Early treatment can help reduce the effects of BPH on your quality of life. Researchers have not found a way to prevent BPH, but being physically active may help reduce your risk. In some cases, these problems may return if not enough of the prostate is removed. The best care plan includes reviewing symptoms, checking prostate health regularly, and making changes to treatment if needed. It should not be used in men with active prostate cancer or very high PSA levels unless cleared by a specialist. Sometimes, prostate cancer may need to be ruled out before continuing therapy. Many men over the age of 40 begin to notice changes in their bodies. Despite this, there is emerging evidence that testosterone plays an important part in the role of treating BPH/LUTS in the aging male. While packet warnings still remain, and there is no high-level evidence to support either position, patients should be warned regarding potential worsening of LUTS if treated with testosterone. The challenge for the basic science and clinical researcher is to determine the real effect of TRT on BPH for hypogonadal men, while identifying those patients who may be harmed from such a therapy. Finally, testosterone replacement should only be considered for symptomatic hypogonadal men after full clinical assessment and correlation. At least separate two measurements of serum testosterone should be taken to confirm any biochemical diagnosis of hypogonadism. Obesity in patients with LUTS was found to be significantly prevalent in men with low testosterone.48 Investigations to be performed, aside from the usual LUTS workup, may include serum testosterone, HbA1c, and fasting serum glucose. Below are some of the possible treatments for BPH. Chronic prostatitis, or inflammation of the prostate, can also cause the prostate to become enlarged. Research also suggests metabolic syndrome, obesity, and genetic factors may increase a person’s risk of developing BPH. Throughout their lives, people assigned as male at birth produce the hormone testosterone and small amounts of estrogen. Dihydrotestosterone (DHT) is a highly active male sex hormone, derived from testosterone. BPH symptoms are similar to prostate cancer symptoms. You have an increased risk of getting prostate cancer if you’re Black or have a family history of prostate cancer. However, BPH and prostate cancer have similar symptoms. Research shows that having BPH doesn’t increase your risk of developing prostate cancer. However, symptoms of BPH may indicate more serious conditions, including prostate cancer. Men with prostate or breast cancer, high red blood cell count, untreated severe sleep apnea, or severe lower urinary tract symptoms. These doctors can work together to find a treatment plan that helps with both problems. This is usually only done if other treatments don’t help or if BPH causes serious problems like kidney damage or infections. They can help men who want to stay on TRT but have bothersome urinary symptoms. PSA is a protein made by the prostate, and higher levels may suggest prostate problems. It may also keep PSA (prostate-specific antigen) levels from rising too much. TRT raises testosterone levels, which can also increase DHT in the body. But they can actually reduce prostate size and lower the risk of needing surgery for BPH. These drugs block the conversion of testosterone to DHT. Some types of TRT, especially injections, can raise DHT levels more than others. DHT (dihydrotestosterone) is a hormone made from testosterone. Each form of TRT affects hormone levels in different ways. Regular PSA testing and prostate checks are key to catching any issues early. A comprehensive evaluation by a medical professional, including prostate cancer screening, is vital to determine if TRT is appropriate. Several misconceptions surround the relationship between TRT and prostate cancer. The purpose of this screening is to identify any existing, undiagnosed prostate cancer. Before initiating TRT, men should undergo thorough prostate cancer screening. Nonetheless, LUTS are a set of subjective and objective symptoms, the causes of which are multifactorial and generally not disease specific. Another concept is an inflammatory cause of BPH, which has been known to directly or indirectly contribute to prostate enlargement since described by Kohnen and Drach29 in 1979. Through a retrospective review of publications from 1941 to 2008, Morgentaler and Traish26 have theorized a "saturation model" to explain the lack of effect of TRT on prostate volume or PSA in these men. This then leads to the AR-dependent transcription of specific target genes resulting in the production and secretion of peptide growth factors, including insulin-like growth factor 1, epidermal growth factor, fibroblast growth factor-related proteins, such as keratinocyte growth factor.3 Furthermore, after initial regression of BPH in older castrated dogs, BPH was restored following testosterone replacement.4 It is thought that the normal interactions between the epithelial and fibromuscular stromal components of the transitional zone prostate tissue are altered leading to a reduced epithelial/stromal ratio and thus micronodular remodeling that characterizes BPH.
