Hopp til hovedinnhold

Benign prostatahyperplasi (BPH)

Sist oppdatert: Sist revidert:
Sist revidert av:
Definisjon:
Forstørret prostata som følge av økt vekst av godartet kjertelvev
Forekomst:
BPH rammer 10% av menn under 40 år og 70-80% av alle menn over 60 år
Symptomer:
Obstruktive vannlatingsproblemer med nedsatt kraft på strålen, hesitasjon, etterdrypp og hyppig vannlatning dag og natt. BPH er ikke nødvendigvis symptomgivende
Funn:
Vanligvis ikke noen spesielle funn ved klinisk undersøkelse. Prostata kan kjennes forstørret ved rektal undersøkelse. Ved betydelig resturin kan urinblæren palperes
Diagnostikk:
Måling av residualurin og urinstrømshastighet kan være nyttig. Utred nyrefunksjon og gjør urinundersøkelse, men tilstanden påvirker normalt ikke disse. PSA-test kan være aktuelt. CT, ultralyd eller cystoskopi er aktuelle undersøkelser ved behov for utredning
Behandling:
Symptomer som forringer livskvaliteten behandles og ev. komplikasjoner forebygges. Behandlingen strekker seg fra informasjon og råd og en avventende observasjon, via medikamentell behandling, til kirurgi
  1. Thorpe A, Neal D. Benign prostatic hyperplasia. Lancet 2003; 361: 1359-67. PubMed  
  2. Sarma AV, St Stauver JL, Hollingsworth JM, et al. Diabetes treatment and progression of benign prostatic hyperplasia in community-dwelling black and white men. Urology 2012; 79: 102-8. PubMed  
  3. D'Silva KA, Dahm P, Wong CL. Does this man with lower urinary tract symptoms have bladder outlet obstruction?: The Rational Clinical Examination: a systematic review. JAMA 2014; 312:535. www.ncbi.nlm.nih.gov  
  4. Schou J, Poulsen AL, Nordling J. The value of a new symptom score (DAN-PSS) in diagnosing uro-dynamic infravesical obstruction in BPH. Scand J Urol Nephrol. 1993;27(4):489-92. PMID: 7512747. PubMed  
  5. Pearson R, Williams PM. Common questions about the diagnosis and management of benign prostatic hyperplasia. Am Fam Physician. 2014 Dec 1;90(11):769-774. .
  6. McVary KT, Roehrborn CG, Avins AL, et al. Update on AUA guideline on the management of benign prostatic hyperplasia. J Urol. 2011;185(5):1793–1803.
  7. Sarma AV, Wei JT. Benign prostatic hyperplasia and lower urinary tract symptoms. N Engl J Med 2012; 367: 248-57. New England Journal of Medicine  
  8. Folkestad B, Spångberg A. Timed micturition and maximum urinary flow rate in randomly selected symptom-free males. Scand J Urol Nephrol 2004; 38: 136-42. pmid:15204399 PubMed  
  9. Eastham JA, Riedel E, Scardino PT, et al. Variation of serum prostate-specific antigen levels. An evaluation of year-to-year fluctuations. JAMA 2003; 289: 2695-2700. Journal of the American Medical Association  
  10. Bjerklund Johansen TE. Medikamenter mot symptomgivende godartet prostataforstørrelse. Tidsskr Nor Lægeforen 2002; 122: 2544-5. PubMed  
  11. Nedre urinveissymptomer hos eldre menn. Norsk urologisk forenings anbefalinger for allmennleger 2014.
  12. Dahm P, Brasure M, MacDonald R, et al. Comparative Effectiveness of Newer Medications for Lower Urinary Tract Symptoms Attributed to Benign Prostatic Hyperplasia: A Systematic Review and Meta-analysis. Eur Urol 2017; 71:570. PubMed  
  13. Chapple C, Herschorn S, Abrams P, et al. Tolterodine treatment improves storage symptoms suggestive of overactive bladder in men treated with alpha-blockers. Eur Urol 2009; 56: 534-41. PubMed  
  14. Gacci M, Corona G, Salvi M, et al. A systematic review and meta-analysis on the use of phosphodiesterase 5 inhibitors alone or in combination with α-blockers for urinary tract symptoms due to benign prostatic hyperplasia. Eur Urol 2012; 61: 994-1003. PubMed  
  15. Welk B, McArthur E, Fraser L-A, et al. The risk of fall and fracture with the initiation of a prostate-selective α antagonist: a population based cohort study. BMJ 2015; 351: h5398. doi:10.1136/bmj.h5398 DOI  
  16. Toren P, Margel D, Kulkarni G, et al. Effect of dutasteride on clinicial progression of benign prostatic hyperplasia in asymptomatic men with elnarged prostate: a post hoc analysis of the REDUCE study. BMJ 2013; 346: f2109. BMJ (DOI)  
  17. Park T, Choi JY. Efficacy and safety of dutasteride for the treatment of symptomatic benign prostatic hyperplasia (BPH): a systematic review and meta-analysis.. World J Urol 2014; 32(4): 1093-105. pmid:24500194 PubMed  
  18. Robinson D, Garmo H, Bill-Axelson A, et al. Use of a 5α-reductase inhibitors for lower urinary tract symptoms and risk of prostate cancer in Swedish men: natiowide, population based case-control study. BMJ 2013; 346: f3406. BMJ (DOI)  
  19. Wei L, Lai EC-C, Kao-Yang Y-H, et al. CCBY Open access Research Incidence of type 2 diabetes mellitus in men receiving steroid 5α-reductase inhibitors: population based cohort study. BMJ 2019; 365: l1204. doi:10.1136/bmj.l1204 DOI  
