In this Article
What Is Benign Prostatic Hyperplasia (BPH)?
Benign prostatic hyperplasia (BPH) is a noncancerous enlargement of the prostate gland.
- “Benign” refers to the fact that the growth is noncancerous.
- The term “prostatic” refers to the prostate gland.
- “Hyperplasia” describes a condition in which the number of cells in an organ increases, leading to an overall increase in size of the prostate.
The prostate gland is an acorn-shaped gland located in a man’s pelvic region. It lies below the
An enlarged prostate gland is a common condition, affecting the lifestyles and, to some degree, the health of many men over the age of 60. It can play havoc on a man’s ability to urinate with ease and, in some cases, can lead to serious medical complications.
However, the condition is not cancerous. And there are many methods to improve the flow of urine if it does become obstructed by an enlarging prostate.
Enlargement in the size of the prostate:
- Is the result of an increase in the number of cells in the prostate gland
- May occur at different locations within the prostate and give rise to different prostate shapes
Nice To Know:
Why does an enlarged prostate gland effect the flow of urine?
Abnormal changes in the size of the prostate are important because its closeness to the neck of the bladder, where urine is stored, and the urethra, through which urine passes. can effect the transport of urine.
The capsule surrounding the prostate gland restricts the multiplying cells of the prostate from spreading outward. Therefore, as the prostate enlarges, it may squeeze the urethra, which passes through it, and may also constrict the neck of the bladder. Both actions reduce the flow of urine.
About the prostate gland
- The prostate lies below the bladder, the sac that stores the urine in the body,and surrounds part of the urethra, the ‘tube’ through which the urine passes from the bladder to the outside world.
- The prostate is one of three glands necessary for reproduction. The fluid it produces provides about 15 percent of the total volume of the
- The exact function of the fluid produced by the prostate remains largely unknown, although it is believed to promote the survival of sperm cells by reducing the acidity within the vagina.
- The prostate gland consists of about 50 small glandular lobes, which are drained by smaller branched tubes and ducts. The ducts empty into the part of the urethra that passes through the prostate gland.
- The prostate gland is surrounded by a lining called the capsule.
Nice To Know:
Is BPH related to prostate cancer?
While BPH causes an increase in the number of cells in the part of the prostate gland that surrounds the urethra, this growth is benign, or noncancerous. This is because the cell growth is in a way controlled by the body. In cancer, cell growth is uncontrolled.
Therefore, BPH does not “turn into” prostate cancer.
However, BPH and prostate cancer can certainly exist side by side. Also, it is possible for a man with BPH to develop prostate cancer at a later date.
So it is important for all men over age 50 (or over age 40, for those at higher risk) to have regular checks for prostate cancer as part of their overall wellness plan.
How Common Is BPH?
The prostate gland normally increases in size as men age. This does not usually create a urinary flow problem for men under 40 years of age.
After age 40, however, the prevalence of BPH rises sharply.
- The incidence of BPH is at least 50 percent for all men at the age of 50.
- The incidence of BPH rises to at least 80 percent of all men in their eighth decade of life.
- However, only about 25 percent of men will actually be treated for BPH by the age of 80.
- Only about 50 percent of men with an enlarged prostate gland have a condition in which there is some degree of obstruction of the bladder outlet.
Of the approximately 300,000 surgical procedures performed each year for BPH treatment, most are for
Facts About BPH
What Causes The Prostate To Enlarge?
Growth in the size of the prostate gland is related to:
- Normal prostate growth during life
- Sex hormone changes that occur with aging
The prostate gland is highly unusual because it undergoes an increase in size at several stages during most of a man’s life.
- The first growth phase is completed before or at birth, when the average prostate weighs about 1.5 grams.
- The second growth phase occurs early during puberty, when the weight of the prostate gland increases to around 11 grams.
- The third growth phase occurs during the mid-20s, when the weight of the prostate gland increases to approximately 18 grams.
- There is another apparent growth phase that begins when a man is in his 50s.
- By the time a man is in his 70s, the prostate gland has reached a maximum weight of 31 grams.
Therefore, throughout a man’s lifetime, the prostate gland normally increases in weight about 21 times, compared to its birth weight.
Although the prostate gland grows during much of a man’s life, urinary flow problems usually appear only after the age of 50 as a consequence of the final growth phase.
