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Enlarged Prostate (Benign Prostatic Hyperplasia)

Enlarged Prostate (Benign Prostatic Hyperplasia)
Key Takeaways
  • Benign prostatic hyperplasia (BPH) is a common condition in older men, affecting up to 90% by age 85. It causes urinary issues like frequent urination, urgency, and incomplete bladder emptying, requiring treatment options ranging from medication to surgery.

  • BPH is influenced by age, hormonal changes, genetics, and lifestyle factors like obesity, diabetes, and heart disease. Although not a risk factor for prostate cancer, BPH can coexist with cancer and present similar symptoms.

  • BPH treatment varies from medications like alpha-blockers and 5-alpha reductase inhibitors to surgical procedures like transurethral resection of the prostate (TURP) and laser therapy. Lifestyle adjustments, such as fluid management and exercise, can also help manage mild symptoms.

BPH is an acronym for benign prostatic hyperplasia, also known as an enlarged prostate. An enlarged prostate is a prostate gland that has grown larger than normal size. It is a common condition in older men. About 50% of men have some signs of BPH by age 50, and almost 90% are affected by age 85.

Enlarged prostate tissue in men with BPH causes lower urinary tract symptoms, such as difficulty peeing or having a sudden urge to pee. Enlarged prostate treatment consists of medications, minimally invasive procedures, and surgery. Continue reading to learn more about this condition.

What is a Prostate?

The prostate gland is a walnut-sized gland that produces semen. It is located in front of the rectum, just below the urinary bladder. Part of the prostate gland surrounds the urethra, the tube that carries urine and ejaculate out of the body. 

The enlarged prostate tissue puts pressure on the urethra and can block the flow of urine. It can also cause bladder and kidney problems due to incomplete emptying of the urinary bladder.

BPH vs Prostate Cancer: Recognizing the Differences

Benign prostatic hyperplasia (BPH) is not cancerous and is not the same as prostate cancer. The key difference is that in prostate cancer, cancer cells grow uncontrollably, while in BPH, normal, healthy prostate cells become bigger. 

However, BPH symptoms and prostate cancer symptoms can be similar. That’s why seeing a healthcare provider and getting a proper diagnosis is important. It may or may not be necessary to have an enlarged prostate treated, depending on the severity of symptoms. In contrast, prostate cancer is a serious, potentially life-threatening condition that needs to be treated.

Note: Having benign prostatic hyperplasia (BPH) is not a risk factor for prostate cancer. However, both conditions can be present at the same time and cause similar symptoms. For this reason, experts recommend yearly prostate cancer screening for all men between the ages of 55 and 69, sooner if risk factors (such as a family history of prostate cancer or Black ethnicity) are present.

What Are the Causes of an Enlarged Prostate?

Age and Hormonal Changes

According to the National Institute of Diabetes and Digestive and Kidney Diseases, the prostate gland has two main growth periods. The first phase occurs during puberty, when the prostate doubles in size. The second period starts around age 25 and continues lifelong. Benign prostatic hyperplasia (BPH) occurs late in the second phase, usually after age 40. Scientists believe the enlargement of prostate tissue occurs due to changes in the levels of sex hormones such as dihydrotestosterone with age.

Genetic Factors

Having a family history of prostate problems is a risk factor for BPH. Studies have also shown that the risk is higher in men whose relatives were diagnosed with BPH at a younger age. 

Lifestyle and Environmental Impacts

Research has found that people with diabetes and heart disease are more likely to develop BPH. In addition, obesity and lack of exercise can increase BPH risk.

Symptoms of Benign Prostatic Hyperplasia

Urinary Symptoms

Common enlarged prostate symptoms include:

  • Increased urinary frequency (frequent need to pee or make repeated trips to the bathroom)

  • Increased urinary urgency (sudden urge to pee)

  • Nocturia (peeing more often at night)

  • Trouble starting urination

  • A urine stream that starts and stops

  • Weak urine stream

  • Dribbling at the end of urination

  • Inability to empty the bladder fully

Less common benign prostatic hyperplasia symptoms include:

 

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How Does An Enlarged Prostate Impact Daily Life?

As the prostate grows, urinary problems develop. Initially, these may cause only minor symptoms. However, lower urinary tract symptoms of BPH can become bothersome over time. For example, getting up multiple times at night to urinate can disrupt sleep. 

With time, symptoms can worsen as the prostate continues to enlarge. Slowly worsening symptoms can affect a person’s overall quality of life. For example, a person with an enlarged prostate may begin to limit participation in certain activities due to bothersome symptoms. 

Note: While slowly worsening symptoms are common, sometimes BPH symptoms stay the same or even improve with time.

