with BPH (as we'll call it from here on), the condition is more personalthan any definition can convey. BPH may mean repeated nighttime trips to the bathroom,annoying drips and drabs of urine at inopportune times, or a nagging feeling thata visit to the men's room is necessary. If BPH progresses, it may partly or completelyblock urination. In its least common, most serious forms, BPH invites kidney damageand failure.
Unfortunately, there's no denying that BPH is a common condition, though mostsufferers face only mild symptoms. It's been said that BPH accounts for urinary problemsin about 10 million men in the United States over age 50. According to the NationalCenter for Health Statistics, each year the condition is responsible for 1.7 milliondoctor's office visits and some 400,000 operations. The good news is that more canbe done today than ever before to help slow the progression and treat the symptomsof BPH.
What Is BPH?
In BPH the prostate is actually growing. When a boy is born, his prostate is aboutthe size of a pea. It grows very slowly until puberty, when there's a period of rapidgrowth that continues for several years, until the prostate reaches its normal adultsize. It remains that size until about age 40 or 45. At that point the prostate beginsto grow again and continues growing until death.
On average, it might grow as large as 33 grams, or 1.5 ounces. That's fairly small.Still, it's an increase of 50 percent over the prostate's normal size. (The largestreported prostate size in a man with BPH was 1,058 grams, but that's the stuff ofmedical case studies.)
BPH is not cancer. As the term itself says, the condition is benign, not malignant.If you looked at both normal prostate tissue and BPH tissue under a microscope, you'dsee that BPH tissue generally has more glandular tissue and less muscle and connectivetissue. But for all practical purposes, there's no difference between the two kindsof tissue.
Even so, prostate growth means trouble. As they say in real estate, it all comesdown to location, location, location. Because of its placement in the body, an enlargedprostate can have a stranglehold on the urethra.
Think of the urethra as a straw that runs from the bladder to the end of the penis,draining urine from the body. BPH begins right up against the wall of the prostaticurethra (the part of the urethra that pa sses through the prostate). If growth isoutward, away from the urethra, or even if the prostate becomes as large as a tennisball, it's not a problem. But if the new growth is inward, the prostate presses inon the urethra, squeezing it and making urination increasingly difficult.
Incidence of BPH
BPH is very common, and becoming more so all the time as life expectancy rises.It's been called the disease of old men--one of the most famous prostate patientsin recent years was President Ronald Reagan, who, at the age of 76, had surgery forBPH in 1987--but it afflicts plenty of not-so-old men too.
Statistically, the odds of a man developing BPH are quite high. However, in theflurry of numbers, it might sound as though any man who lives long enough to growa few gray hairs is doomed. So it's useful to distinguish between an obstructiveprostate and one that's merely enlarged. Autopsy studies show that more than halfof all men who are age 50 or over and about three-quarters of men who are age 70or over have BPH. By age 80, the incidence is even higher.
That doesn't mean that the men died from the condition--just that it was presentwhen they died. It also doesn't mean that the enlargement was progressive or thatthey had any symptoms. Stephen N. Rous, M.D., estimates in The Prostate Book thatbetween one-quarter and one-half "of those men who have anatomic changes ofBPH will also have the symptoms which will send them to their physicians." Thataverages out to about one in six men over age 50 and about one in three over age70. That's a minority, but it's still a big number.
Causes of BPH
Two groups of men ar e impervious to BPH, and their characteristics provide uswith a lot of information about the causes of BPH and how it might be treated.
One group includes men who've been castrated--that is, they've had their testiclesremoved surgically or shrunk by taking female hormones such as estrogen andno longer produce testosterone. These men's immunity to BPH led doctors yearsago to the conclusion that enlargement of the prostate gland is somehow related tothe production of testosterone.
About 100 years ago, in fact, men with obstructive BPH were sometimes castratedas a way of relieving their symptoms, and doctors boasted that their patients improvedat rates of 80 to 87 percent. Once surgical remedies were introduced, castrationwas out.
The second group consists of men who have normal tes-tosterone levels but in whomBPH just does not develop. Not only do these men have small prostates throughouttheir lives, but their prostates actually decrease slowly in volume as they age.Although in other ways the men are normal, they have less facial and less body hairthan the average male, and they don't grow bald.
