Benign Prostatic Hyperplasia (BPH) and PSA Screening: A Guide to Understanding Prostate Health

by Dr. Grace Downs

Benign Prostatic Hyperplasia, or prostate gland enlargement, is a common condition affecting older people with prostates. It involves the non-cancerous growth of the prostate, a small gland responsible for producing seminal fluid. As people age, the prostate naturally enlarges, potentially leading to uncomfortable urinary symptoms. While BPH is not life-threatening, it can significantly impact quality of life. One common method of evaluating prostate health is the prostate-specific antigen (PSA) test.

In this post, we’ll explore BPH, its symptoms, some nutritional and herbal treatment options, and the role of PSA screening in detecting potential prostate problems.

What is Benign Prostatic Hyperplasia (BPH)?

Benign Prostatic Hyperplasia or BPH occurs when the prostate gland enlarges and starts to press against the urethra, the tube that carries urine from the bladder out of the body. As the prostate grows, it can create pressure, making it more difficult to urinate. This condition primarily affects people with prostates over the age of 50, though it can begin earlier for some individuals.

Symptoms of BPH

  • Frequent Urination: A need to urinate often, especially at night (nocturia).

  • Weak Urine Flow: Difficulty starting or maintaining a steady stream of urine.

  • Incomplete Bladder Emptying: Feeling like the bladder hasn't fully emptied after urination.

  • Urgency and Incontinence: A sudden, strong urge to urinate that may lead to leakage.

While BPH is not cancerous, the symptoms can closely mimic those of prostate cancer, which is why checking with your doctor is important if you are experiencing any symptoms.

Understanding the PSA Test

The prostate-specific antigen (PSA) is tested via bloodwork. PSA is a protein produced by both normal and cancerous cells in the prostate. While a high PSA level doesn’t necessarily indicate cancer, it can suggest that further investigation is necessary. Elevated PSA levels may be due to BPH, prostatitis (inflammation of the prostate), or prostate cancer.

PSA Levels and What They Mean

  • Normal PSA Levels: Typically, PSA levels below 4 nanograms per milliliter (ng/mL) are considered normal, though age can influence what is "normal" for an individual.

  • Elevated PSA Levels: Levels between 4-10 ng/mL suggest a higher risk of prostate conditions, including BPH or prostate cancer.

  • Very High PSA Levels: Levels above 10 ng/mL are concerning and warrant further testing.

It’s important to note that PSA levels naturally rise as people age, so an elevated level does not automatically indicate prostate cancer.

PSA Screening and BPH

In the context of BPH, PSA screening can be somewhat complicated. While BPH is a non-cancerous condition, it can still cause elevated PSA levels, making it more challenging to distinguish between BPH and prostate cancer based on PSA alone. However, regular PSA screenings can help doctors monitor changes over time, offering clues about whether further testing is necessary.

Benefits of PSA Screening

  • Early Detection: PSA tests can detect prostate issues early, even before symptoms occur, which is crucial in catching prostate cancer in its early stages.

  • Monitoring BPH: For people with diagnosed BPH, PSA tests can help track the progression of the condition.

Limitations of PSA Screening

  • False Positives: Elevated PSA levels due to BPH, prostatitis, or even recent physical activity can lead to unnecessary biopsies or anxiety.

  • Overdiagnosis: In some cases, slow-growing prostate cancers that may not pose an immediate risk are detected, leading to treatment that may not have been necessary.

What Happens If PSA is Elevated?

If PSA levels are higher than normal, the next steps might include:

  • Repeat PSA Test: A second test to confirm elevated PSA levels.

  • Digital Rectal Exam (DRE): A physical exam to feel the prostate for abnormalities.

  • Prostate Biopsy: A sample of prostate tissue may be taken to test for cancer cells.

  • Imaging: An ultrasound or MRI to visualize the prostate.

BPH Treatment Options

For people diagnosed with BPH, several treatment options are available, depending on the severity of symptoms and their impact on daily life.

  1. Medications:

    • Alpha Blockers: Relax the muscles of the prostate and bladder neck to ease urination.

    • 5-Alpha Reductase Inhibitors: Reduce the size of the prostate over time.

  2. Minimally Invasive Procedures:

    • Transurethral Resection of the Prostate (TURP): A common surgery that removes part of the prostate.

    • Laser Therapy: Uses lasers to remove overgrown prostate tissue.

  3. Lifestyle Changes:

    • Reducing caffeine and alcohol intake, practicing bladder training, and urinating on a schedule can help ease symptoms.

    • Incorporating phytoestrogens into your diet. Phytoestrogens support healthy hormone metabolism. Examples are:

      1. Soy (PMID22268969)

      2. Legumes – like beans and lentils (PMID15491706)

      3. Ground flax seed (PMID18358071)

      4. Cruciferous veggies – like broccoli, cabbage, kale, Brussel sprouts, and cauliflower.

    • Pumpkin seeds can also help to improve symptoms of BPH. (PMID27377091)

Conclusion: Is PSA Screening Right for You?

PSA screening can be a useful tool for monitoring prostate health, especially as people age. However, its effectiveness in detecting prostate cancer early must be weighed against the potential for overdiagnosis and unnecessary treatment. For people with BPH, discussing the pros and cons of regular PSA tests with a healthcare provider is essential in managing symptoms and preventing potential complications.

Ultimately, BPH is a manageable condition, and PSA screening, when used appropriately, can help people stay on top of their prostate health. I encourage you to schedule a visit to discuss additional treatment options for BPH and if PSA screening would be beneficial for you depending on your symptoms, family history, and overall health!

see you in clinic,

Dr. Downs

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