It’s worth noting that the size of the prostate gland does not always correlate with the severity of BPH symptoms. An enlarging prostate does not always increase BPH symptoms. Some people with enlarged prostates have no symptoms, others with very large prostate glands have mild symptoms, and yet others with only slight enlargement of the prostate have severe symptoms. 

Complications of BPH

Left untreated, benign prostatic enlargement can cause complications such as:

  • Acute urinary retention or the sudden inability to urinate, which can require catheter drainage or even surgery to drain urine from the bladder

  • Urinary tract infection (UTI). Incomplete emptying of the bladder can increase the risk of infections. Sometimes, surgery to remove part of the prostate is necessary if UTIs keep recurring.

  • Bladder stones. The inability to empty the bladder can lead to bladder stones, which can lead to bladder irritation, blood in urine, and blockage of urine flow if a stone gets stuck in the bladder neck.

  • Damage to the bladder muscle. Excess urine storage in the bladder can cause the bladder muscle to stretch and weaken over time. Weak bladder muscles can make it hard to fully squeeze the bladder and empty urine. 

  • Reduced kidney function due to kidney damage. Incomplete emptying of the bladder can cause backflow pressure and lead to kidney infections.

Note: Research does not suggest that an enlarged prostate increases the risk of prostate cancer. 

Diagnosing an Enlarged Prostate

A urologist can diagnose BPH based on symptoms, medical history, physical examination, and test results. Common diagnostic tests for an enlarged prostate include:

  • Digital rectal exam: Your healthcare provider will insert a gloved finger into your rectum to check for an enlarged prostate gland.

  • Urine test: A sample of your urine will be sent to the lab to look for signs of illnesses that can cause similar symptoms to BPH.

  • Blood tests: A blood test might point towards kidney problems.

Additional tests after the initial evaluation may include: 

  • Prostate-specific antigen (PSA): This is a blood test that looks for a specific protein called PSA. PSA levels are high in people with an enlarged prostate, but they can also be a sign of recent surgery, illness, or prostate cancer.

  • Urine flow test: This test measures the strength of urine flow and urine volume. It requires you to urinate into a container that is attached to a machine. The results of a urinary flow test can be used to monitor worsening BPH symptoms over time. 

  • Post-void residual volume: This is a measure of how much urine remains in the bladder after urinating. It is done using a catheter or ultrasound.

  • 24-hour voiding diary: Your healthcare provider might ask you to pee into a container and note down the volume. It can help with diagnosis by showing if you’re making more than one-third of your urine at night. 

In more complex cases, additional testing may include:

  • Transrectal ultrasound: This test uses sound waves to image the prostate and check its size. The ultrasound device is inserted into the rectum. 

  • Prostate biopsy: This test involves using ultrasound to guide a needle to the prostate and obtain a small tissue sample for examination in the laboratory. It can provide a definitive diagnosis of benign prostatic hyperplasia versus prostate cancer.

  • Urodynamic and pressure flow studies: These are studies done using a catheter in the urethra. Water or air is gently pumped into the bladder to check the functioning of the bladder muscle. 

  • Cystoscopy: This imaging test uses a cystoscope, a thin, flexible device with a light and camera at its tip. It is inserted through the urethra, allowing your doctor to see inside your urethra and bladder.

When to See a Doctor For BPH

Make an appointment to see your healthcare provider if you have any benign prostatic hyperplasia symptoms. As mentioned, symptoms of BPH and prostate cancer can be similar. It’s also important to rule out other conditions, such as chronic prostatitis or testicular cancer

Proper diagnosis can help you get treatment, decrease symptoms, and improve your quality of life. Remember, while benign prostatic hyperplasia is not cancerous, it carries the risk of serious complications like urinary retention and kidney damage.

Treatment Options for Enlarged Prostate

Medications

Medications can help to manage mild to moderate symptoms of prostate enlargement. Treatment options include: 

  • Alpha-blockers: These medications make urination easier by relaxing the smooth muscle in the prostate gland and bladder neck. Examples include alfuzosin (Uroxatral), tamsulosin (Flomax), doxazosin (Cardura), silodosin (Rapaflo), and terazosin (Hytrin). Alpha-blockers are more effective in people with relatively less enlargement of the prostate. They may also have additional benefits for people with high blood pressure. Possible side effects include dizziness and retrograde ejaculation (backflow of semen in the urethra). Learn more about tamsulosin.

  • 5-alpha reductase inhibitors: These medications block hormones to prevent prostate growth. By shrinking the prostate, they can help relieve enlarged prostate symptoms. Examples include dutasteride (Avodart) and finasteride (Proscar). The full effect of 5-alpha reductase inhibitors can take up to six months. Possible side effects include sexual dysfunction.

  • PDE5 inhibitors: Medications used to treat erectile dysfunction, such as tadalafil (Cialis), have shown some benefit in treating an enlarged prostate.