We do not know why the prostate gland enlarges during multiple growth spurts. However, there are two theories that attempt to explain this phenomenon. Both theories believe hormonal changes over time are responsible.
- Changes in the normal balance of sex hormones. With advancing age, the amount of the male hormone
testosterone, decreases relative to the amount of circulating estrogen, the main female reproductive hormone which also circulates in the male.
There is some evidence to suggest that this relative increase in circulating estrogen may strengthen the effect of the testosterone derivative DHT, which promotes cell growth in the prostate gland and is formed when testosterone is acted upon by a specific enzyme. As a consequence of estrogen and DHT acting together, cell growth and glandular enlargement are promoted.
- Changes in the role of DHT. Prostate gland development requires the conversion of testosterone into DHT (dihydrotestosterone), in the presence of a specific enzyme called 5-alpha reductase. As aging occurs, the amount of DHT in the prostate gland remains high, even through the circulating testosterone level drops.
Some evidence supports the idea that this high level of prostate DHT may by itself promote cell growth and lead to enlargement.
Prostate Enlargement: What Are The Symptoms?
Although symptoms of an enlarged prostate gland may vary among individuals, the most common ones involve problems with passing urine.
- A stream of urine that is hesitant before starting, weak in force, or intermittently interrupted while flowing can indicate an enlarged prostate gland. Dribbling, with one drop or less a second, may persist for 10 to 20 seconds or more at the end of
- There may be an urgency to urinate, or urine may leak at an inappropriate time. Some men feel as if their
bladderis not completely empty; other may feel a sudden, urgent need to urinate.
- Increased number of urinations, which is especially apparent at night and cause two or more nightly trips to the bathroom. This symptom results in interrupted and inadequate sleep.
About 80 percent of the time, these symptoms are caused by BPH, but they can also be the result of other conditions, such as prostate cancer that should be carefully diagnosed by a urologist.
The size of the prostate gland does not always correlate with the degree of urinary obstruction. Smaller prostate glands may cause more obstruction to the flow of urine than much larger ones.
How Severe Are Your Symptoms?
With the use of the following “symptom index” developed by the American Urological Association (AUA), a distinction can be made between symptoms.
To take the test, record the most appropriate number in each row or line.
Add the sum of the seven numbers you recorded. The ratings are as follows:
- Mild (0-7 points)
- Moderate (8-19 points)
- Severe (20-35 points).
This symptom index can be used during the initial diagnosis and as a record of improvement following treatment.
Questions to be answered
Not at all
Less than 1 time in 5
Less than half the time
About half the time
More than half the time
Over the past month, how often have you had a sensation of not emptying your bladder completely after you finished urinating?
Over the past month, how often have you had to urinate again less than two hours after you finished urinating?
Over the past month, how often have you found you stopped and started again several times when you urinated?
Over the past month, how often have you found it difficult to postpone urination?
Over the past month, how often have you had a weak urinary stream?
Over the past month, how often have you had to push or strain to begin urination?
Over the past month, how many times did you most typically get up to urinate from the time you went to bed at night until the time you got up in the morning?
What Diagnostic Tests Are Useful for Prostate Enlargement?
Several clinical or laboratory tests can help the urologist:
- Diagnose the cause of the urinary problem
- Determine the best course of treatment
Generally, the urologist will test your blood to assess kidney function and the level of prostate specific antigen (PSA).
PSA is a protein present in the normal
If your PSA is elevated, your urologist may recommend a transrectal ultrasound examination and a biopsy to distinguish between the two possibilities of prostate enlargement and prostate cancer
Digital Rectal Exam (DRE)
After putting on a lubricated glove, the physician gently inserts a finger through the anus into the rectum and assesses the size and hardness of the prostate gland. This exam is done when prostate enlargement is suspected or as part of an annual physical examination.
Urinary Flow Rate Study
This technique, which is used to detect an obstruction of the
However, while a urinary flow rate study can indicate an obstruction, it cannot provide a definitive diagnosis of BPH. Many other variables affect flow, including a weak
A pressure-flow study is more diagnostic but involves
Intravenous Pyelography (IVP)
This test is performed only in cases complicated by a finding such as blood in the
An instrument called a cystoscope is inserted through the urethral opening of the penis and visually guided through the urethra to the bladder. This test can be performed in the doctor’s office, using a local anesthetic. During
What Are The Treatment Options For an Enlarged Prostate?
