Enlarged Prostate (BPH)

While it may be caused, in part, by existing prostate cancer, BPH itself is not itself a sign that a man has cancer of the prostate. Some men have BPH with few symptoms, while others have related issues with urination that may include frequently having to void, especially at night, or related urinary tract infections.

Treatment will depend on how an enlarged prostate is affecting urination habits.

It’s not clear why the male prostate enlarges later in life. One possibility is that BPH may be related to changes with the balance of male sex hormones that occurs with age. Most men with an enlarged prostate that’s placing pressure on their urine tube (urethra) first notice issues with increasingly frequent urination or the process of starting urination.

Men with a family history of BPH, or those with underlying health conditions such as diabetes and heart disease, tend to be more likely to develop prostate enlargement. Benign prostatic hyperplasia symptoms may include:

• Incomplete bladder emptying
• Weak or dribbling urine streams
• Blood in urine (hematuria)
• Kidney or bladder stones
• Having issues with bladder nerves

Risk factors can include:

• Being excessively overweight
• Having cancer of the bladder or prostate
• Bladder neck scarring from a previous procedure

Diagnosis of BPH usually involves asking about symptoms and how urination is affected. A digital rectal exam (DRE) is usually done to determine if the prostate gland is enlarged. Urine and blood tests may also be done to look for signs of infection and check kidney functioning. A prostate-specific antigen (PSA) blood test is sometimes done as well to look for elevated PSA levels, which suggests that a prostate may be enlarged.

If cancer is suspected, a prostate biopsy may be done. Additionally, some men are asked to keep a voiding diary for 24 hours so urination patterns can be evaluated. Tests performed may also include:

• An ultrasound probe via the rectum
• A urinary flow test
• An examination of urethra and bladder with a special scope (cystoscopy)
• Pressure flow studies

The first attempt at managing benign prostatic hyperplasia symptoms usually involves medications such as alpha blockers and 5-alpha reductase inhibitors to relax muscles and shrink the prostate gland. If medication isn’t helping or symptoms are severe, surgery may be recommended.

Procedures commonly performed include ones where prostate tissue is removed or destroyed with microwave energy. Another option involves the insertion of a special device that compresses the prostate gland so the urine tube has more room (prostatic urethral lift). In some situations, it may be necessary to remove part or all of the prostate gland (prostatectomy).

The prostate gland naturally increases in size with age. In fact, it’s believed all men will eventually have an enlarged prostate if they live long enough, so it’s not considered a preventable condition. What men can do, however, is be mindful of symptoms suggesting they may have issues with benign prostatic hyperplasia. It may be possible to minimize urination problems related to BPH by being proactive about diet and exercise habits and making an effort to strengthen pelvic floor muscles.