  • Combination therapy with an alpha-blocker and 5-alpha reductase inhibitor may be prescribed to increase the urine flow rate and relieve other symptoms. 

Surgical Interventions

Transurethral Resection of the Prostate (TURP)

TURP is one of the first-line surgical treatments for BPH; the treatment is usually chosen based on the size of the prostate. A surgical tool called a resectoscope is passed through the tip of the penis into the urethra and used to remove part of the prostate. This surgery provides quick relief from enlarged prostate symptoms and improved urine flow. Sometimes, a catheter is needed to drain urine from the bladder for some time after a TURP procedure.

Transurethral Incision of the Prostate (TUIP)

TUIP is a minimally invasive surgical procedure in which the surgeon inserts an instrument into the urethra and uses it to make small cuts in the prostate. This surgery relieves pressure and makes urine flow easier. TUIP is recommended for mildly enlarged prostates and in patients who are at high risk for other types of prostate surgeries. 

Transurethral Microwave Thermotherapy (TUMT)

TUMT is performed using a special catheter (a thin, flexible tube) inserted through the urethra to the prostate gland. The surgeon uses microwave energy to destroy prostate tissue and shrink the gland. TUMT can take time to see results, and repeat treatments may be necessary. TUMT is therefore reserved for smaller prostate glands.

Laser Therapy for BPH

Healthcare providers can use a high-energy laser beam to destroy prostate tissue and relieve benign prostatic hyperplasia symptoms. Laser therapy carries a lower risk of side effects compared to other types of BPH surgery. It is an option for people who take anticoagulant medicine and is preferred in patients with very enlarged prostates. Men might have this versus other prostate procedures if they are at high risk of complications. Types of laser therapy include:

  • Photoselective vaporization of the prostate (PVP) 

  • Holmium laser ablation of the prostate

  • Holmium laser enucleation of the prostate (HoLEP)

Transurethral Electrovaporization of the Prostate (TUVP)

TUVP or TUEVAP (transurethral electro-vaporization of the prostate) is performed using an instrument inserted through the urethra. This instrument consists of a special wire loop that heats prostate tissue and vaporizes it (turning the prostate tissue into vapor). This treatment relieves pressure on the urethral tissues and improves urinary symptoms caused by prostate enlargement. Other names for this procedure are photovaporization and transurethral electro-vaporization of the prostate (TUEVAP).

Prostate Lift

A prostate lift, also called UroLift, is a surgical procedure in which tags are used to lift the prostate tissue away from the urethra. This procedure reduces benign prostatic obstruction and improves urine flow. A prostate lift is an option for people who don’t have enlargement in the middle part of the prostate. The risk of sexual side effects is less with a prostate lift compared to other surgical procedures.

Water Vapor Thermal Therapy (WVTT)

WVTT is a procedure in which a device is inserted into the urethra. It creates steam from water, which helps reduce excess prostate tissue. WVTT is less likely to cause sexual side effects compared to some other surgical procedures for benign prostatic hyperplasia.

Aquablation Therapy (Robotic Waterjet Treatment)

Robotic waterjet therapy is a BPH procedure in which robotic tools are used along with imaging studies to insert a device into the urethra. This device releases small but powerful jets of water that help to wear away excess prostate tissue. 

Open or Robot-Assisted Prostatectomy

Prostatectomy surgery is done through incisions (cuts) in the lower abdomen, through which the surgeon removes extra tissue from the prostate. Robotic tools are sometimes used. Prostatectomy is recommended for very large prostate glands and requires a short hospital stay. Like most surgeries, it carries a risk of bleeding and infection. 

Prostate Artery Embolization (PAE)

Prostate artery embolization (PAE) is a procedure in which the surgeon blocks blood supply to the prostate, shrinking it. PAE can only be performed by specially trained surgeons called interventional radiologists who use imaging methods, such as ultrasound, X-ray, or MRI, to guide the procedure.

Alternative Remedies 

The U.S. FDA has not approved any herbal supplements to treat benign prostatic hyperplasia (BPH). 

The American Urological Association says dietary supplements for BPH (saw palmetto, ryegrass, pygeum, beta-sitosterol extracts) are not proven to work and have not been studied enough to ensure safety. For example, two large studies found that a commonly used supplement for BPH, saw palmetto, has no benefits over a placebo (an inactive substance). 

Always check with your healthcare provider before taking any herbal remedies for BPH. Some natural or herbal products can interact with prescribed medications and increase the risk of adverse effects such as bleeding.

What Is the Latest Treatment for Enlarged Prostate?

Transurethral resection of the prostate (TURP) remains the gold standard treatment for most cases of benign prostatic hyperplasia (BPH). However, researchers continue to explore alternative minimally invasive procedures that may provide shorter recovery times and lower risks of complications, one of which is The Optilume BPH Catheter System.

