Benign prostatic hyperplasia, or BPH, is a non-cancerous enlargement of the prostate gland. This gland is situated just below the bladder and surrounds a portion of the urethra, the tube that carries urine from the body. The term “hyperplasia” refers to an increase in the number of cells, which causes the gland to grow.
While BPH is a natural occurrence for many men as they age, it is distinct from prostate cancer. Although both conditions can share similar symptoms, having BPH does not increase an individual’s risk of developing prostate cancer. The growth of the prostate is characterized by the proliferation of cells within the prostate transition zone. This expansion can lead to compression of the urethra, which is the underlying cause of the associated urinary symptoms.
Causes and Associated Risk Factors
The primary driver of benign prostatic hyperplasia is the aging process. The likelihood of developing an enlarged prostate begins to rise after the age of 40. Histological evidence of BPH is found in approximately 50% to 60% of men in their 60s, a figure that climbs to 80% to 90% in men over 70.
Hormonal changes that occur with age are also a significant factor. The hormone dihydrotestosterone (DHT) is implicated in prostate growth. As men age, testosterone is converted to DHT by an enzyme called 5-alpha reductase, and DHT stimulates the proliferation of prostate cells, leading to enlargement.
Beyond age and hormones, several other factors can influence the risk of developing BPH.
- A family history of prostate problems suggests a genetic predisposition.
- Obesity, particularly excess abdominal fat, increases the risk.
- Regular physical exercise can help lower the risk.
- Certain medical conditions, such as type 2 diabetes and heart disease, have been linked to a higher chance of developing BPH.
Recognizing the Symptoms
The symptoms of BPH are often grouped as lower urinary tract symptoms (LUTS). The severity of symptoms does not always correlate with the size of the prostate. Some men with slightly enlarged prostates may experience significant issues, while others with very enlarged prostates have only minor symptoms. These symptoms are divided into two categories.
Obstructive symptoms are those that cause problems with the flow of urine. These can manifest as:
- Hesitancy, which is difficulty or a delay in starting urination.
- A weak or slow urinary stream.
- A stream that stops and starts, known as intermittency.
- A feeling of incomplete bladder emptying or straining to urinate.
Irritative symptoms relate to problems with bladder storage. These include:
- Urinary frequency, the need to urinate more often than usual.
- Urgency, a sudden and strong need to urinate that is difficult to defer.
- Nocturia, which is the need to wake up multiple times during the night to urinate.
The Diagnostic Journey
Diagnosing BPH begins with a detailed discussion of your medical history and symptoms. Your doctor may use a questionnaire, such as the International Prostate Symptom Score (I-PSS), to formally assess them. This scoring system helps quantify the impact of the symptoms on your quality of life and provides a baseline for monitoring treatment.
A physical examination will include a digital rectal exam (DRE), where a doctor inserts a gloved, lubricated finger into the rectum to feel the prostate gland. A smooth, symmetric, and enlarged prostate often indicates BPH, whereas a hard or nodular feel could raise concerns about other conditions.
To refine the diagnosis and rule out other causes, several tests are commonly used. A urinalysis checks a urine sample for signs of infection or other abnormalities. A blood test to measure prostate-specific antigen (PSA) levels is also performed. While elevated PSA can be a marker for prostate cancer, it is also often increased in BPH.
In some cases, additional tests may be recommended. A urine flow study can measure the speed of your urine stream, with a slower rate suggesting an obstruction. A post-void residual volume test uses an ultrasound to measure how much urine is left in your bladder after you urinate.
A Spectrum of Treatment Approaches
The management of BPH depends on symptom severity, prostate size, age, and personal preferences. For men with mild symptoms, a strategy of “watchful waiting” or active surveillance is often the first step. This involves monitoring the condition over time with lifestyle adjustments, such as managing fluid intake and avoiding bladder irritants like caffeine.
When symptoms are more moderate, medications are a common option. Alpha-blockers, such as tamsulosin, work by relaxing the muscles in the bladder neck and prostate to improve urine flow. 5-alpha reductase inhibitors, like finasteride, shrink the prostate gland by blocking the hormonal changes that cause it to grow. Sometimes, a combination of these two medications is prescribed.
For individuals who do not find relief from medication, a range of minimally invasive procedures are available. These treatments are performed on an outpatient basis with a lower risk of side effects and quicker recovery. Procedures include the UroLift system, which uses small implants to hold prostate tissue away from the urethra, or Rezūm water vapor therapy, which uses steam to remove excess tissue.
In cases of severe symptoms or when other treatments have been ineffective, surgery may be considered. The most common surgical procedure for BPH has been the transurethral resection of the prostate (TURP), which removes the inner portion of the prostate. Other techniques, including laser therapies like Holmium laser enucleation of the prostate (HoLEP), are also used to remove obstructing prostate tissue.