It's been found that these men have a genetically linked deficiency of an enzymecalled 5-alpha-reductase. That enzyme converts testosterone into a more activeandrogen, or male hormone, called dihydrotestosterone (DHT). Becausethey lack this enzyme, testosterone cannot be converted into DHT.
Because men who lack DHT don't suffer from BPH, many experts believe this hormonehas much to do with the development of an enlarged prostate. The concentration ofDHT in the normal prostate and in seminal vesicles is much higher than in other tissues.And DHT co ncentrations in BPH tissue that's removed during surgery are higher thanthose seen in normal prostate tissue. Moreover, in test-tube studies, DHT has beenshown to stimulate hyperplasia in prostate cells.
Most animals lose their ability to produce DHT as they age. Men produce less testosteroneas they age, but they continue to produce and accumulate high levels of DHT in theprostate.
The belief is that DHT is transported to the nuclei of the prostate cells, whereit sets off a cascade of events that ultimately stimulate the production of proteinscalled growth factors. These factors act on prostate tissue to cause the enlargementknown as BPH. Studies have shown that BPH tissue has more growth factors than normalprostatic tissue.
In addition to testosterone, it's believed that estrogen may also be a causativefactor in BPH. Men's bodies normally make a certain amount of estrogen, which, alongwith testosterone, stimulates normal prostate tissue. As men age, they produce lesstestosterone and relatively more estrogen. Studies done with animals suggest thatthe higher amounts of estrogen in the prostates of older men may increase the activityof substances that make the cells grow.
No strong evidence exists that BPH runs in families. In other words, it's probablynot hereditary in the traditional sense. However, some researchers think BPH maydevelop as a result of genetic programming--"instructions" given to cellsearly in life. In this theory, BPH occurs because cells in one section of the glandfollow these instructions and "reawaken" later in life. These "reawakened"cells then deliver signals to other cells in the gland, instructing them to growor mak ing them more sensitive to hormones that influence growth.
Another theory on the cause of BPH involves the tissue of the prostate. Some scientistsbelieve that, in addition to hormonal factors, the nervous system is sending messagesto tighten up the prostate's muscle tone. And that means increased pressure on theurethra.
Here's how. As much as 60 percent of the prostatic tissue in people with BPH isstroma--that is, tissue that makes up the framework of the gland--and a substantialportion of stromal tissue is made up of muscle. Under an electron microscope, thestromal tissue appears to have larger cells than the prostatic tissue of men whodon't have BPH.
Some scientists believe that receptors in the stromal tissue respond to signalsfrom the nervous system and heighten prostatic muscle tone. One group of researchershas suggested that as much as 40 percent of the urethral closure pressure in menwith BPH is due to stimulation of prostatic muscles.
Risk Factors for BPH
There is little that can be done to prevent BPH from developing. Apart from testosterone,researchers haven't identified any special risk factors in men who eventually developBPH. They can't blame the usual suspects, such as smoking, caffeine, or obesity.Sexual habits and previous infections don't seem to make any difference. About theonly practice that has been clearly implicated in the development of BPH is the useof anabolic steroids by athletes and others who are active in bodybuilding.
One study did find that the risk of BPH seemed to decrease among men who drankbetween two and four beers a day. Before you head out for a six-pack, however, youshould be aware that ther e's no clear cause and effect. The study questioned menwho'd already had surgery for BPH, so it's possible that they changed their drinkinghabits after their conditions developed. Or drinking may correspond to other factorssuch as diet.
Experts are not sure if diet has an impact on the risk of BPH, and there are nohard data to say it does. It's worth noting, however, that the incidence of BPH amongAsian men has historically been very low and has risen significantly as the men havemoved to the West or changed their traditional lifestyles. Since Asians tend to havea low-cholesterol, low-fat diet, American men who want to avoid BPH (not to mentionheart disease and other health problems) might wish to follow their example.
Having BPH does not increase your risk of prostate cancer. It's true that thetwo often appear together, but that's only because both diseases are fairly commonin older men. Men with enlarged prostates subsequently develop cancer at the samerate as men with normal-size glands do.