The Optilume BPH Catheter System is an inflatable catheter inserted through the urethra and positioned within the prostate to provide long-lasting relief from benign prostatic hyperplasia (BPH) symptoms for up to four years. Once in place, the catheter creates a V-shaped channel at the top of the prostate gland to alleviate pressure on the urethra, thereby improving urinary flow rates. Notably, the catheter is coated with paclitaxel, a chemotherapy agent that helps reduce inflammation.

Lifestyle Changes for Managing BPH Symptoms

The following lifestyle adjustments may help in managing mild BPH symptoms: 

  • Avoid liquids for 2-3 hours before bedtime.

  • Avoid fluids before going out.

  • Avoid drinking too much fluid at once. Spread out fluid intake throughout the day. 

  • Limit caffeine and alcohol intake as they can irritate the bladder and cause frequent urination.

  • Urinate as soon as you have the urge. 

  • Use the toilet on a schedule even when you don’t have an urge to pee.

  • Stay warm. Cold weather can worsen symptoms.

  • Manage stress. Nervousness and tension can cause frequent urination.

Dietary Considerations and Physical Activity

What Is The Number One Food For The Prostate?

There is no number one food or specific diet for benign prostatic hyperplasia (BPH). But because obesity and lack of exercise are known risk factors for the condition, healthcare providers recommend the following:

  • Eat a low-fat diet with various fruits and vegetables, lean proteins, and low-fat dairy.

  • Engage in moderate to vigorous physical activity for at least 150 minutes a week. 

  • Maintain a healthy weight.

What Are 10 Drinks To Avoid With An Enlarged Prostate?

Some of the drinks to avoid with an enlarged prostate that can make symptoms worse include:

  • Caffeinated beverages:

    • Coffee

    • Tea

    • Energy drinks

  • Carbonated beverages:

    • Regular and diet sodas

    • Sparkling waters

    • Seltzers

  • Alcoholic beverages:

    • Beer

    • Wine

    • Spirits

    • Cocktails

  • Fruit juices

    • Grapefruit juice

    • Orange juice

    • Lemonade

    • Fruit punches

  • High-fat dairy drinks:

    • Full-fat milk

    • Chocolate milk

    • Milkshakes

Long-Term Outlook and Preventive Measures

There is no way to 100% protect against BPH. It is an age-related condition that affects the majority of men as they grow older. However, healthy habits such as a well-balanced diet, regular exercise, and a healthy body weight can lower the risk of BPH as well as health conditions like diabetes and heart disease, which are linked to a higher risk of BPH.

FAQs on Enlarged Prostate

Can You Live A Long Life With An Enlarged Prostate?

Yes, most people can live a long life with an enlarged prostate. Benign prostatic hyperplasia (BPH) or enlarged prostate is not cancer and is not usually a serious threat to health. However, BPH should be properly diagnosed and treated as it can lead to complications like recurrent infections, urinary retention, and kidney damage.

How To Pee With An Enlarged Prostate?

Here are some tips to make peeing easier if you have an enlarged prostate:

  • Do Kegel exercises. These can help improve bladder control. Contract the muscle that controls urine flow. Hold for 5-10 seconds. Repeat 5-15 times, up to 5 times a day. 

  • Try double voiding. Urinate once and go again after a couple of minutes. This practice can help to fully empty the bladder, lessen the feeling of needing to pee all the time, and perhaps save a trip to the bathroom. 

How Long Does It Take For An Enlarged Prostate To Go Down?

  • Medicines called alpha-1 blockers start working quickly and lead to improvement in enlarged prostate symptoms within a week. However, they work by relaxing bladder and prostate muscles and do not shrink the prostate.

  • Medications called 5-ARIs (alpha-reductase inhibitors) help to shrink the prostate, but you must take them every day for 3-6 months before your enlarged prostate goes down and symptoms improve. 

  • Improvement in lower urinary tract symptoms (LUTS) can occur almost immediately after surgical procedures such as transurethral resection of the prostate (TURP), in which excess prostate tissue is removed to relieve pressure on the urethra (the tube through which urine passes).

References:

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  2. https://my.clevelandclinic.org/health/diseases/9100-benign-prostatic-hyperplasia

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  4. https://www.niddk.nih.gov/health-information/urologic-diseases/prostate-problems/enlarged-prostate-benign-prostatic-hyperplasia

  5. https://www.mountsinai.org/health-library/diseases-conditions/enlarged-prostate

  6. https://prostatecanceruk.org/prostate-information-and-support/just-diagnosed/other-prostate-problems/enlarged-prostate

  7. https://pubmed.ncbi.nlm.nih.gov/7572978/#:

  8. https://pubmed.ncbi.nlm.nih.gov/7687780/

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  14. https://www.cancer.gov/publications/dictionaries/cancer-terms/def/tuvp

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