Talk:Benign prostatic hyperplasia

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[edit] BPH Discussion

I have created this discussion for people who have BPH to share their experiences with this condition. For those who contribute, there is a template for your history with BPH -- see Personal History Template below. Contributors to this discussion may enhance the layout and scope of the discussion and/or contribute his personal experience with BPH. I have started the discussion with my own experience using "BPH#1" as my identifier.

  • Above comment by 68.192.215.132; rest of comment was such a personal experience, removed as superfluous per WP:REFACTOR. --Kinu t/c 19:21, 9 June 2006 (UTC)
You seem to be mistaking Wikipedia for a discussion board. Please start a blog, but don't use this page for discussions, unless they pertain directly to the article. Thank you. JFW | T@lk 00:20, 11 September 2005 (UTC)

[edit] Age and occurance

Can DPH occur in younger males? This article claims that it never does. Peoplesunionpro 01:03, 14 November 2005 (UTC)

  • It doesn't say that, it just refers to the enlargement in middle-aged and elderly men. It *can* occur in younger men, but it is rare. In younger men, the same symptoms can occur, but they tend to be due to dysfunction of the bladder neck rather than obstruction from prostatic hypertrophy. Jfbcubed 23:07, 29 January 2006 (UTC)

Typically, the symptoms of BPH do not manifest until the 40's or 50's. A younger man exhibiting these symptoms should be carefully evaluated for other causes (i.e. prostatitis). The prostate growth occurs in response to hormonal changes within the prostate, which increase with age. User:Lasermama 05:43, 12 June 2007 (UTC) Lasermama

[edit] BPH - Hyperplasia or Hypertrophy

It is, technically speaking, a hyperplastic process rather than hypertrophic, so I have amended it as such. Even as a urologist, though, I often call it "Benign Prostatic Hypertrophy". Old habits die hard... Jfbcubed 21:12, 29 January 2006 (UTC)

[edit] Western vs. Rural Lifestyle

Anonymous, 06:24, 10 November, 2006 (UTC)

Please explain and cite this quote located under the Etiology heading, "This is confirmed by research in China showing that men in rural areas have very low rates of clinical BPH, while men living in cities adopting a western lifestyle have a skyrocketing incidence of this condition, though it is still below rates seen in the West.".

What exactly are the differences of western and rural lifestyles pertaining to this article? This implies that BPH can be prevented through a lifestyle change but no explanation of exactly which changes are needed. If true, it is interesting and should be expanded.

  • I'd never heard the urban / rural distinction before. It is without doubt true that some Eastern races have a lower incidence of BPH. There is a good chart depicting rates by age and geography in Campbells Urology. If you need it, I'll dig out the references. Jfbcubed 20:27, 12 November 2006 (UTC)

[edit] Causes

What about mentioning the causes? Especially in younger males (even though it's rare).

  • The causeology is not exactly known. There are factors important in the causation, and factors important in its prevention, but this is not like heart disease... Jfbcubed 00:06, 19 January 2007 (UTC)
    • I was searching the web about this, because my father is now dealing with this problem, but it seems that causes are frequently not a concern. Why is medicine always so concerned with symptomatology, concerned with lowering symptoms instead of searching for the root of the problem? Isn't this like poisoning rats instead of searching where and why are they entering our houses? You may kill them but they will keep coming again and more. —Preceding unsigned comment added by 217.129.73.208 (talk) 16:48, 7 April 2008 (UTC)

[edit] Symptoms

I have re-written the symptoms section. Any comments are welcomed. I intend to edit the entire article, and will appreciate any help.--Derwig 18:22, 3 March 2007 (UTC)

  • Slight change to the statement that BPH is necessarily progressive. It isn't. This was pretty well demonstrated by the Ball, et al.'s findings (British Journal of Urology 1981; 53:613-6). The study is not without weaknesses, but they found that there was very little evidence of symptomatic or urodynamic deterioration in untreated men over 5 years. Jfbcubed 17:05, 8 March 2007 (UTC)
  • The concept of BPH progression has changed significantly since the 1981 study, as was demonstrated in studies like the MTOPS (added to the references, currently #3). Nevertheless, as BPH is not always progressive in all patients, I agree with your edit.