When men have surgery for BPH, a procedure we describe in the next chapter, thetissue removed is routinely checked for hidden cancer cells. In about one out of10 cases, some cancer tissue is found. Often, however, it's limited to a few cellsof a nonaggressive type of cancer, and no treatment is needed.
Symptoms of BPH
A number of symptoms are associated with BPH. Generally, they arise at differentstages of the condition. But even if your prostate enlarges to the point where youneed to seek surgical or other treatment, you won't necessarily have all the symptoms.And even if you have all the symptoms, you don't necessarily have BPH.
Now that you're f orewarned, here's a list of what you can expect:
- More frequent urination, especially at night
- Some difficulty beginning urination
- A urine stream that's weak and thin
- Difficulty stopping urination abruptly, often followed by a persistent "dribbling"
- A feeling that you need to urinate urgently
- A feeling that your bladder hasn't completely emptied
- Urinary retention (inability to urinate)
Blood in the urine is another common symptom. In fact, BPH is one of the mostcommon causes of hematuria in men over 40. You can develop hematuria when the urethralblood vessels and the bladder neck get stretched so much by the growing prostatetissue that they burst.
If a very small blood vessel ruptures, there may be only a microscopic trace ofblood in the urine. But if it's a larger blood vessel, the urine will turn pink orred. It's rare but possible for a severe hemorrhage to take place. When that happens,you've got to take care of the condition immediately--seek emergency care.
The Progression of BPH
BPH is a progressive disease, meaning that it slowly grows worse. When BPH firstbegins, you probably won't realize that your prostate is growing. The condition developsso gradually that it's generally years before you realize there's a problem.
As the prostate grows, it begins to encroach on the urethra. Initially, the bladdercompensates for the narrowed urethra by contracting more forcefully than before topush urine through. To do this, the bladder muscle--like any muscle that has to workovertime--thickens, particularly just inside the bladder neck and on the floor ofthe bladder.
As long as the bladder muscle can overcome the resistance put up by the growingprostate and narrowed urethra, the bladder can empty itself every time you go tothe bathroom. In this stage, your bladder is said to be compensated, and youdon't have any symptoms of BPH.
Symptoms set in during the months and years after the onset of BPH. As the bladdermuscle builds and thickens, the floor of the bladder becomes more sensitive to thepresence of urine. As a result, you feel the need to urinate more often. Most mennotice this initially at night, when they're awakened by the need to go to the bathroom,so the symptom is called nocturia.
As a rule, your bladder can accommodate about 5 ounces of urine before you feelthe need to void. When you're sleeping, you can generally tolerate even more thanthat without waking up. Furthermore, when you're asleep, the amount of urine yourkidneys produce--generally about 2 ounces each hour when you're awake--falls off.That's why most people can sleep a full eight hours without going to the bathroom.
Once nocturia begins, however, considerably less than 5 ounces will sound nature'scall. As the bladder grows more and more sensitive, you'll wake up once, twice, fivetimes a night.
Of course, this sensitivity doesn't end when the sun rises. You'll probably feelthe need to urinate more frequently during the day too. But that's a feeling peoplecan ignore more easily when they're up and about. It's when you're sleeping, evenwhen you're dreaming, that your brain pays prompt attention.
As BPH progresses, you'll probably start to notice the condition during the dayas well. This usually occurs when y our bladder can no longer push effectively pastthe obstructing prostate. Because the bladder muscle is straining against the resistanceof the prostate, you'll start noticing that it takes several seconds to a coupleof minutes for your urine flow to start. When the stream finally starts, it's "hesitant"and weak. This condition is called hesitancy.
You're particularly likely to run into this situation if you've waited a longtime to urinate. Maybe you've been on a long car trip, or you've refused to budgefrom your seat during an especially riveting football game. Your bladder may becomeoverstretched, and since it has gradually lost its tone, it contracts only weakly.
As BPH progresses and the muscles of the bladder continue to build, complicationsmay occur. For example, bands of scar tissue, called trabeculations, eventuallybegin to form in the bladder wall. In more advanced cases of BPH, weaker areas ofthe bladder wall between the areas of trabeculation begin to bulge outward, creatinglittle sacs or pouches called cellules.