The effectiveness of the various treatments for BPH is determined by:
- How well the urine flow has improved
- A reduction in the number of times or the need to pass urine
In general, the results from surgical treatments have been significantly better than those from medical treatments.
Your doctor can help you determine which treatment option is best for you.
Medical treatments for BPH include:
Watchful waiting. This simply involves careful monitoring, rather than active treatment. This method is elected by most people who have mild to moderate symptoms.
Because up to one-third of all mild cases clear up spontaneously, the strategy of watchful waiting is a prudent course for many individuals. Over 40 percent of men with mild to moderate symptoms have experienced improvement with this method of management.
Alpha blocker. These are drugs that can inhibit the contraction of the smooth muscle of the prostate glandand bladder neckand, in this way, improve the urinary flow rate. About 75 percent of individuals who choose alpha blocker therapy have experienced an improvement in the symptoms of BPH,particularly relief from the symptoms of urinary frequencyand urgency.
Nice To Know:
Alpha blockers have traditionally been used to treat people with high blood pressure. This type of drug should not have an effect on your blood pressure, if it is already in the normal range.
- Finasteride (Proscar®): This drug inhibits production of DHT, the
hormonethat is thought to cause prostate enlargement, by inhibiting the enzyme 5-alpha reductase. As a result of this, the prostate gland shrinks in size, alleviating the symptoms of BPH.
It can take six months to experience the full effects of this drug. About two-thirds of individuals who choose finasteride therapy will experience an improvement in the symptoms of BPH. On average, the size of their prostates shrunk about 30 percent.
Sometimes, finasteride is used in conjunction with an alpha blocker.
Surgical treatments for BPH include:
Transurethralincision of the prostate (TUIP). This procedure widens the urethraby simply making a few cuts in the prostate gland and the bladder neck, without actually removing tissue. The procedure is believed to reduce the probability of retrograde ejaculation, a complication of prostate removal, in which the semenis shunted into the bladderinstead of directly into the urethra, but the long-term side effects of TUIP have not yet been established.
Approximately 80 percent of individuals treated with TUIP have experienced an improvement in the symptoms of BPH.
- Transurethral resection of the prostate (TURP). Used in 90 percent of all surgeries performed for BPH, TURP involves inserting an instrument called a resectoscope through the urethral opening of the penis and guiding it to the constricted portion of the urethra within the prostate gland.
A wire loop of the resectoscope then cuts the prostate tissue surrounding the urethra and cauterizes the surrounding blood vessels to prevent bleeding. The cut pieces of prostate tissue are carried to the bladder by a controlled water stream and flushed out of the bladder in the final phase of the operation.
Almost 90 percent of individuals who had a TURP have experienced an improvement in the symptoms of BPH.
prostatectomy. Open surgery to remove part of the prostate gland is performed when transurethral procedures cannot be used. This form of surgery, which requires an incision in the skin, is necessary if the prostate gland is greatly enlarged, if there are significant complicating factors, or if the muscular wall of the bladder has been significantly damaged and requires repair.
Almost 100 percent of individuals treated with open surgery have experienced an improvement in the symptoms of BPH.
Newer Treatment Option
A variety of minimally invasive treatment options seem promising at the present time.
- Laser prostatectomy – A laser guided through the urethra produces energy that is directed at the prostate tissue surrounding the constricted portion of the urethra. The laser energy vaporizes the offending prostate tissue.
Transurethral microwave thermotherapy– With this technique, precisely controlled microwaves are passed through a catheter inserted in the urethral opening of the penis, guided to the prostate gland, and focused on the prostate tissue. The device that delivers the microwave energy is called a Prostatron.
The tissue is heated by the microwave energy, causing cell death of the offending prostate tissue, while the surrounding tissues are protected by a cooling system that dissipates the heat. The procedure takes approximately one hour.
Almost 70 percent of the men treated with microwaves experienced significant relief of symptoms caused by BPH. The recurrence rate over a four-year post-treatment period is slightly over 10 percent. Swelling of the irradiated tissue can result in an inability to urinate for several days, requiring the temporary use of a catheter to drain urine.
