Bph

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Nursing

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Mount Royal University

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1. Does BPH predispose this patient to cancer?

BPH involves an increase in the epithelial cells and/or stromal cells in the prostate. This

increase in cell number is non-neoplastic and as such BPH is not a precursor lesion for cancer,

hence the term “benign” prostatic hyperplasia. The increase in cell number is due to

decreased cell death and not uncontrolled cell multiplication as is the case in malignancies or

cancer. This increase in cell survival is attributed to increased sensitivity to testosterone,

particularly to dihydrotestosterone or DHT, which is why most BPH medications target DHT

production, particularly through 5α-reductase (Kumar et al., 2015).

2. Why are patients with BPH at risk for urinary tract infections?

The prostate can be divided into three main zones – the peripheral zone, transition zone, and

central zone. The urethra passes through the prostate through the middle of the transition

zone. In BPH, the increased cell number generally occurs in the peripheral and transition

zones, causing the formation of large, discrete nodules. These nodules, when present in the

transition zone, may then impinge the prostatic urethra resulting in a slit-like compression.

This causes an increased resistance to the flow of urine. As a result, bladder hypertrophy and

distention may occur together with urinary retention. These would eventually lead to the lower

urinary tract symptoms (LUTS) that clinically define BPH. Due to the inability to void the

bladder, urinary stasis occurs, and this buildup of fluid increases the risk for urinary tract

infections (Kumar et al., 2015).

3. What would you expect the patient’s PSA level to be after surgery?

The surgical procedure used for cases of BPH that are resistant to medical therapy is usually

TURP or transurethral resection of the prostate. This procedure involves the removal of

tissues known as prostatic chips to increase the patency of the urethra or in other words, make

the urethra’s lumen larger (Kumar et al., 2015). PSA or prostate specific antigen is a serine

protease which is used as a biological marker for prostate cancer. It is chiefly synthesized by

tissues in the peripheral zone and transition zone and as such it is expected to be elevated in

the setting of prostate cancer due to the involvement of the peripheral zone. Since the

transition zone is involved in TURP, it is therefore expected that PSA production would

gradually decrease following this surgical procedure. However, it is important to note that PSA

level transiently rises shortly after performing TURP before exhibiting the expected decline

(Fonseca et al., 2008).

4. What are the recommended screening guidelines and treatment for BPH?

BPH most commonly occurs in men older than 50 years old. Specifically, the risk of BPH

increases annually after the age of 40, with the highest histologic and clinical incidences

occurring in the 81-90 years old age range (Kumar et al., 2015). As such, it is particularly

important to follow the guidelines for screening, diagnosis, and management of BPH in these

patients. In general, the American Urological Association recommends that patients who

present with LUTS that may be attributed to BPH are screened for BPH through a complete

history and physical examination, specifically including a digital rectal exam to assess the size

and/or state of the prostate, as well as through a urinalysis. Imaging techniques should also

be utilized to assess the prostate prior to proceeding with surgical intervention. For the

treatment and/or management of BPH, TURP is generally offered as a surgical procedure for

symptomatic patients and is recommended for those who experience recurrent UTIs or other

complications due to BPH(American Urological Association, 2018).

5. What are some alternative treatments/natural homeopathic options for treatment?

Management of BPH should be based on the severity of symptoms, patient preference, and

how the quality of life of the patient is affected. For patients with mild, non-bothersome

symptoms, lifestyle modification is recommended, including fluid restriction before bedtime,

avoidance of caffeinated beverages, spicy food, and some drugs like diuretics and

decongestants, bladder retraining, and pelvic floor exercises (Nickel et al., 2010).

Meanwhile, for patients with mild to severe bothersome symptoms, the initial treatment should

include pharmacologic or medical options prior to surgical intervention. These pharmacologic

interventions are aimed at inhibiting DHT formation at the level of 5α-reductase. An example

of a common drug used is Finestride. Drugs that cause smooth muscle relaxation through

blocking alpha-adrenergic receptors may also be used to relieve pain due to bladder spasms.

An example of a drug with this mode of action is Flomax (Kumar et al., 2015).

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1. Does BPH predispose this patient to cancer? BPH involves an increase in the epithelial cells and/or stromal cells in the prostate. This increase in cell number is non-neoplastic and as such BPH is not a precursor lesion for cancer, hence the term “benign” prostatic hyperplasia. The increase in cell number is due to decreased cell death and not uncontrolled cell multiplication as is the case in malignancies or cancer. This increase in cell survival is attributed to increased sensitivity to testosterone, particularly to dihydrotestosterone or DHT, which is why most BPH medications target DHT production, particularly through 5α-reductase (Kumar et al., 2015). 2. Why are patients with BPH at risk for urinary tract infections? The prostate can be divided into three main zones – the peripheral zone, transition zone, and central zone. The urethra passes through the prostate through t ...
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