Eventually the cellules balloon and form small pouches, called diverticula,that can trap urine and become a home for bacteria. If you've developed trabeculationsand diverticula, you may still have urinary problems even after you've been treatedfor BPH.
Urinary problems may also persist if your bladder muscle has deteriorated to thepoint where it's permanently weakened. In that case, you can expect to continue tohave a problem with urinary retention.
As the bladder muscle starts to weaken, an annoying phenomenon that doctors callintermittency--what most men refer to as dribbling--occurs. As the obstructiongro ws, your bladder eventually can't empty itself completely with a single musclecontraction. Your stream of urine stops before your bladder is empty. Seconds laterthe muscle contracts a second time, weakly, and the stream starts again.
Sometimes this occurs near the end of the stream. You think you're through urinating,so you zip up. Then a few drops to an ounce or more of urine may dribble onto yourunderwear.
As the condition progresses, the bladder becomes decompensated. It can'tempty, even with a second contraction, so some residual urine is always present.(Under normal conditions, a bladder empties itself almost completely.)
Once the residual urine in the bladder reaches 3 or 4 ounces, you notice thatit's only a short time after voiding that you feel the need to void again. You maybe voiding every 30 minutes to two hours. You may also become unusually susceptibleto bladder or kidney infections. The collecting urine is stagnant, so it's a perfectculture for growing bacteria. If this happens, you begin to feel burning pain whenurinating. Often your urine acquires what some people call a barnyard smell. In addition,some men develop bladder stones. Sometimes they're extremely painful, and sometimesso insignificant they aren't bothersome at all.
As the residual urine builds up to a pint or more, there's no room left in thebladder for new urine coming down from the kidneys, and urine involuntarily leaksfrom the urethra, usually when you're asleep. This is an advanced stage of BPH.
Having all that urine in the bladder is uncomfortable and potentially dangerous,and complications can occur. If urine can't leave the bladder through the urethra,eventually reflux pr essure backs the urine into the kidneys. That makes itimpossible for the kidneys, which should be filtering and removing various wasteproducts from the body, to do their job. This condition can result in kidney damageand, more rarely still, kidney failure. A condition called uremic poisoningcan result, which, if left untreated, can lead to coma and death.
Uremic poisoning can be prevented by regularly monitoring kidney function. Doctorsrecommend that all men with BPH get a blood test as part of their yearly checkup,to determine how well their kidneys are functioning. The test reveals your levelsof creatinine and urea nitrogen, two of the waste products that thekidneys are supposed to flush constantly out of your blood. If the creatinine levelis abnormally high--which may occur if you've had a major problem with residual urinefor a long time--that usually means the kidneys have already been damaged.
If the kidneys continue to function and if the condition isn't too severe, somemen can live with urinary retention indefinitely. But other men eventually arriveat a painful state called acute urinary retention. That's when they're completelyunable to urinate.
Acute urinary retention can be brought on suddenly in men with only moderate BPHwho take over-the-counter cold remedies or allergy medicines. Cold and allergy medicinesmay contain antihistamines, which block nerve impulses. Other cold and allergy medicationscontain a decongestant drug known as a sympathomimetic, which may, as a sideeffect, tighten the bladder neck and make it difficult to urinate. (These medicationsdon't usually have this effect on younger people.)
When there's a partial obst ruction, urinary retention can also be brought on byalcohol, cold temperatures, or a long period of immobility, such as being confinedto a bed or wheelchair or simply sitting for several hours.
Acute urinary retention is treated at a doctor's office or the emergency departmentof a hospital. The condition can be alleviated easily and quickly; a doctor insertsa catheter into the penis to drain the urine directly from the bladder. Relief isimmediate. If you haven't urinated for 12 hours or more, as much as 4 quarts of urinemay pour out.
In most cases, urinary retention occurs long after BPH has been diagnosed. Thereare times, however, when it might take a man by surprise. It's hard to believe, butvery occasionally a man may not be aware he has an obstruction until it becomes completelyimpossible for him to urinate.