- Transurethral needle ablation (TUNA) – Following insertion of an instrument through the urethral opening of the penis, two needles are inserted into the prostate gland. Heat energy is then passed through the needles, causing shrinkage in the surrounding prostate tissue and a corresponding increase in the flow of urine.
- High energy focused ultrasound (HIFU) – Following insertion of an ultrasound probe through the rectum behind the prostate gland, ultrasound energy is focused and used to shrink the size of the prostate gland.
stent– A prostate stent is a tubular device inserted through the urethra to the point of constriction, where it is allowed to expand. The pressure exerted by the stent on the inside wall of the urethra widens its bore and reduces the obstruction to urinary flow. However, an increased urgency to urinate may be experienced in the first few days following insertion of the device. Balloon urethroplasty– A tube with a small balloon at the end is inserted through the urethral opening of the penis and guided to the constricted portion of the urethra, where the balloon is inflated. The pressure exerted by the balloon against the inside of the urethral wall increases the diameter of the urethra and improves the flow of urine.
The procedure is a safe alternative to surgery, although the recurrence rate of BPH following this procedure is not yet established. However, almost 60 percent of individuals treated with balloon urethroplasty have experienced an improvement in the symptoms of BPH.
Prostate Enlargement: Which Treatment Option Is Right For Me?
The right treatment depends on the severity of a man’s symptoms.
If Your Symptoms Are Mild
Individuals with mild symptoms of BPH usually elect “
If Your Symptoms Are Moderate To Severe
Depending on how the symptoms are affecting quality of life, men with moderate symptoms may:
- Elect watchful waiting
- Opt for medical treatment with an
alpha blockeror enzyme blocker
- If possible, select a minimally-invasive surgical procedure such as
balloon urethroplasty, TURP, or TUIP
- Require open surgery because of need, as determined by the surgeon in consultation with the individual
Who May Need Surgery?
A man may be a candidate for surgery if he has any of the following significant complications:
- Inability to urinate because of an enlarged
- Noticeable blood in the
urine, either persistent over time or reappearing from time to time
- The presence of
bladderstones because of stagnating urine
- A condition called renal or kidney insufficiency, which occurs when an inability to urinate causes the concentration of potentially toxic urea in the bloodstream, resulting in a poisoning of the body
- Backward pressure of the urine on the kidneys causes them to swell
Nice To Know:
Will my symptoms get worse if I decide not to undergo treatment?
Because BPH may clear up spontaneously, selecting the option of “watchful waiting,” in which there is careful monitoring without active treatment, is a prudent course of action for men with mild-to-moderate symptoms, unless there are complications.
When to receive treatment is usually a quality-of-life issue. If the symptoms interfere sufficiently with sleep, work, and social activities, and place undue stresses on your life, treatment is recommended.
What Can I Expect As I Recover From Prostate Surgery?
Following surgery, the body needs time to recover. You can expect the following:
- Blood may appear in the urine. This blood should gradually disappear as the urethra mends.
- You may experience a sense of urgency to urinate, even as the flow of urine is more vigorous and steady. The experience should lessen over time, although it may take up to one month to completely clear up.
In the first two weeks after surgery, it is prudent modify your normal routine. Avoid lifting heavy objects. Give your body a chance to heal properly.
The goal of treatment is to return to being able to pass urine normally. Even if you don’t fully achieve that goal, most men experience a noticeable improvement in the urinary flow rate or in the frequency or urgency to urinate and, therefore, in the symptoms of BPH.
Need To Know:
Will I be able to have sex again after surgery for BPH?
If you had erections before surgery, the chances are very good that you will be able to have erections after surgery. However, complete recovery of sexual function may take as long as a year.
Will I be able to control my
The chances are excellent that you will be able to regain your ability to control
What Are The Possible Complications Of Treatments For Prostate Enlargement
All medical and surgical treatments involve some risk. This is especially true for surgical procedures such as TUIP, TURP, and open prostatectomy.
Following surgery for BPH, the incidence of
If a man was potent before surgery, the chances are very good that he will be able to maintain an erection after surgery. However, a problem called retrograde ejaculation can occur. During sexual intercourse,
Postoperatively, a man may have temporary problems controlling his ability to pass urine-but in only one to three percent of cases is there permanent
Following surgery, the urine may appear bright red or may contain clumped blood. This may suggest continued bleeding at the operation site. This complication, if excessive or persistent, should be reported immediately to your urologist.
