Benign Prostatic Enlargement: What It Is, How To Spot It, and How It’s Treated

Take-home points

• Benign prostatic enlargement is common, particularly in men aged 45 years or older.  
• Benign prostatic enlargement can cause a number of symptoms of the lower urinary tract, including increased urinary frequency, difficulty when urinaring, urinary urgency, and post-urination dribbling.  
• The exact cause of benign prostatic enlargement is unknown, though multiple risk factors have been found to play a role in the development of the condition.
• Treatment of benign prostatic enlargement includes oral medicines and, in more severe cases, surgery.

What is benign prostatic enlargement?

Benign prostatic enlargement (BPE), or benign prostatic hyperplasia (BPH), is a common condition that results in an enlarged prostate in ageing men.¹ The prostate, a small gland found below the bladder, plays a vital role in the male reproductive system by producing semen, regulating urine flow, and playing a part in hormone production.²

As men age, the prostate naturally grows in size, usually to around the size of an orange.³ At times this prostatic enlargement can prove to be troublesome, particularly when it starts affecting your lower urinary tract, which can in turn affect how you pee.⁴ This prostate enlargement is not cancerous and, despite misconceptions, is not linked to prostate cancer.⁵

Many risk factors, both in and out of your control, contribute to the development of BPH.¹ Thankfully, though, with medicines and lifestyle interventions, BPH can be managed to allow you to lead a relatively normal quality of life.

What are the symptoms of benign prostatic enlargement?

Being able to spot the symptoms of BPH is essential for timely treatment. BPH symptoms can be classified as obstructive, meaning that they cause sensations of hesitancy or incompleteness when urinating; irritative, causing you to feel the need to urinate more frequently; and delayed, occurring after you think you’ve finished emptying your bladder.¹ The most common symptoms which prostate gland enlargement causes include:⁶

• Urinating more frequently than normal.
• Finding it more difficult to start urinating or maintaining a stream of urine.
• Feeling like you still need to empty your bladder after you finish urinating.
• Feeling a sudden urge to urinate.
• Leaking or dribbling urine after urination.

The severity of these symptoms varies from person to person. Some men may experience mild symptoms that do not significantly affect their quality of life, whereas others may have more severe symptoms that interfere with their daily activities and warrant prostate enlargement treatment treatment.

What causes benign prostatic enlargement?

Prostate enlargement causes are rather complex and multifactorial, with research having identified the dysregulation of male hormones as one of the most prominent contributing factors.⁷ As men age, hormonal changes, particularly an increase in dihydrotestosterone (a potent male hormone, or androgen, responsible for the development of male characteristics) levels, play a part in prostate enlargement.⁴  An imbalance also occurs whereby the testes produce less testosterone over time, but natural oestrogen levels remain level.⁴  

There are, however, certain risk factors that can increase your risk of developing BPH. These include:

• ‍Age: BPH is common in men aged 45 years and older.⁴  
  
• Genetics: Studies suggest that those with a family history of BPH are more likely to develop the condition.⁴  
  
• Diabetes: Changes in insulin concentrations in people with diabetes may influence hormone levels, leading to BPH.⁸ Likewise, symptoms of uncontrolled diabetes, such as increased urinary frequency, may mask symptoms of BPH, making it more difficult to diagnose.⁸
• Heart disease: Though not a direct causative factor of BPH, the risk factors underlying heart disease such as obesity, high blood pressure, and diabetes, can all increase your risk of developing BPH.⁹  
• Lifestyle: Sedentary behaviour can lead to obesity and diabetes. One proposed mechanism is that obesity may increase estrogen levels, which can promote BPH.⁴  

How is benign prostatic hyperplasia diagnosed?

If you experience any symptoms of BPH, it is crucial you consult with a certified healthcare professional. A BPH diagnosis is carried out through a thorough assessment of your medical and family histories, followed by a series of physical examinations, namely:

• Digital rectal exam (DRE) or prostate exam: a test whereby your physician will examine your back passage and feel your prostate for any abnormalities.⁴  
• Prostate-specific antigen (PSA) test: a blood test that measures the level of PSA in your body. Higher levels of PSA may indicate an enlarged prostate. A PSA test can also be used to test for prostate cancer.⁴  
• Urine testing: various urine tests may be ordered to rule out alternative causes of your symptoms. These tests inlude urine dipsticks (to rule out infection), urinalysis (abnormalities and infection), and post-residual volume tests (testing how much urine is left in the bladder after urination.⁴  
  
• Imaging: an ultrasound scan can create a detailed image of the prostate gland and allow your physician to more accurately assess for an abnormalities.⁴  
  
• Cystoscopy: a common, invasive test used to confirm a diagnosis of BPH. A cystoscopy is often carried out by a urologist, a dr who specialises in the treatment of conditions affecting the urinary tract. The test involves inserting a tube-like camera into your urethra, which is the tube that carries urine out of the penis. The camera at the end of the tube is used to relay images of the prostate onto a screen for your doctor to examine.⁴ Red flag prostate symptoms such as blood in the urine may be identified using a cystoscopy.

How is benign prostatic hyperplasia treated?

Benign prostatic hyperplasia treatment is generally only recommended once symptoms start interfering with your everyday life.⁴  Those with mild BPH may not require any treatment, particularly if the risk of treatment outweighs the benefit.

The first line of treatment for BPH is medication.¹⁰ Most men with BPH that require treatment will be prescribed an oral BPH medication that can help alleviate the symptoms of BPH and prevent the condition from worsening. The medications prescribed include alpha blockers, 5-alpha reductase inhibitors, phsophodiesterase-5 inhibitors, or a combination of two or more of these medicines.¹⁰

In more severe cases where medicines are unable to control your symptoms, BPH surgery may be required.¹⁰ Surgical treatment of BPH is often minimally invasive, using newer technologies. Possible BPH surgical treatments include a transurethral resection of the prostate, transurethral microwave thermotherapy, and photoselective vaporisation of the prostate, among others.¹⁰ The best prostate treatment for you will depend entirely on the severity of your condition. Your doctor will work with you to decide whether you need BPH medicines or prostate surgery.

If in doubt, ask a specialist

We understand that those dreaded nightime toilet trips can be tedious, particularly in aging men. If you leave them be, they can prove to be detrimental to your overall physical and mental wellbeing. If you’re experiencing symptoms of BPH that are starting to interfere with the quality of your daily life, it is important to reach out to a doctor and get your prostate health checked out. And remember, prostate the earlier you catch your symptoms, the better your treatment outcomes will be, and the quicker your prostate problems can be resolved.  

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References:

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4. Ng M, Baradhi KM. Benign Prostatic Hyperplasia. In: StatPearls. Treasure Island (FL): StatPearls Publishing; August 8, 2022.
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6. NHS UK. Symptoms: Benign prostatic hyperplasia [Internet]. NHS; 2020 [cited 2023 Jun 5]. Available from: https://www.nhs.uk/conditions/prostate-enlargement/symptoms/.
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