This condition--the combination of acute urinary retention and asymptomatic obstruction--iscalled silent prostatism. For several days before the crisis develops, asthe man's kidneys fail, he may become extremely weak, sleepy, and irritable. Withoutwarning, he may suddenly become comatose. Unless he has his bladder drained immediately,he can die.
One explanation for why you may have an obstruction and not know it is that BPHcan develop so gradually that you can get used to the symptoms to the point whereyou can't remember when you didn't have them. Or maybe you're denying the problembecause you don't want anybody tinkering with that part of your anatomy.
Diagnosing and Evaluating BPH
Not every urinary problem can be attributed to BPH. All the symptoms we've listedabove, particularly residual urine, often occur in elderly wo men. Obviously, theycan't blame the prostate for their conditions.
The symptoms that are characteristic of BPH can also be caused by urethral strictureor scarring, bladder problems, inflammation, infection, or other conditions, suchas neurological disorders. Diabetes also can lead to frequent urination and can interferewith sexual performance. It's not unusual for a man to think he has prostate problemswhen he's really showing signs of diabetes. The same problems can also be causedby some of those medications we mentioned earlier, such as antihistamines or decongestants,that can interfere with bladder function.
The point we're trying to make here is that it is important to seek out a diagnosisif you have urinary problems. If there's a possibility that you have any of the conditionswe just mentioned, particularly if you're under 55, you should have a series of diagnostictests to determine bladder function. The prostate isn't always to blame, either.For example, according to several studies, about one-third of men who are told thattheir incontinence is due to prostate enlargement actually learn from urodynamicstudies that there's an altogether different cause.
Doctors can pinpoint BPH and evaluate its progression in a number of ways. Theystart by taking a history that includes information about your sexual habits. Theywant to know, for example, whether you've ever had a sexually transmitted disease,which can result in symptoms similar to those seen in prostate disorders. They alsowant to know how often you urinate and whether there's been any change in the pattern.
Because it's hard to give more than a subjective account, you can help the diagnosticprocess by monitoring your urinary habits and symptoms before the visit. On a sheetof paper, write down four urinary symptoms (you can take any of the several symptomswe enumerated earlier). Each day put a check for each time the problem occurs. Afterone week you'll have a factual record to present to the doctor.
A physical exam also helps to diagnose BPH, though it is not as valuable as otherdiagnostic methods. In such an exam, the doctor may press down on your bladder todetermine whether it's full of urine and distended. He's also likely to do a rectalexam, though that's of limited use in detecting BPH. The rectal exam indicates whetherthe prostate is enlarged but not whether it's causing urinary symptoms. You see,the part of the prostate that generally causes obstruction is the middle lobe, orcentral zone, and that's what tightens around the urethra. Unfortunately, that'sthe part that can never be felt during a rectal exam.
Another problem with the rectal exam is that the overall size of the prostatedoesn't necessarily indicate the stage of BPH. As a rule, the size of the prostatedoesn't reflect how severe the obstruction is. Some men with greatly enlarged prostateshave little obstruction and few symptoms, while others whose glands are less enlargedhave more blockage and greater problems.
To find out more, the doctor will probably do a urinalysis and urine culture tolook for infection. The presence of red blood cells suggests problems in the urinarytract, such as stones or tumors, but it may also indicate BPH. White blood cellsor pus may indicate infection or inflammation in the kidneys, the bladder, or theureters, the tubes that carry urine between the two organs.
He may a lso conduct a urodynamic evaluation, which may consist of a urine flowtest and a residual urine test. To measure urine flow, he'll use either a machinecalled a uroflometer or just a stopwatch and a measuring container; you'llcontribute a full bladder. The doctor will measure what you think is your strongestflow, and compare it with the standard flow rate for your age group. Men over 60should have a flow rate greater than 13 milliliters per second, for example, comparedwith 22 milliliters per second for men under 40. A slow flow rate may indicate BPH,but it may sometimes be due to weak bladder muscles, not to prostate problems. Othertests may be necessary.