  20. Björnebo L, Nordström T, Discacciati A, et al. Association of 5α-Reductase Inhibitors With Prostate Cancer Mortality. JAMA Oncol 2022; 8: 1019-26. pmid:35587340 PubMed  
  21. Baboudjian M, Gondran-Tellier B, Dariane C, et al. Association Between 5α-Reductase Inhibitors and Prostate Cancer Mortality A Systematic Review and Meta-analysis. JAMA Oncol 2023. pmid:37079318 PubMed  
  22. Filson CP, Hollingsworth JM, Clemens JQ, Wei JT. The efficacy and safety of combined therapy with α-blockers and anticholinergics for men with benign prostatic hyperplasia: a meta-analysis. J Urol. 2013;190(6):2153–2160.
  23. Lenfant L, Pinar U, Roupret M, et al. Role of antimuscarinics combined with alpha-blockers in the management of urinary storage symptoms in patients with benign prostatic hyperplasia: An updated systematic review and meta-analysis. J Urol 2023 Feb; 209:314. PMID: 36395428 PubMed  
  24. van Kerrebroeck P, Chapple C, Drogendijk T, et al. Combination therapy with solifenacin and tamsulosin oral controlled absorption system in a single tablet for lower urinary tract symptoms in men: Efficacy and safety results from the randomised controlled NEPTUNE trial. Eur Urol 2013. pmid: 23932438 PubMed  
  25. Filson CP, Hollingsworth JM, Clemens JQ, Wei JT. The efficacy and safety of combined therapy with α-blockers and anticholinergics for men with benign prostatic hyperplasia: a meta-analysis. J Urol 2013; 190: 2153-60. pmid:23727412 PubMed  
  26. Tacklind J, MacDonald R, Rutks I, et al. Serenoa repens for benign prostatic hyperplasia. Cochrane Database of Systematic reviews 2012; 12: CD001423. The Cochrane Library  
  27. Vela-Navarrete R, Alcaraz A, Rodríguez-Antolín A, et al.. Efficacy and safety of a hexanic extract of Serenoa repens (Permixon® ) for the treatment of lower urinary tract symptoms associated with benign prostatic hyperplasia (LUTS/BPH): systematic review and meta-analysis of randomised controlled trials and observational studies. BJU Int. 2018 Dec;122(6):1049-1065. Epub 2018 Jun 6. PMID: 29694707.
  28. Huang SW, Tsai CY, Tseng CS, et al. Comparative efficacy and safety of new surgical treatments for benign prostatic hyperplasia: Systematic review and network meta-analysis. BMJ 2019 ; 367: l5919. PMID: 31727627 PubMed  
  29. Perera M, Roberts MJ, Doi SA, Bolton D. Prostatic urethral lift improves urinary symptoms and flow while preserving sexual function for men with benign prostatic hyperplasia: A systematic review and meta-analysis. Eur Urol. 2014 Nov 15 . doi:10.1016/j.eururo.2014.10.031 DOI  
  30. Chughtai B, Simma-Chiang V, Kaplan SA. Evaluation and management of post-transurethral resection of the prostate lower urinary tract symptoms. Curr Urol Rep. 2014 ;15:434. doi: 10.1007/s11934-014-0434-1.
  31. Madersbacher S, Marberger M. Is transurethral resection of the prostate still justified? BJU Int 1999, 83:227.
  32. Glazener C, Boachie C, Buckley B, et al. Urinary incontinence in men after formal one-to-one pelvic-floor muscle training following radical prostatectomy og transurethral resection of the prostate (MAPS): two parallell randomised controlled trials. Lancet 2011; 378: 328-37. PubMed  
  33. Andersen M, Walter S. Mikrobølgetermoterapi for benign prostatahyperplasi. Gennemgang af et Cochrane-review. Ugeskr Læger 2009; 171: 2281. Ugeskrift for Læger  
  34. Hoffman RM, Monga M, Elliott SP, MacDonald R, Langsjoen J, Tacklind J, Wilt TJ. Microwave thermotherapy for benign prostatic hyperplasia. Cochrane Database of Systematic Reviews 2012, Issue 9. Art. No.: CD004135. DOI: 10.1002/14651858.CD004135.pub3. DOI  
  35. Green Z, Westwood J, Somani BK. What's New in Rezum: a Transurethral Water Vapour Therapy for BPH. Curr Urol Rep 2019; 20: 39. pmid:31152253 PubMed  
  36. Dixon C, Cedano ER, Pacik D, et al. Efficacy and Safety of Rezūm System Water Vapor Treatment for Lower Urinary Tract Symptoms Secondary to Benign Prostatic Hyperplasia. Urology 2015; 86: 1042-7. pmid:26216644 PubMed  
  37. Roehrborn CG, Barkin J, Gange SN, et al. Five year results of the prospective randomized controlled prostatic urethral L.I.F.T. study. Can J Urol. 2017;24(3):8802-8813. PubMed  
  38. Serlin DC, Heidelbaugh JJ, Stoffel JT. Urinary Retention in Adults: Evaluation and Initial Management. Am Fam Physician 2018; 98(8): 496-503. pmid:30277739 PubMed  
  39. Chang RT, Kirby R, Challacombe BJ. Is there a link between BPH and prostate cancer? Practitioner. 2012 Apr;256(1750):13-6, 2. PMID: 22792684. PubMed  
  • Wolfgang Lilleby, spesialist i onkologi
  • Peter D. Jost, spesialist i allmennmedisin, redaktør NEL

Tidligere fagmedarbeidere

  • Trygve Talseth, spesialist urologi, dr. med
  • Svein Z. Bratland, spesialist i allmennmedisin, Sandviken Legesenter, Bergen, og seniorrådgiver i Statens helsetilsyn, Oslo