Benign prostatic hyperplasia, otherwise known as BPH, is a condition characterised by the enlargement of the prostate gland.
The prostate gland is a small organ about the size of a walnut, and it forms part of the male reproductive system. It is located in front of the rectum, and lies below the urinary bladder – where urine is stored – in the lowest part of the abdomen.
The prostate also surrounds the urethra, the tube through which urine is transported out of the body. The urethra also carries semen from the sex glands out through the penis.
The main job of the prostate is to make fluid for semen. During ejaculation, sperm made in the testicles moves to the urethra. At the same time, fluid from the prostate and the seminal vesicles also moves into the urethra.
This mixture goes through the urethra and out the penis.
As men age, their prostates get larger, a change that is thought to be linked to changes in hormone levels. The enlarged prostate may then compress and gradually obstruct the urethra, blocking the channel for urine stored in the bladder.
Although the growth is benign, that is, it is neither cancerous nor fatal, it can cause much discomfort and pain to the sufferer – nocturia (the need to urinate two or more times per night), incontinence (leakage of urine), having a weak or painful urinary stream, or having blood in the urine, are just some of the bothersome lower urinary tract symptoms (LUTS) many BPH sufferers face.
The size of the prostate is not always correlated with the course of symptoms in BPH. Some men with greatly enlarged glands have little obstruction and few symptoms while others, whose glands are less enlarged, have more blockage and greater problems.
Research also suggests a reticence amongst men to seek medical help following the onset of BPH symptoms, with “hoping that the condition would go away” identified as the primary reason for delaying a visit to the doctor.
The cause of BPH is not well understood; however, it occurs mainly in older men. BPH does not develop in men whose testicles were removed before puberty. For this reason, some researchers believe factors related to ageing and the testicles may cause BPH.
Throughout their lives, men produce testosterone, a male hormone, and small amounts of oestrogen, a female hormone. As men age, the amount of active testosterone in their blood decreases, which leaves a higher proportion of oestrogen.
Scientific studies have suggested that BPH may occur because the higher proportion of oestrogen within the prostate increases the activity of substances that promote prostate cell growth.
Another theory focuses on dihydrotestosterone (DHT), a male hormone that plays a role in prostate development and growth.
Some research has indicated that even if a drop in blood testosterone levels occurs, older men continue to produce and accumulate high levels of DHT in the prostate. This accumulation of DHT may encourage prostate cells to continue to grow. Scientists have noted that men who do not produce DHT do not develop BPH.
Last month, GlaxoSmithKline Pharmaceutical Sdn Bhd (GSK) and the Malaysian Urological Association (MUA), in support of the Blue Cap Movement and promotion of men’s health, launched a partnership to cast light upon the symptoms of BPH in Malaysia.
The launch marks the beginning of a series of educational initiatives targeted at both healthcare professionals and members of the public, which aim to illustrate that when it comes to your prostate, bigger is not better.
“When faced with a condition such as BPH, which may make an individual feel embarrassed or even vulnerable, it is crucial to first redefine the approach that we, as men, typically take in addressing prostate-related health,” said Ramesh Balakrishnan, Business Unit Director, Classic and Established Products, GSK Pharmaceutical Sdn Bhd.
“Through this collaboration, GSK is proud to be at the forefront of men’s health to lead the national conversation about BPH and reduce the stigma associated with its symptoms.”
BPH is universally extensive, with 612 million cases estimated to occur globally by 2018.
Its prevalence has been shown to be incremental as men get older, with estimates of approximately 50% of men between the ages of 51 and 60, and up to 90% of men older than 80 being affected.
In Malaysia, similar patterns have been reported; according to a study conducted on local BPH prevalence, approximately 40% of men aged 50–59 were affected, which jumped to 65.4% of men aged 70 and above. Despite its prevalence, there is still a significant lack of awareness of the condition, with the symptoms often disregarded as an inevitable sign of ageing.
To address this, the GSK-MUA partnership’s first line of action is the facilitation of disease screening. BPH can be detected and diagnosed through the use of uroflow meters – devices that measure the amount of urine in a patient’s stream, and the speed of urination.
The initiative will distribute and implement 12 of the devices in clinics without current access to the equipment, with the onsite support of a local nursing agency to train users. Clinics currently without access will be able to apply for the initiative via the MUA website, thus enabling them to identify BPH sufferers and to allow early intervention of the disease.
“BPH is a progressive condition; initially the symptoms may be just uncomfortable and inconvenient, but these can lead to serious long-term complications,” explained Datuk Dr Selvalingam Sothilingam, President, Malaysian Urological Association.
“If left untreated, the urethra may become completely blocked, resulting in an inability to urinate (otherwise known as acute urinary retention) and putting the patient at risk of kidney damage, urinary tract infections, and the development of bladder stones, not to mention having a significant impact on the sufferers’ quality of life.
“Men who are aged 40 and above, have a family history of BPH, have existing medical conditions such as obesity, heart and circulatory disease, and type 2 diabetes, or men who lack the appropriate amount of exercise are all at higher risk of BPH.
“By providing the tools required to make an accurate diagnosis through our screening programme, we can equip healthcare professionals with the confidence and means to proactively address BPH within these groups, helping to break through any reservations the patient may feel,” Dr Selva continued. Research has also indicated that doctors are generally unaware that men may be embarrassed to discuss their condition, suggesting a need for healthcare professionals to proactively discuss the topic of BPH with patients.
The GSK-MUA partnership will offer online medical training to better equip physicians in disease management and provide patients greater access to support.
The course will cover several topics, ranging from anatomy to the various treatment options available in Malaysia.
The Malaysian Medical Association is in support of initiatives such as this to provide online training to medical doctors. Participants will also be accredited with Continuing Personal Development points upon completion.
In addition, the campaign will feature a number of public materials which aim to illustrate the magnitude of BPH symptoms amongst older men, educate on the risks of complications, and encourage sufferers to seek medical attention.
“By spearheading these multi-faceted components, we aim to pioneer Malaysia’s approach to prostate health, and we encourage healthcare professionals, industry leaders and members of the public to support us in changing the BPH landscape nationwide.” Balakrishnan concluded.