One such test, for residual urine, is done with a bladder catheterization.After you've emptied your bladder (or think you have), the doctor inserts a catheterinto the bladder for a few minutes to measure the amount of residual urine. In theory,the more residual urine, the greater the need for treatment of BPH. However, residualurine can also indicate a weak bladder muscle.
One other note regarding bladder catheterization: When most people hear the wordcatheter, they tend to think of the Foley catheter. However, the catheterused here is a simple "in-and-out" catheter, not a Foley catheter, whichis designed to be left in the bladder for long periods of time and stays inside withthe help of an inflatable bag that catches on the bladder neck. There are many differentreasons for using Foley catheters, but in the case of BPH, they're normally insertedwhen the prostate is so large that a man can't urinate at all. As a rule, the Foleycatheter remains only until the obstruction is resolved. But it may remain indefinitelyif the patient refuses to be treated or his medical condition is so poor that he'sconsidered a poor risk for surgery.
Blood tests may be performed as part of the diagnostic process as well. Althoughthere aren't any blood tests for BPH, there are tests for related conditions. We'vealready mentioned the blood tests for kidney function. There are two other bloodtests, for prostatic acid phosphatase (PAP) and for prostate-specific antigen(PSA) levels, that are routinely performed on men being examined for BPH. The primarypurpose of both these tests is to detect prostate cancer. You can expect some bloodtests during the exam and certainly before any surgery takes place. We describe thePSA test at greater length in Chapter 5. Let us just say here that the results ofthe PSA test must be handled with care. Men with enlarged prostates tend to haveelevated PSA readings, which can also indicate the presence of prostate cancer. Soif you have a high PSA level, you may be subjected to other tests--and a lot of worry--untilit can be determined that the only problem is BPH.
X-rays may also be used at times. Some urologists take an excretory urogram,also known as an intravenous pyelogram (IVP) or intravenous urogram (IVU),which provides a lot of information about the entire urinary tract. It's performedby injecting (into a vein in the forearm) a dye that concentrates in the kidneysand appears white against the dark background of an x-ray.
The dye's passage through the system over the course of half an hour is recordedon a series of films. The test shows how well a patient empties his bladder, revealsany obstruction to the drainage of the kidneys, and even in dicates the size of theprostate through a shadow it casts within the bladder. However, there's a major drawbackto IVPs. People have had serious--and occasionally even fatal--allergic reactionsto the dye. One explanation may be that iodine is the base of some of the injectedmaterial. It's almost impossible to predict who will have a bad reaction, so an alternativedye has been developed. Because it's extremely expensive, many urologists preferto use other tests.
Other tests that might be done if you're being examined for BPH include renalscans and ultrasound. Renal scans, produced after injecting a very smallamount of radioactive material, give a picture of the kidneys. So does ultrasound,a totally noninvasive procedure that is generally considered one of the safest tests.But while ultrasound can help estimate the size of the prostate, it doesn't helpyou or your doctor decide whether surgery or other treatment is actually needed.That's because prostate size isn't an indication of the extent of obstruction.
A cystoscope lets a doctor see the degree of obstruction in the prostatic urethraand estimate the size and weight of the obstructing prostatic tissue. This test helpsdetermine how best to treat BPH if surgery is recommended. The doctor will also beable to measure any residual urine that may be present, since the urine will comeout through the cystoscope after it has entered the bladder. The test also showschanges in the bladder, such as the trabeculations we spoke of earlier. But the testcannot determine whether you actually need treatment for BPH--that is, whether theobstruction is bothersome. That's up to you.
While none of the tests and examinations we've described is conclusive alone,as a group they can confirm a diagnosis of BPH. They can also help determine theextent of the enlargement and evaluate its effect on your urinary health. Once youhave this information in mind, you can use it to sort out your treatment options--thesubject of our next chapter.
Table of Contents
Chapter 1: A Primer on the Prostate.
Chapter 2: Dealing with Prostatitis.
Chapter 3: All About Benign Prostatic Hyperplasia.
Chapter 4: Treatment for Benign Prostatic Hyperplasia.
Chapter 5: Understanding Prostate Cancer.
Chapter 6: Treatment of Prostate Cancer.
Informational and Mutual-Aid Groups.