--Derwig 17:50, 8 March 2007 (UTC)

    • I agree that is a compelling point. Technically there is a difference between BPH and lower urinary tract symptoms, however (Hald's rings and all that); also "progression" was defined differently in the two studies we are talking about. Most of those that progressed in MTOPS were deterioration in AUA scores - the AUA didn't publish their scoring system until 11 years after Bristol group (Ball, et al). Progression in the Bristol paper was surgical intervention (there was no accepted medical treatment in those days), acute retention, or a "significant" deterioration in urodynamic variables. I accept these are cruder tests and may explain the different "progression" rates seen in the two studies. My point remains though that both studies did have cohorts that did not progress. In fact, the Bristol paper showed a sizeable number improved with no treatment (I believe - I have neither paper to hand - about 30% improved with conservative management).


    • To slightly contradict myself however, and for completeness, the Olmsted County paper (Jacobsen, et al., Journal of Urology 1996: 155; 595-600) did show widespread symptomatic progression before patient presentation to a physician. The evidence that this progression continues in the post-presentation period is less strong, although it is difficult to explain why it wouldn't. (Sorry for being so verbose) Jfbcubed 18:35, 8 March 2007 (UTC)
      • On another topic, while Wilt's paper suggested equivalence of Saw Palmetto it was not a prospective trial. A reasonable attempt to achieve a prospective randomised study was reported in either NEJM or JAMA (can't immediately recall) last year and showed that, at the doses studied (which were commonly available doses), there was no effect above placebo. I'll dig out the paper when I get a chance. It's changed my practice (as I used to cautiously recommend enthusiasts to use Saw Palmetto, now I don't!). Jfbcubed 20:25, 8 March 2007 (UTC)


      • The NEJM paper is : N Engl J Med. 2006 Feb 9;354(6):557-66. I never recommended phytotherapy, because I thought a true EBM was not availabe. The paragraph dealing with phytotherapy should be edited, it does not reflect current scientific knowledge or clinical practice. Hopefuly I will get to it soon.Derwig 20:36, 8 March 2007 (UTC)
      • I commend your dedication! Jfbcubed 12:06, 9 March 2007 (UTC)

Is it possible for anesthesia to cause BPH or at least make manifest a condition that might have been latent? —Preceding unsigned comment added by 198.45.19.48 (talk) 16:24, 12 March 2008 (UTC)

[edit] DRE does not increase PSA

There is no evidence to suggest that digital rectal examination increases levels of prostate specific antigen (PSA). Urologists agree on this fact. Please research claims before posting so-called "facts". Un-found knowledge such as this may dissuade men from receiving a digital rectal examination for fear of an accidental labeling of prostate cancer. This is NOT true. ^ Kumar and Clark, Sixth Edition, Elsevier Saunders, 2005, p. 685 —The preceding unsigned comment was added by 74.129.180.149 (talk) 01:02, 11 April 2007 (UTC).

  • I concur, to a point. Technically speaking, DRE can increase PSA, but not by a clinically significant amount. We are probably talking about tenths of nanograms per mL. Jfbcubed 18:52, 16 April 2007 (UTC)


    • I agree with Jfcubed, increases are clinically insignificant. See for example:

1.Lechevallier E, Eghazarian C, Ortega J, Roux F, Coulange C (1999). "Effect of digital rectal examination on serum complexed and free prostate-specific antigen and percentage of free prostate-specific antigen". Urology 54 (5): 857-61. PMID 10565747. 

2.Collins G, Martin P, Wynn-Davies A, Brooman P, O'Reilly P (1997). "The effect of digital rectal examination, flexible cystoscopy and prostatic biopsy on free and total prostate specific antigen, and the free-to-total prostate specific antigen ratio in clinical practice". J. Urol. 157 (5): 1744-7. PMID 9112518. 

Derwig 19:21, 16 April 2007 (UTC)

[edit] Diagnosis section

"THIS IS NOT A FACT." probably should be investigated dirther/ tidied up. Not really a good phrase to remain in an encylopedia...

217.155.82.154 12:52, 20 April 2007 (UTC)oaf

[edit] Treatment

There are many different laser wavelengths now being employed, including Thullium and a 980nm wavelength. GreenLight has now added a 120W laser to the 532nm offering, in addition to the 30W. Ethanol (absolute alcohol) is still experimental (in fact, they have also experimented with injecting botox) Most urologists no longer use VLAP, as was described in the 1990's due to long catheterization time, prolonged irritative symptoms, and disappointing outcomes. Lasermama 05:52, 12 June 2007 (UTC)lasermama 1:49, 12 June, 2007

"Thullium" - Thulium? Thallium? --Hugh7 (talk) 00:55, 15 January 2008 (UTC)