Enlarged Prostate (BPH)



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Editor
Alvin Matsumoto, MD



Additional Resources
American Urological Association
NIDDK (NIH)
Mayo Clinic

What is benign prostatic hyperplasia (BPH)?

Benign prostatic hyperplasia (BPH) is an enlargement of the prostate gland. As men age, it’s common for the prostate to get larger. BPH does not lead to prostate cancer.

The prostate gland is located in the abdomen just below the bladder. It’s about the size and shape of a walnut. As part of the male reproductive system, it produces a milky white fluid that helps to transport sperm during ejaculation (expulsion from the penis). Enlargement of the prostate may affect the flow of urine (urination).

Who is at risk for benign prostatic hyperplasia (BPH)?

BPH affects more than half of men in their 60s and most men in their 70s and 80s.

  • Likelihood of developing an enlarged prostate increases with age
  • A small amount of prostate enlargement is present in many men over age 40
  • More than 90% of men over age 80 have the condition
  • In addition to age, family history, ethnicity (less common in Asians), obesity, and sedentary lifestyle are risk factors
  • BPH often occurs in men who also have an inability to get an erection sufficient to have sexual intercourse (erectile dysfunction or ED)

What are the signs and symptoms of BPH?

As the prostate enlarges, it can squeeze the urethra (the tube for urine to pass out of the body). Common symptoms of BPH are referred to as lower urinary tract symptoms (LUTS):

  • Frequent urination (especially at night)
  • Urgent need to urinate
  • Trouble or hesitation when starting to urinate
  • Weak urinary flow that may be interrupted with dribbling or leakage after urination
  • Feeling that the bladder is not empty after urination
  • If severe, complete inability to urinate (requires urgent medical attention)

How is BPH diagnosed?

To determine if you have BPH, your doctor will

  • Take your medical history
  • Ask you to describe the severity of your symptoms
  • Ask if you are taking medications that may worsen symptoms (antihistamines, decongestants, certain antidepressants, water pills [diuretics], or asthma medications [bronchodilators])
  • Examine your abdomen to check for bladder enlargement
  • Perform a digital rectal exam to determine the size and shape of your prostate and whether there is a lump or hardness that may indicate prostate cancer
  • Order a urinalysis (a urine exam) to look for signs of infection and/or to see if the kidneys have been affected (and sometimes measure the amount of urine that is left in the bladder after urination, usually done with a sound wave machine called an ultrasound bladder scanner)
  • Order a blood test for prostate-specific antigen (PSA) to screen for prostate cancer

How is BPH treated?

Treatment for BPH and its symptoms usually begins with your family doctor, who may refer you to a urologist. Your doctor may ask you to stop or change medications or treat a urinary tract infection that might be worsening your symptoms. Your doctor will usually base your treatment on the severity of your symptoms and how they affect your quality of life, rather than on the size of the prostate or medical need (unless the kidneys are affected). The most common complaints leading to treatment are interrupted sleep because of the need to urinate at night, and frequency and urgency with inability to control urination on a regular basis.

Although for most men many of the symptoms do not get worse for years, and may even get better with time, a rare complication of BPH involves a sudden and complete blockage of urination. This needs to be treated immediately.

For moderate to severe symptoms that interfere with daily life, there are three types of drug treatment:

  • Alpha-adrenergic blockers (doxazosin, terazosin, alfuzosin, tamsulosin, and silodosin).
  • Phosphodiesterase type 5 inhibitor (tadalafil)
  • 5-alpha-reductase inhibitors (finasteride and dutasteride)

Some men may benefit from using both alpha-adrenergic blockers and 5-alphareductase inhibitors at the same time. One or both drugs are usually continued for the rest of your life. If you stop taking them, your symptoms will return.

The main surgical treatment for BPH is a transurethral resection of the prostate (TURP) or similar procedures to remove excessive prostate tissue blocking urine flow. Surgery is an option if you:

  • Are not able to completely empty your bladder (which can damage the kidneys)
  • Are not able to urinate
  • Are not able to hold your urine (incontinence)
  • Have bladder stones
  • Have repeated infections that are difficult to treat (due to incomplete emptying of the bladder)
  • Have large amounts of blood in the urine on a regular basis

Although surgery can improve symptoms of BPH, it is less common since medical treatments became available. Surgery can cause long-term complications including ED and incontinence. And a small number of men need a second operation because of continued prostate growth or a narrowed urethra caused by the first surgery.

Questions to ask your doctor

  • Are my symptoms from BPH?
  • What are my treatment options?
  • What are the advantages and disadvantages of each of my treatment options?
  • Should I see a urologist for my condition?