However, as a consequence of the healing process, blood may appear in the urine following surgery for BPH. With adequate rest and increased fluid intake, the appearance of blood in the urine should disappear within a few days or weeks.
Death associated with surgery for BPH ranges between 1.5 and 3.5 percent of all cases. The risk is relatively low but must be carefully weighed against the need for and benefits of the surgical intervention.
Do The Treatments Work for Prostate Enlargement (BPH)?
The treatments for BPH do work. Many men are cured of their symptoms, but some require re-treatment.
- BPH that creates urinary symptoms can be treated by numerous medical procedures and minimally invasive surgical options. Today, open surgery is no longer necessary in most cases. The array of medical and surgical techniques allows better choices that can be tailored to an individual’s needs.
- After medical treatment for BPH, the percentage of men requiring re-treatment over a five-year period ranges between 30 and 40 percent.
- The recurrence rate of BPH in patients treated surgically is significantly better, with only two to 10 percent requiring re-treatment.
These findings suggest that surgical treatments can be more effective over the long term than medical treatments. However, surgical treatments usually involve greater risks.
The Future Outlook for Benign Prostatitc Hyperplasia
New treatments for BPH are constantly being developed. As we learn more about the normal development of the prostate gland and how its growth is controlled, our improved understanding can be better applied as to how best to inhibit prostate cell multiplication.
The problems of BPH may be completely eliminated at some time in the future, as our understanding of the disease deepens. In the meantime, treatment for relief of its symptoms has never been so diverse or as effective as at the present time.
Prostate Enlargement: Frequently Asked Questions
Here are some frequently asked questions related to prostate enlargement.
Q: Can my prostate enlargement turn into prostate cancer?
A: There is no relationship between BPH and a cancerous growth in the
Q: Should I have surgery if my symptoms are only mild or moderate?
A: How badly your symptoms interfere with the quality of your life should be used as the guiding principle. If your symptoms are just a daily inconvenience, you may not require any form of treatment.
Q: Shouldn’t I follow a more conservative approach by using medical treatments, rather than a surgical approach with its possible complications?
A: A conservative approach is usually the best approach. The use of an
Q: How do I determine what treatment option is best for me?
A: To the extent possible, you should take charge of the treatment of your disease through discussions with your physician. To accomplish this, you will need to learn a good deal about your disease and its treatment. This knowledge and your physician’s guidance will enable you to determine the most appropriate treatment option, given your symptoms and the nature of the prostate enlargement. Potential improvement in quality of life should be a guiding principle in the selection of a treatment option.
Prostate Enlargement: Putting It All Together
Here is a summary of the important facts and information related to prostate enlargement.
- An enlarging
prostate glandcan squeeze against the urethraand, in some cases, constrict the neck of the bladder. This can cause problems with the flow of urine. Benignprostatic hyperplasia(BPH) is a noncancerous condition.
- The prostate normally increases in size as men age.
- The incidence of BPH rises sharply after age 40, possibly due to hormonal changes.
- The symptoms of BPH include irregularities in the stream of urine, problems controlling
urination, and an increased frequency of urination.
- Symptoms of BPH are categorized as mild, moderate, or severe; the severe symptoms are usually treated medically or surgically.
- Treatment options include
watchful waiting; medical treatments such as alpha blockers and 5-alpha reductase enzyme inhibitors; and surgical treatments such as TUIP, TURP, and open prostatectomy.
- Potential side effects of treatment include
impotence, urinary incontinence, bleeding, and recurrence of enlargement requiring additional treatment; these risks must be weighed against the potential benefits.
- Among the more recent treatment options are laser prostatectomy,
transurethralneedle ablation (TUNA), high intensity focused ultrasound (HIFU), and prostate stents.
Prostate Enlargement: Glossary
Here are definitions of medical terms related to prostate enlargement.
Alpha blocker: A drug that blocks the effects of impulses sent by certain fibers in the nervous system.
Balloon urethroplasty: A method of widening a narrowed portion of the urethra by threading a narrow tube into the urethra and inflating a balloon at its tip when it is in the appropriate position.
Benign: A growth that is not cancer.
Benign prostatic hyperplasia (BPH): An increase in the size of the prostate gland due to an increase in the number of gland cells and certain other cell types in the prostate gland. It is noncancerous.
