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Enlarged prostate

The prostate is a gland that produces the fluid that carries sperm during ejaculation. The prostate gland surrounds the urethra, the tube through which urine passes out of the body.

Male reproductive anatomy

An enlarged prostate means the gland has grown bigger. Prostate enlargement happens to almost all men as they get older. As the gland grows, it can press on the urethra and cause urination and bladder problems.

An enlarged prostate is often called benign prostatic hyperplasia (BPH). It is not cancer, and it does not raise your risk for prostate cancer.

Enlarged prostate gland
Enlarged prostate gland

Alternative Names

BPH; Benign prostatic hyperplasia (hypertrophy); Prostate - enlarged

Causes

The actual cause of prostate enlargement is unknown. Factors linked to aging and changes in the cells of the testicles may have a role in the growth of the gland. Men who have had their testicles removed at a young age (for example, as a result of testicular cancer) do not develop BPH.

Also, if the testicles are removed after a man develops BPH the prostate begins to shrink in size.

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Some facts about prostate enlargement:

  • The likelihood of developing an enlarged prostate increases with age.
  • BPH is so common that it has been said all men will have an enlarged prostate if they live long enough.
  • 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.
  • No risk factors have been identified other than having normally functioning testicles.

Symptoms

Less than half of all men with BPH have symptoms of the disease. Symptoms may include:

Exams and Tests

Your doctor will ask you questions about your medical history and do a digital rectal exam to feel the prostate gland. Other tests you may have include:

  • Urine flow rate
  • Post-void residual urine test to see how much urine is left in your bladder after urination
  • Pressure flow studies to measure the pressure in the bladder as you urinate
  • Urinalysis to check for blood or infection
  • Urine culture to check for infection
  • Prostate-specific antigen (PSA ) blood test to screen for prostate cancer
  • Cystoscopy

You may be asked to fill out a form to rate how bad your symptoms are and how much they affect your daily life. Your doctor can use this score to judge if your condition is getting worse over time.

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Treatment

The treatment you choose will be based on how bad your symptoms are and how much they bother you. Your doctor will also take into account other medical problems you may have.

Treatment options include "watchful waiting," lifestyle changes, medicines, or surgery.

If you are over 60, you are more likely to have symptoms. But many men with an enlarged prostate have only minor symptoms. Self-care steps are often enough to make you feel better.

If you have BPH, you should have a yearly exam to monitor your symptoms and see if you need changes in treatment.

SELF-CARE

For mild symptoms:

  • Urinate when you first get the urge. Also, go to the bathroom when you have the chance, even if you don't feel a need to urinate.
  • Avoid alcohol and caffeine, especially after dinner.
  • Don't drink a lot of fluid all at once. Spread out fluids during the day. Avoid drinking fluids within 2 hours of bedtime.
  • Try NOT to take over-the-counter cold and sinus medicines that contain decongestants or antihistamines. These drugs can increase BPH symptoms.
  • Keep warm and exercise regularly. Cold weather and lack of physical activity may worsen symptoms.
  • Learn and perform Kegel exercises (pelvic strengthening exercises).
  • Reduce stress. Nervousness and tension can lead to more frequent urination.

MEDICINES

Alpha 1-blockers are a class of drugs that are also used to treat high blood pressure. These medicines relax the muscles of the bladder neck and prostate. This allows easier urination. Most people who take alpha 1-blockers notice improvement in their symptoms. .

Finasteride and dutasteride lower levels of hormones produced by the prostate. These drugs also reduce the size of the gland, increase urine flow rate, and decrease symptoms of BPH. You may need to take these medicines for 3 to 6 months before you notice symptoms getting better. Possible side effects include decreased sex drive and impotence .

Antibiotics may be prescribed to treat chronic prostatitis (inflammation of the prostate), which may occur with BPH. BPH symptoms improve in some men after a course of antibiotics.

SAW PALMETTO

Many herbs have been tried for treating an enlarged prostate. Many men use saw palmetto to ease symptoms. Some studies have shown that it may help with symptoms, but results are mixed and more research is needed. If you use saw palmetto and think it works, ask your doctor if you should still take it.

SURGERY

Prostate surgery may be recommended if you have:

The choice of a specific surgical procedure is usually based on the severity of your symptoms and the size and shape of your prostate gland.

Transurethral resection of the prostate (TURP): This is the most common and most proven surgical treatment for BPH. TURP is performed by inserting a scope through the penis and removing the prostate piece by piece.

Simple prostatectomy : An open prostatectomy is usually performed using general or spinal anesthesia. An incision is made through the abdomen or perineum (the area behind the scrotum). Only the inner part of the prostate gland is removed. The outer portion is left behind. This is a long procedure. Most people need to stay in the hospital for 5 to 10 days. This treatment is most often done on men who have very large prostate glands.

Most men who have prostate surgery have improvement in urine flow rates and symptoms.

Other, less-invasive procedures use heat to destroy prostate tissue. None have been proven to be better than TURP. Patients who receive these procedures are more likely to need surgery again after 5 or 10 years. However, these procedures may be a choice for:

  • Younger men (many of the less-invasive procedures carry a lower risk for impotence and incontinence than TURP, although the risk with TURP is not very high)
  • Elderly patients
  • Patients with severe medical conditions, including uncontrolled diabetes , cirrhosis , alcoholism, psychosis , and serious lung, kidney, or heart disease
  • Men who are taking blood-thinning drugs

Support Groups

Some men may find it helpful to take part in a BPH support groups .

Possible Complications

Men who have had BPH for long time with slowly worsening symptom may develop:

  • Sudden inability to urinate
  • Urinary tract infections
  • Urinary stones
  • Damage to the kidneys
  • Blood in the urine

BPH may come back over time even after having surgery.

When to Contact a Medical Professional

Call your doctor right away if you have:

  • Less urine than usual
  • Fever or chills
  • Back, side, or abdominal pain
  • Blood or pus in your urine

Also call your doctor if:

  • Your bladder does not feel completely empty after you urinate.
  • You take medicines that may cause urinary problems such as diuretics, antihistamines, antidepressants, or sedatives. Do NOT stop or change your medicines without talking to your doctor
  • You have tried self-care steps for 2 months and symptoms have not improved.

References

Roehrborn CG. Male lower urinary tract symptoms (LUTS) and benign prostatic hyperplasia (BPH). Med Clin North Am. 2011 Jan;95(1):87-100.

McVary KT, Roehrborn CG, Avins AL, et al. Update on AUA guideline on the management of benign prostatic hyperplasia. J Urol. 2011 May;185(5):1793-803. Epub 2011 Mar 21.

McNicholas TA, Kirby RS, Lepor H. Evaluation and nonsurgical management of benign prostatic hyperplasia. In: Wein AJ, ed. Campbell-Walsh Urology. 10th ed. Philadelphia, PA: Saunders Elsevier; 2011:chap 91.

Updated: 10/2/2013

Scott Miller, MD, Urologist in private practice in Atlanta, GA. Also reviewed by David Zieve, MD, MHA, Bethanne Black, and the A.D.A.M. Editorial team.


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