Benign Prostatic Hyperplasia

What is benign prostatic hyperplasia? Benign prostatic hyperplasia (BPH) is a condition in which your prostate grows in size. Your prostate is a gland that rests below your bladder and in front of your rectum. It’s about the size of a walnut, and it surrounds part of your urethra. Your urethra is a tube that carries urine (pee) and sperm (ejaculate) out of your body. If your prostate grows in size, it can prevent pee and ejaculate from passing through your urethra. BPH isn’t cancerous. However, symptoms of BPH may indicate more serious conditions, including prostate cancer.

Does having benign prostatic hyperplasia increase the risk of prostate cancer? Research shows that having BPH doesn’t increase your risk of developing prostate cancer. However, BPH and prostate cancer have similar symptoms. If you have BPH, you may have undetected prostate cancer at the same time. To help detect prostate cancer in its early stages, every person with a prostate should get a prostate screening every year between the ages of 55 and 69. You have an increased risk of getting prostate cancer if you’re Black or have a family history of prostate cancer. If you have an increased risk of prostate cancer, you should start getting prostate screenings at age 40.

Who does benign prostatic hyperplasia affect? BPH is the most common prostate problem in men and people assigned male at birth (AMAB). Almost all people with a prostate will develop some enlargement in their prostate as they grow older.

How common is benign prostatic hyperplasia?

Benign prostatic hyperplasia is common.

By age 60, about 50% of people with a prostate will have some signs of BPH. By age 85, about 90% will have signs of the condition.

About half of all people with BPH will develop symptoms that require treatment.

What are the warning signs of benign prostatic hyperplasia?

Your prostate surrounds your urethra. When BPH causes your prostate to grow, it can cause blockage in your urethra. As a result, early symptoms of BPH include:

- Slowness or dribbling when you pee.

- Difficulty starting to pee.

- Uncontrollable leaking (incontinence).

- Sudden need to pee (urgency).

- Need to get up at night to pee.

- Inability to completely empty your bladder.

- Pain after ejaculating or while peeing.

- Your pee changes color.

- Your pee smells.

What happens if you leave an enlarged prostate untreated?

Without treatment, BPH can cause further blockage in your urethra, and your symptoms may worsen. It may also cause:

- Urinary tract infection.

- Bladder stones.

- Blood in your pee.

- Kidney damage due to pee backflow from your bladder up to your kidney. The pee backflow increases pressure on your kidney.

What causes benign prostatic hyperplasia?

Healthcare providers and medical researchers aren’t sure what causes BPH.

One theory is that, as you age, the amount of testosterone in your body decreases (low testosterone). At the same time, your estrogen levels remain the same. These hormone changes may cause your prostate cells to grow. However, people who take supplemental testosterone may develop or worsen BPH.

Older men and people AMAB also have higher levels of dihydrotestosterone (DHT). DHT is a more potent form of testosterone that increases the size of your prostate.

Is benign prostatic hyperplasia contagious?

No, BPH isn’t contagious. You can’t spread BPH to another person.

What type of doctor treats benign prostatic hyperplasia?

If your healthcare provider suspects you have BPH, they may refer you to a urologist. A urologist is a doctor who specializes in treating conditions that affect your urinary system.

How is benign prostatic hyperplasia diagnosed?

Your healthcare provider will review your medical history, ask you questions and perform a physical examination. Part of the physical exam involves a digital rectal exam.

During a digital rectal exam, your healthcare provider will carefully insert their gloved digit (finger) into your rectum. They’ll feel the edges and surface of your prostate, estimate the size of your prostate and detect any hard areas that could be cancer.

Your healthcare provider may also order:

- A survey to evaluate the severity of your symptoms.

- A urine flow test to measure the speed of your pee stream.

- A study to detect how much pee remains in your bladder after you’ve finished peeing.

- A cystoscopy to look into your bladder.

Can benign prostatic hyperplasia be cured?

There isn’t a cure for BPH. However, treatment options are available to help alleviate your symptoms.

How is benign prostatic hyperplasia treated?

