Facts on File Encyclopedia of Health and Medicine

• hesitation when urinating (stopping and start-
  ing during the flow)


• URINARY URGENCYandURINARY FREQUENCY, espe-
  cially at night (NOCTURIA)


• dribbling URINEafter the man finishes urinating


• HEMATURIA(bloody urine)


• URINARY INCONTINENCE

The diagnostic path includes a BLOODtest to
measure the PROSTATE-SPECIFIC ANTIGEN(PSA) level
and a DIGITAL RECTAL EXAMINATION (DRE), which
allows the doctor to palpate (feel) the prostate
gland through the wall of the RECTUM. This exami-
nation helps determine whether the enlargement
of the prostate gland is likely benign (the gland
feels soft to palpation) or suspicious (the gland
feels hard or irregular). Further diagnostic proce-
dures may include measurement of postvoiding
urine (urine that remains in the bladder after uri-
nation), ULTRASOUNDof the bladder, and occasion-
ally CYSTOURETHROGRAMto rule out other causes of
the symptoms.

Treatment Options and Outlook
Treatment depends on the nature of the prostate
gland’s overgrowth, the severity of symptoms, and
the man’s preferences. Treatment options include

• MINIMALLY INVASIVE SURGERY to remove excess
  prostate gland tissue


• transurethral resection of the prostate (TURP),
  an OPERATIONin which the urologist removes
  portions of the prostate gland using an endo-
  scopic instrument inserted through the urethra


• PROSTATECTOMY, an operation to entirely remove
  the prostate gland


• alpha blocker medications, which relax smooth
  MUSCLEtissue to improve the flow of urine


• 5-alpha reductase inhibitor medications such as
  finasteride and dutasteride, which block the
  conversion of TESTOSTERONE to dihydrotestos-
  terone (DHT) to slow the growth of prostate
  gland cells


• herbal remedies such as SAW PALMETTO, stinging
  nettle extract, SOYprotein and soybean prod-
  ucts, and flaxseed oil

MEDICATIONS TO TREAT

BENIGN PROSTATIC HYPERPLASIA (BPH)

alfuzosin doxazosin

dutasteride finasteride

prazosin tamsulosin

terazosin

Prostatectomy is the only cure for BPH, though

it has significant risks and potential complications.

Most men are able to achieve long-term relief of

symptoms through medication or minimally inva-

sive procedures.

Risk Factors and Preventive Measures

Age is the primary risk factor for BPH. BPH is rare

in men under age 50 and nearly always present in

men over age 70. There are no known methods

for preventing BPH. It is important for men over

age 50 to undergo recommended preventive

screening and examination for prostate cancer, as

the risk for prostate cancer also increases with age

and its early symptoms are indistinguishable from

those of BPH.

See also AGING, REPRODUCTIVE AND SEXUAL

CHANGES THAT OCCUR WITH; BLADDER CANCER;

ENDOSCOPY; HORMONE-DRIVEN CANCERS; SURGERY BENE-

FIT AND RISK ASSESSMENT; URETHRAL STRICTURE.

birth control See CONTRACEPTION.

breast The mammary gland. Both men and

women have breasts. Each person’s two breasts

are close to but not exactly the same size and

shape. Breasts vary widely in appearance among

both men and women.

At PUBERTYthe female sex hormones (primarily

ESTROGENS) in girls cause the glandular components

of the breast to enlarge, establishing the potential to

produce milk. The nipple also enlarges as does the

glandular tissue surrounding it, the areola.

Enlarged breasts are among the female SECONDARY

SEXUAL CHARACTERISTICS. Female breasts fill out with

adipose (fatty) tissue and connective tissue in addi-

tion to its glandular structures, becoming rounded,

and extend out from the chest. The male sex hor-

mones (primarily TESTOSTERONE) have the opposite

effect in boys, causing the glandular components to

all but disappear. In adulthood the male breasts

remain relatively flat against the chest.

breast 249