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Enlarged prostate (benign prostatic hyperplasia)

Published by Bupa's health information team, February 2009.

This factsheet is for people who have an enlarged prostate (benign prostatic hyperplasia or BPH) or who would like information about it.

BPH, sometimes known as benign prostatic hypertrophy or benign prostatic obstruction, is an overgrowth of cells of the prostate gland that blocks the flow of urine, making it difficult to pass urine.

About benign prostatic hyperplasia
Symptoms of benign prostatic hyperplasia
Causes of benign prostatic hyperplasia
Diagnosis of benign prostatic hyperplasia
Treatment of benign prostatic hyperplasia
Questions and answers
Related topics
Further information
Sources

About benign prostatic hyperplasia

The prostate is a gland about the size of a walnut, that is only present in men. It's located just below the bladder and surrounds the urethra, the tube that carries urine from your bladder and out through your penis. One of the main functions of the prostate gland is to produce prostatic fluid, one of the components of semen.

BPH is very common - up to four in 10 men over 65 have it.

Illustration showing the position of the prostate gland and surrounding structures
The position of the prostate gland and surrounding structures

Symptoms of benign prostatic hyperplasia

If you have BPH, you may have:

difficulty in starting to pass urine
a weak flow of urine that sometimes starts and stops
dribbling of urine before and after urinating
a frequent or urgent need to pass urine

The symptoms of BPH can be similar to those of certain types of prostate cancer, so you should see your GP if you start to have problems passing urine. BPH is easier to treat if the treatment starts early.

Causes of benign prostatic hyperplasia

Although it's not known why only some men develop BPH, you're more likely to get it as you get older.

Diagnosis of benign prostatic hyperplasia

Your GP will ask you about your symptoms and examine you. He or she may also ask you about your medical history and may do some of the following tests or will refer you to an urologist (a surgeon specialising in the urinary system) for them.

Your GP will feel your abdomen (tummy) to find out if your bladder is over-filled with urine. This may indicate that you're not completely emptying your bladder. This is called chronic urinary retention. You may need to have some other tests to make sure that your urinary problems are due to BPH and not other conditions.

You will be asked to give a urine sample which will be tested for infection or blood.

You will be given a digital rectal examination - this is to check the size and consistency of your prostate.

Blood tests may be carried out, including one to assess how your kidneys are working.

You may be given other tests such as:

urine flow tests
ultrasound to check for urine left in the bladder (residual urine - a measure of how severe the obstruction to your bladder is) and bladder stones
urodynamic measurements using a catheter inserted into the bladder to measure the pressure of the urine and how fast it flows

You may have a blood test for prostate-specific antigen (PSA). This measures the amount of PSA, a protein produced by the prostate. When the prostate gland is enlarged, PSA may be released into the bloodstream. Various conditions can affect PSA levels including prostate cancer, BPH or prostatitis (inflammation of the prostate). Although healthy men do occasionally have a raised PSA, high levels of the protein can indicate a greater chance of getting prostate cancer.

You may also be asked to keep a 24-hour record of when you pass urine and how much - this is called a voiding diary.

Treatment of benign prostatic hyperplasia

Active monitoring

Many men only have mild symptoms of BPH and no treatment is required. This is often called active monitoring or watchful waiting. Your condition will be monitored closely with routine check-ups. You will be given plenty of information about your condition, and advice on simple lifestyle changes that may help to improve your symptoms. You should cut down on alcoholic or caffeinated drinks, and you can learn techniques to increase how much urine your bladder can hold. If your symptoms get worse, your GP will recommend the best treatment for you.

Medicines

There are two main classes of prescription medicine that are used to treat BPH - alpha-blockers and 5-alpha-reductase inhibitors. These medicines can be given on their own or in combination, depending on the severity of your condition.

Always ask your doctor for advice and read the patient information leaflet that comes with your medicine.

Alpha-blockers

Alpha-blockers, such as tamsulosin and terazosin, relax muscle fibres that control the tension in your prostate gland and bladder. They can reduce the pressure on your urethra and increase the flow of urine. They don't cure BPH but may help to alleviate some of your symptoms.

Although alpha-blockers are likely to help, they don't work for everyone. If your symptoms don't improve within a couple of months, your GP or surgeon may suggest trying an alternative treatment.

Some common side-effects of alpha-blockers include tiredness, dizziness, light-headedness, weakness and headaches.

5-alpha-reductase inhibitors

5-alpha-reductase inhibitors, such as finasteride (eg Proscar) and dutasteride (eg Avodart), block production of a hormone called dihydrotestosterone (DHT). This can reduce the size of the prostate by up to one-third.

5-alpha-reductase inhibitors are able to reverse BPH to some extent and can delay your need for surgery.

Potential side-effects of these drugs include a reduced sex drive, difficulty in maintaining an erection and tender or enlarged breast tissue. These medicines pass into your semen, so you should use a condom if your partner is pregnant or likely to become pregnant, because they can harm the developing baby.

The best results tend to be seen after at least six months of treatment, and all side-effects will disappear when you stop treatment.

Surgery

There are a number of surgical options for BPH. Generally, surgery is considered for men who don't get relief from symptoms using medicines.

As with any surgical procedure, there are risks. A common side-effect of these procedures is retrograde ejaculation - where semen passes into your bladder during orgasm instead of out of the penis. Retrograde ejaculation isn't usually a problem, although it may reduce fertility. Other complications include urinary incontinence and difficulty passing urine.

Your surgeon will advise which is the best option for you.

Transurethral resection of the prostate

Transurethral resection of the prostate (TURP) is the most common operation for BPH. TURP is usually done under general anaesthesia. This means you will be asleep during the operation. TURP is performed using a narrow, flexible, tube-like telescopic camera called an endoscope. The endoscope is inserted into your urethra and your surgeon will then cut out the middle of your enlarged prostate using specially adapted surgical instruments.

Transurethral incision of the prostate

Transurethral incision of the prostate (TUIP) may be appropriate for men who have a less enlarged prostate. It's a quicker operation than TURP and may be done under general or regional anaesthesia. Regional anaesthesia completely blocks feeling from the area and you will stay awake during the operation. Your surgeon will make small cuts in your prostate and the neck of your bladder to reduce the blockage and improve the flow of urine.

Open prostatectomy

Open prostatectomy is only recommended for men whose prostate is very large. It's a major operation and may require up to a week in hospital. It's usually done under general anaesthesia. An incision is made in your abdomen in order to remove the obstructing part of your prostate.

Minimally invasive surgical treatment

Minimally invasive surgical treatment uses high energy to heat up and destroy parts of your prostate. Examples of minimally invasive techniques include:

microwave therapy
laser therapy
water-induced thermotherapy

These types of surgery have a lower risk of side-effects than TURP, TUIP and open prostatectomy, but may not be as effective and the long-term effects aren't known. Ask your surgeon for more information about minimally invasive surgical treatment.

Complementary therapies

There is some evidence that certain plant extracts, such as beta-sitosterols and saw palmetto, can help relieve your symptoms.

Always speak to your GP or pharmacist before taking plant extracts with other medicines.