Facts About Benign Prostatic Hyperplasia (BPH)

Benign prostatic hyperplasia (BPH) is the medical term used to describe a prostate enlarged beyond its expected or normal size. In non-medical terms, BPH is an enlarged prostate. The prostate, in the ordinary development of a male body, is expected to increase in size. For example, the prostate grows up to double its size during the teenage years. But BPH occurs when the prostate enlarges to a point that it starts to affect the normal function of other organs in the urinary system. It is also worth noting that BPH is not cancerous.

Risk Factors for Benign Prostatic Hyperplasia

There is no precise understanding of the causes of BPH. However, it is accepted that the main risk factor for BPH is advanced age. The condition is so common that it is reported that about 50 percent of all men over the age of 50 are likely to have it. Of that 50 percent, however, only about 10 percent are likely to need medical intervention. The prevalence of BPH among older males may be related to an increase in the production of estrogen and the proportionate decrease in testosterone as men grow older. Estrogen promotes the growth of prostatic cells which ultimately leads to an enlarged prostate. Other risk factors include a family history of BPH, heart and circulatory diseases and obesity.

Effects of Benign Prostatic Hyperplasia

The location of the prostate is such that the urethra passes through its middle and the bladder surrounds it. An enlarged prostate presses against the urethra and forms an obstruction to the smooth flow of urine as it comes from the bladder and flows through the urethra. For this reason, BPH is known to contribute to many urinary tract problems in men. These problems are manifested in one or more of the following symptoms:

  1. Sudden urge to urinate;
  2. Frequent need to urinate;
  3. Blood in the urine;
  4. Urine retention
  5. Weak or interrupted urine stream; and
  6. Inability to pass urine.

The symptoms may be mild and can be managed by watchful waiting. However, men experiencing a complete inability to urinate, painful and frequent need to urinate, blood in the urine or pain and great discomfort in the urinary tract area are advised to seek medical attention immediately.

Since the causes of BPH are not very well understood, it is not easy to prevent but it can be managed by frequent monitoring. It is recommended that men nearing 50 should establish and maintain a relationship with a good urologist. The Advanced Urology Institute is a good place to start for people new to this subject. They offer the necessary information and a staff of trained and experienced urologists to help you.

For more information about BPH and how to diagnose and treat it, visit the “Advanced Urology Institute” website.

What is Dr. David Harris’ Journey to Becoming a Urologist?

KEY TAKEAWAYS:

  • Dr. David Harris initially wanted to be a veterinarian, but discovered his passion for urology after realizing veterinary medicine wasn’t the right fit. He completed his medical education at Stritch Medical School, Loyola University, Chicago, and received training in urology at the Lahey Clinic.
  • With over two decades of experience, Dr. Harris has expertise in treating kidney disorders, kidney stones, and prostatic diseases, and has a keen interest in minimally invasive procedures such as laser surgery, laparoscopic surgery, and da Vinci robotic surgery.
  • Dr. Harris finds practicing urology at Advanced Urology Institute (AUI) rewarding because of the warm, collaborative environment, access to the latest medical and surgical equipment, and a focus on compassionate, multidisciplinary patient care

Urology is a constantly intriguing and gratifying specialty. With its many sub-specialties, innovative procedures and generally great outcomes for most patients, it offers the opportunity to improve human life while also genuinely enjoying what you do. As urologists, our job involves diagnosing and treating disorders of the genitourinary tract, including pelvic pain, enlarged prostate, kidney stones, urinary incontinence, male infertility and urologic cancers. It means that most of the time patients come to us feeling embarrassed, humiliated, troubled and hopeless and need not only to be treated but also to be reassured, motivated and encouraged to get back to their normal lives. It is a noble job, one that I really relish.

My path to urology

Growing up, I wanted to be a veterinarian. My dad was a veterinarian so I wanted to follow in his footsteps. However, everything changed when I was in college. I developed a dislike of working with all kinds of animals and quickly realized veterinary medicine wasn’t the field for me. I had to find a career that I was really interested in. Eventually that became medicine, and urology ultimately became the specialty that I preferred.