Bladder: The muscular sac in the pelvis that stores urine. The urine passes out of the bladder through the urethra.
Bladder neck: The narrow outflow portion of the bladder surrounded by the prostate gland.
Catheterization of the bladder: The insertion of a narrow, flexible tube through the opening of the penis and into the bladder.
Cauterize: To burn tissues with thermal heat, usually to destroy tissue or seal bleeding blood vessels.
Cystoscopy: The direct visualization of the urinary tract by means of a tube (called a cystoscope) with a camera that is attached to a monitor. The cystoscope is inserted in the urethra, and the images it records are displayed on the monitor.
Digital rectal exam (DRE): An exam that helps a physician assess the size and firmness of the prostate gland, DRE involves gently placing a gloved finger through the anus into the rectum and pressing against, and along the length of, the prostate gland.
Dihydrotestosterone (DHT): A chemical derived from the hormone testosterone that promotes cell growth in the prostate gland and which is formed when testosterone is acted on by a specific enzyme.
Estrogen: A female hormone that is also normally found in small quantities in a man’s bloodstream.
High intensity focused ultrasound (HIFU): A minimally-invasive treatment for BPH in which an ultrasound probe is inserted into the rectum and placed next to the prostate gland. It radiates focused ultrasound energy to specific portions of the prostate tissue.
Hormone: A complex chemical substance which is secreted directly into the blood stream from a gland in one part of the body and initiates or regulates the activity of an organ or a group of cells in another part of the body.
Hyperplasia: A noncancerous increase in the number of cells in a specific structure of the body, such as the prostate gland.
Impotence: An inability to achieve penile erection or, much less commonly, to ejaculate after achieving an erection.
Intravenous pyelography (IVP): An x-ray examination of the kidneys and urinary tract after an injection of a special dye into a vein, allowing the kidneys and urinary tract to be clearly viewed.
Prostate gland: A chestnut-shaped gland in men that surrounds the neck of the bladder and a portion of the urethra and which secretes substances that liquefy the semen
Prostatectomy: Surgical removal of all, or a portion, of the prostate gland.
Stent: A tube-like device that, once properly inserted in the appropriate position, keeps the area open and prevents it from narrowing.
Semen: Fluid made up of sperm cells and products of accessory sex glands, which is passed through the urethra to the outside during ejaculation. Also called ejaculate.
Testosterone: The primary male reproductive hormone. Made in the testes, it is responsible for the growth and maturation of the primary male reproductive organs and the development of characteristics such as a low-pitched voice, the male’s unique distribution of body hair, the relative lack of fat below the skin, and bigger bone structure.
Transurethral: Performed through the urethra ( the passage through which the urine passes through the penis )
Transurethral needle ablation (TUNA): A minimally-invasive treatment of BPH that involves inserting two needles into the prostate gland and directing focused heat energy through the needles to the surrounding portions of the prostate gland.
Transurethral microwave thermotherapy: Microwaves of controlled energy content vaporize portions of the prostate gland surrounding the urethra while the surrounding tissues are protected by a cooling system.
TUIP (transurethral incision of the prostate): A surgical procedure performed through the urethra, in which the urethra is widened by making a few cuts in the prostate gland and bladder neck without removing tissue surgically.
TURP (transurethral resection of the prostate): A procedure during which part of the prostate is removed using a device that is inserted through the urethral opening of the penis.
Urethra: The passage that runs from the bladder through the penis, through which urine and semen are passed from the body.
Urinary frequency: The need to pass urine more frequently.
Urinary hesitancy: Difficulty with starting or passing urine as well as a less powerful stream of urine.
Urinary incontinence: The inability to control urine flow. Urination occurs involuntarily.
Urinary tract: The organs (kidney and bladder) and ducts (ureters and urethra) involved in the formation and elimination of urine from the body.
Urination: The act of passing urine from the body.
Urine: The waste fluid secreted by the kidneys, transported by the ureters, stored in the bladder, and voided through the urethra.
Watchful waiting: Careful periodic monitoring without providing any treatment.
Prostate Enlargement: Additional Sources of Information
Here are some reliable sources that can provide more information on prostate enlargement.
National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC)
Medline Plus: Prostate Enlargement
National Cancer Institute: Understanding Prostate Changes