Benign enlarged prostate is a condition that affects many men as they get older. In some men, increased growth of the tissue in the prostate gland (known as benign prostatic hyperplasia or BPH) can cause the prostate gland to become enlarged, which can make it difficult to pass urine.
Benign means non-cancerous. Many things, including prostate cancer and prostatitis, can cause an enlarged prostate. This information is just about an enlarged prostate caused by BPH.
Your prostate is a gland that produces the liquid part of semen (the fluid produced when you ejaculate). It’s about the size of a walnut and lies at the base of your bladder. The front of your prostate surrounds your urethra – the tube that carries urine from your bladder and out through your penis.
If you have BPH, a rapid growth in the cells in your prostate can cause the middle part of your prostate to gradually grow bigger. When this happens the prostate gland presses on your urethra, narrowing it and making it more difficult to pass urine.
BPH is a common problem in men as they get older. Around half of all men have an enlarged prostate by the age of 50 and about 9 out of 10 men have an enlarged prostate by the age of 90.
If you have an enlarged prostate you may not have any symptoms at all. If you do have symptoms, how severe they are isn’t linked to the size of your prostate. For example, if your prostate is very large it doesn’t mean your symptoms will be severe. The symptoms of BPH may include:
If you have any of these symptoms, see your GP.
In some men, enlarged prostate can lead to more serious problems. The main complications of benign enlarged prostate are listed below.
The exact reasons why some men develop BPH and an enlarged prostate aren’t fully understood at present. However, there are two factors that affect your likelihood of developing BPH; your age and the level of hormones in your body. As you get older the level of hormones in your body change and this may affect your prostate gland.
Your GP will ask you about your symptoms and examine you. He or she may ask you to complete a questionnaire, or keep a diary, to assess how severe your symptoms are and how much they are bothering you.
Your GP will ask to feel your abdomen, to check if your bladder is swollen. Your GP may also advise you to have a digital rectal examination. This is an examination to check the size of your prostate gland and what it feels like. Your doctor will insert his or her finger into your rectum (back passage), where he or she will be able to feel your prostate gland.
Your GP may ask you for a urine sample and advise you to have some blood tests. These check for urinary tract infections and check how well your kidneys are working.
You may be offered a blood test to check your prostate-specific antigen (PSA). This is a protein produced by the prostate. High levels of PSA can sometimes be a sign of cancer, but may also be a result of BPH, infections and other reasons. In fact, around half of men with BPH will have a raised PSA level. Your GP will discuss the pros and cons of this test with you to help you decide whether to have it.
Your GP may refer you to a urologist if there are any doubts about your diagnosis, or if you need surgery. A urologist is a doctor who specialises in identifying and treating conditions that affect the urinary system. The urologist may advise the following tests.
There are a number of treatment options for BPH, as described below. Which treatments you are offered will depend on your personal circumstances, including how severe your symptoms are and how much they bother you. Treatment may not be able to get rid of your symptoms completely but it can ease them effectively. Your doctor will discuss these with you to help you make a decision that’s right for you. Your decision will be based on your doctor’s expert opinion and your own personal values and preferences.
If you have mild to moderate symptoms that aren't bothering you much, your GP may suggest you don’t have any immediate medical treatment, but just monitor your condition with routine check-ups. This is called watchful waiting. Your GP may give you some advice on simple lifestyle changes you can make to improve your symptoms, such as cutting down on caffeine and alcohol and reducing the amount of fluid you drink when you know you’re going out.
He or she may also suggest a programme of exercises known as bladder training. This involves increasing how much urine your bladder can hold by trying to increase the amount of time before you need to urinate.
If your symptoms are bothering you, your GP may suggest treatment with medicines.
These include alfuzosin, doxazosin and tamsulosin. Alpha-blockers work by relaxing the muscles at the neck of your bladder, reducing the pressure on your urethra and increasing the flow of urine. They don’t cure BPH but may help to alleviate some of your symptoms. Alpha-blockers can be associated with side-effects such as dizziness and light-headedness, as a result of low blood pressure. Your GP can prescribe alpha-blockers. You can also buy tamsulosin from a pharmacist.
5-alpha reductase inhibitors
Your GP may offer you a 5-alpha reductase inhibitor, such as finasteride or dutasteride. You may be offered this treatment if you have a particularly large prostate or a high PSA level, but don’t have any signs of prostate cancer. These medicines work by blocking the production of a hormone called dihydrotestosterone, which can reduce the size of your prostate. They can take six months or more to work.
The most common side-effects of 5-alpha reductase inhibitors are sexual problems, including a reduced sex drive, difficulty in maintaining an erection and problems with ejaculation. However, these problems seem to affect more men during the first year of treatment and become less common as treatment continues.
Your urologist may suggest an operation if other treatments haven’t worked, or if your symptoms are severe. If you develop any complications as a result of your enlarged prostate your urologist may also suggest surgery.
There are a number of different types of surgery that can treat an enlarged prostate. The most common type of surgery is transurethral resection of the prostate (TURP). The procedure involves passing a narrow, flexible tube-like telescopic camera called an endoscope up through your urethra, and cutting out the middle of your enlarged prostate using specially adapted surgical instruments.
There are other types of procedure, such as holmium laser enucleation of the prostate (HoLEP) and transurethral vaporisation of the prostate (TUVP), where some or all of your prostate gland is removed or destroyed. Your urologist will discuss the options with you.
There have been claims that the plant extract saw palmetto is an effective treatment for symptoms of enlarged prostate. However, there is no good quality evidence to support these claims.
If you do choose to try herbal medicines, talk to your GP or pharmacist first.
Produced by Dylan Merkett, Bupa Health Information Team, June 2013.
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