I completed my undergraduate studies at the University of Illinois, then went to Stritch Medical School, Loyola University, Chicago, for my medical education. I finished my residency training in general surgery by joining the New England Deaconess Hospital, Harvard Surgical Service in Boston for three years. After that, I received my training in urology at the Lahey Clinic. I became a board-certified urologist with the American Board of Urology, a fellow of American College of Surgeons, and a member of Castle Connolly, prominent doctors chosen through peer reviews and physician-led research.

Areas of expertise

I have practiced urology for more than two decades tackling a wide range of issues and amassing a wealth of experience. I routinely see patients with issues such as recurrent urinary tract infections, enlarged prostate, prostatitis, urinary incontinence, urinary stones, urethral strictures, testicular pain, erectile dysfunction and urologic cancers. But I have particular expertise in treating kidney disorders, kidney stones and prostatic diseases. I have a keen interest in minimally invasive procedures (such laser surgery, laparoscopic surgery and the da Vinci robotic surgery) that preserve renal tissue and minimize postoperative pain and recovery time.

Job satisfaction

Urology is really about helping people with distressing and debasing conditions to recover and enjoy normal lives. As a urologist you get to know your patients, address many kinds of patient issues, and establish an ongoing relationship with them. It is deeply satisfying to see patients who have come to you when in their lowest moments and to be able to help them progress and enjoy normal lives again. In fact, there is a unique sense of joy and gratification that comes with procedures that offer immediate relief to patients with agonizing urinary stones, embarrassing urinary incontinence and other uncomfortable conditions.

But you also feel profound satisfaction with every positive outcome realized in treating life-threatening urologic cancers or debilitating genitourinary problems. With urology, you can go home every day feeling happy and contented with the outcomes you’ve achieved for your patients. Besides, I enjoy being a urologist because the specialty is quite flexible and I can choose the extent to which I am busy every day.

Why Advanced Urology Institute?

AUI has just about everything a urologist requires to excel. The place is always warm and buzzing, with colleagues telling jokes or sharing delightful stories. It is such a relaxed and pleasant working environment that brings out the best from every one of us. The administrative duties have been centralized to enable physicians to concentrate on the most important task — delivering the best possible care to patients. We also have access to the latest medical and surgical equipment, regular opportunities to collaborate with other certified, knowledgeable and experienced professionals, and a thriving culture of compassionate, multidisciplinary approach to patient management. In a nutshell, it’s always wonderful practicing urology at AUI. For more information on the services offered at AUI, visit the “Advanced-Urology-Institute” site.

TRANSCRIPTION:

My name is David Harris and I’m a urologist with Advanced Urology Institute in Fort Myers. I’m from suburban Chicago in the Midwest. My father was a veterinarian and I grew up with aspirations of becoming a veterinarian. However, I found out in college as I was actually getting close to applying that I was allergic to many animals and had to have a rethinking of my career plans. So, I’m happy I went into medicine and I think within medicine I found the right niche in urology. 

I went to school through medical school in Chicago and then I trained in Boston in general surgery and urology and met my wife in Boston. We lived in New England for a while and we’ve now been in the south for about 20 years. I went to undergrad at the University of Illinois in Champaign. I did a medical school at Loyola in Chicago. I trained in general surgery at the Deaconess Program at Harvard Medical School and then I trained in urology at the Lahey Clinic in Boston.

REFERENCES:

What is MRI with Transrectal Ultrasound Fusion-Guided Prostate Biopsy

Prostate cancer has a new standard of care in MRI-guided fusion biopsy with transrectal ultrasound. While a prostate biopsy has been the only way to get a definitive diagnosis of prostate cancer, it has only been working if cancer cells are identified in the sample tissue. But in some cases, such as when the tumor occurs at the top surface of the prostate or other unusual locations, a biopsy may not give a correct diagnosis. For instance, the standard TRUS (transrectal ultrasound) guided biopsy in which tissue samples are collected from the prostate in a systematic pattern gives a negative result with tumors located in unusual areas of the prostate. About 15-20 percent of tumor locations can be missed by the biopsy needle.