If you have mild symptoms, you may not require any treatment. Your healthcare provider may recommend a “watchful waiting” approach in which you schedule regular appointments to ensure your BPH doesn’t get any worse.

Treatment options include:

Medications

The most commonly prescribed medications relax the muscle in your prostate, which reduces tension on your urethra. Examples include:

- Tamsulosin (Flomax®).

- Terazosin (Hytrin®).

- Doxazosin (Cardura®).

- Alfuzosin (Uroxatral®).

- Silodosin (Rapaflo®).

Some medications decrease the production of the hormone DHT, which can slow the growth of your prostate gland. These medications are most beneficial to people with larger prostates. Examples include:

- Finasteride (Proscar®).

- Dutasteride (Avodart®).

Your healthcare provider may prescribe combined medications that help treat your symptoms as well as improve your urine flow. One example is dutasteride and tamsulosin (Jalyn®).

After you start a medication, it may take between one and eight weeks for your symptoms to improve.

Surgery

Several different types of surgery can remove prostate tissue that blocks your urethra. These include:

- Transurethral resection of the prostate (TURP). Your urologist inserts a special instrument (resectoscope) through your urethra that allows them to see and remove prostate tissue.

- Transurethral incision of the prostate (TUIP). Your urologist makes two small incisions in your prostate and where your urethra and bladder join (bladder neck) to widen your urethra and improve urine flow.

- Transurethral electrovaporization. Your urologist uses an electrode to heat your prostate tissue. This turns the tissue cells in the enlarged areas of your prostate into steam.

- GreenLight™ laser. Your urologist uses a special laser to evaporate your enlarged prostate tissue.

- After a surgical procedure, you should be able to resume normal activities within a few days or a week.

Minimally invasive treatments

New BPH treatments are less invasive and damaging to healthy tissue than surgery. In general, most of these treatments are outpatient procedures, which means you can go home the same day as the procedure. They’re also cheaper, have fewer side effects and allow for a faster recovery. However, because these techniques are new, there isn’t much information about their long-term effects or complications.

Examples of minimally invasive treatments include:

Prostatic urethral lift. This procedure separates your enlarged prostate lobes to make your urethra wider, making it easier to pee. Your urologist inserts a special instrument (UroLift®) into your urethra and up to your prostate. When the UroLift reaches the side wall of your prostate, it ejects small implants that pull your prostate lobes apart and open your urethra. Your urologist may place two to six implants, depending on the size of your prostate.

Water vapor therapy. Your urologist inserts an instrument into your urethra and moves it to your prostate. Your urologist then ejects a needle into your prostate. The needle emits steam vapor, which turns into water. The water’s thermal energy destroys your prostate cells. Your body reabsorbs the dead cells, and your prostate shrinks. Another name for this procedure is the Rezūm™ System.

The most common side effects of these treatments include peeing more than normal and discomfort or irritation while your prostate heals.

After a minimally invasive procedure, you should be able to return to your normal activities in a few days. You should see improvements in your symptoms within three to six weeks.

What is the best treatment for benign prostatic hyperplasia?

TURP is the most effective treatment for most cases of BPH.

However, in adults 65 and older, medications and minimally invasive treatments are preferable. Older patients may have more complications and a longer recovery time after surgery.

What can/can’t I eat/drink if I have benign prostatic hyperplasia?

Fruits, vegetables and healthy fats may benefit your prostate health. Consider following the Mediterranean diet or incorporating more of the following in your meals:

- Berries.

- Broccoli.

- Citrus.

- Nuts.

- Tomatoes.

- Turmeric.

A poor diet may worsen your BPH. If you have BPH, it’s a good idea to avoid processed foods, sugars and large amounts of carbohydrates as well as:

- Alcohol.

- Caffeine.

- Dairy.

- Red meat.

- Sodium (salt).

Can an enlarged prostate go back to normal?

In some people with mild BPH, their symptoms went away without treatment. If your symptoms don’t go away during a watchful waiting approach, you and your healthcare provider should start discussing treatment options.