What makes the MRI-ultrasound fusion biopsy more definitive?

The MRI-ultrasound fusion approach is an improvement on the traditional 12-core TRUS, which involved taking biopsies from twelve prostate areas where the cancer is considered more likely to occur. With the TRUS biopsy, about 70 percent of men who have a negative biopsy result are not essentially free of the cancer. The MRI-ultrasound fusion technology blends the superior imaging capability of the high-definition multi-parametric (mp) MRI with real-time ultrasound imaging. There is better visualization of the suspicious areas of the prostate where the cancer may occur that may not be visible on ultrasound alone. The fusion-guided biopsy detects almost twice as many prostate cancers in all stages as the standard TRUS biopsy.

The ability of MRI-ultrasound fusion-guided biopsy to create a three-dimensional (3D) map of the prostate ensures that doctors are able to see the targeted areas of the prostate better and perform more precise biopsies. The technology uses a machine known as UroNav developed by Invivo, which is supplied with sophisticated software to produce super-detailed MRI images and fuse them with the ultrasound images generated by a transrectal probe administered on the patient in an outpatient setting. The resulting images enable the examining physician to direct biopsy needles with pinpoint accuracy and to easily access any lesions or suspicious areas revealed by MRI. The technology allows the urologist to hit the target spot more accurately and improves cancer detection rate. In fact, it is primarily used for men who have an ongoing suspicion of prostate cancer, such as those with consistently elevated PSA, but whose TRUS biopsy results are repeatedly negative.

Fewer biopsies, more accurate detection

The fusion-guided biopsy is a very targeted approach in which biopsies are performed only in highly suspicious areas of the prostate appearing in the MRI image. As a result, significantly fewer biopsies are done with the MRI-ultrasound fusion than with the traditional TRUS technique, minimizing the adverse effects that often accompany repeat biopsies. Multiple prostate biopsies can lead to complications such as bleeding, infection, urinary retention problems, sepsis or even death.

In spite of fewer biopsies, the MRI fusion approach increases the rate of detection of aggressive prostate cancer. The extensive MRI images obtained before the biopsy helps highlight both high-risk and intermediate-risk cancers often missed by traditional TRUS biopsy. With MRI-ultrasound fusion, the likelihood of detecting cancer increases as the grade of the tumor increases. The use of MRI fusion biopsy helps to avoid metastatic disease by finding cancer before it spreads to other areas of the body.

Improved cancer differentiation

Through MRI fusion, doctors are able to more accurately differentiate cancers that require treatment from the ones that should undergo watchful waiting (active surveillance). Fusion technology is able to show higher-risk cancers and does not highlight the insignificant low-grade tumors, making it less likely for urologic oncologists to over-treat indolent and low-grade cancers. A number of prostate cancers are low-grade, non-aggressive and do not cause problems at all and treating them through chemotherapy, radiotherapy or surgery can impair the quality of life or even cause death. MRI fusion effectively saves patients from the adverse effects of treating low-grade tumors. Fusion technology eliminates up to 50 percent of prostate cancer treatments that are unnecessarily administered on low-grade cancers.

At Advanced Urology Institute, we have adopted the MRI-ultrasound fusion biopsy and changed the way we screen, evaluate and diagnose prostate cancer. It has become our standard for detecting prostate cancer and we believe in the next few years it will be the gold standard for detecting the cancer. We are proud that it offers a higher detection rate, superior accuracy and reduces the rate of repeat biopsies — making our practice one of the best places for detection and monitoring of the cancer. It helps us deliver the best treatment outcomes for our patients.

If you think you are at high risk of prostate cancer or already have started experiencing some symptoms, let us show you how the precision of our high-definition MRI fusion machine, the expertise of our skilled physicians in MRI fusion biopsy and the know-how of our radiologists proficient in multi-parametric MRI imaging can help you. For more information on the treatment and diagnosis of prostate cancer, visit the “Advanced Urology Institute” site.