Benign Prostatic Hyperplasia (Enlarged Prostate)

Causes of benign prostatic hyperplasia

It is unknown why the prostate starts to enlarge, but research suggests it could be due to the balance of sex hormones as men age.

The prostate gland sits beneath the bladder, and the urethra passes through the center of it. As the prostate grows larger, it can significantly block urine flow.

Risk factors for benign prostatic hyperplasia

Risk factors for an enlarged prostate include:

• Age — as men age, they are more likely to develop an enlarged prostate, more than half of men over 80 have symptoms from benign prostatic hyperplasia.
• Family history — if your father or brother (blood relatives) have prostate conditions including BPH, you are more likely to develop an enlarged prostate.
• Chronic conditions — chronic conditions such as diabetes and heart disease can increase your risk of developing benign prostatic hyperplasia.
• Obesity — being overweight makes you more likely to develop an enlarged prostate as you age.
• Inactivity — men who lead sedentary lifestyles are more likely to develop BPH as they age.

Symptoms of benign prostatic hyperplasia

The most common symptoms of BPH include:

• Urgent need to urinate
• Blockage of urine in the bladder
• Dribbling when you are finishing urinating 
• Urine stream that is weak or starts and stops as you go
• Trouble starting to urinate
• Increased need to urinate during the night time hours

Rarely, patients will develop a urinary tract infection, find blood in their urine or won’t be able to urinate because of BPH.

Symptoms often intensify over time as the condition progresses.

Diagnosis of benign prostatic hyperplasia

BPH causes symptoms similar to other urological conditions such as prostate cancer or urinary infections. To accurately diagnose your condition, your primary care doctor or urologist may order a variety of tests including:

• Digital rectal exam (DRE) — an exam where your doctor will insert a finder into your rectum to check the size of your prostate.
• Urine test — can diagnose an infection or other causes of your symptoms.
• Blood test — can indicate issues with your kidneys.
• Prostate-specific antigen (PSA) blood test — will help your doctor evaluate if you have an increased number of antigens in the blood (PSA) that can indicate an enlarged prostate.
• Urodynamic tests — a series of tests to determine how urine is held and released in the bladder and through your urethra.
• Transrectal ultrasound— will determine visually if your prostate is enlarged; the diagnostic test uses sound waves to take images of the prostate gland.
• Cystoscopy — a diagnostic test using a surgical instrument called a cystoscope, which can be inserted through the urethra to the bladder; the goal of the procedure is to visualize any abnormalities in the urinary tract.
• Biopsy — can confirm if you have prostate cancer; during a prostate biopsy, your doctor will remove a sample of tissue from the prostate and evaluate it for cancerous growth.

Treatment for benign prostatic hyperplasia

Some patients may not need any treatment, while others may need a minimally invasive procedure to correct the issue. And others may need a combination of treatments. Your Mercy Health doctor and care team will evaluate your case to determine the most appropriate treatment plan for you.

Common BPH treatment options include:

Watchful waiting

If you have a mild case of BPH and your symptoms are not interfering with your daily activities, your doctor may recommend watchful waiting. The care team will evaluate your case during a yearly exam to determine if your case is stabilized or if it has advanced and you need active treatment.

Medical management

If your symptoms are worsening and you are at risk for urinary complications related to your BPH, medical management may be an option for you.

Classes of medications that are effective in relieving symptoms of BPH include:

• Alpha blockers - these medications relax the prostate and bladder muscles
• 5-alpha reductase inhibitors (5-ARIs) - 5-ARIs work to shrink the prostate and prevent future growth
• Phosphodiesterase 5 inhibitors (PDE5 inhibitors) - improve BPH symptoms

Your doctor may recommend a combination of the medications above to maximize efficacy. It is important to be closely monitored by your doctor when on any medications, especially if you are taking multiple medications.

Minimally invasive procedures

If your BPH has advanced and you are experiencing urinary tract obstructions, kidney damage or kidney stones, your doctor may recommend minimally invasive surgery to correct the problem.

Types of minimally invasive procedures your doctor may recommend include:

• Transurethral resection of the prostate (TURP) — involves removing all but the outer layers of the prostate
• Transurethral incision of the prostate (TUIP) — involves making cuts into the prostate gland in order to allow urine to pass through the urethra; this option is most appropriate for patients who have a slightly enlarged prostate gland and when more invasive surgeries are not options.
• Transurethral microwave thermotherapy (TUMT) — involves using an electrode that emits microwave energy to destroy part of the enlarged prostate; this procedure is most appropriate for patients who have smaller prostates and may need additional treatments.
• Transurethral needle ablation (TUNA) — involves destroying prostate tissue that is blocking urine flow by using radio waves; if you bleed easily or have multiple medical conditions, this may be an option for you.
• Laser therapy — laser therapy, such as ablative procedures and enucleated procedures, destroy excess prostate tissue with high-energy lasers; most appropriate for patients who are on blood-thinning medications and can’t have more invasive surgical procedures.
• Surgery — the most common surgical procedure to treat BPH is through open or robotically-assisted prostatectomy to remove the excess prostate tissue.

Recovery from benign prostatic hyperplasia

Unfortunately, there is not a cure for an enlarged prostate. As men age, the prostate will continue to get larger. Most men will find relief with medications. If surgery is necessary, recovery will depend upon the surgical option that your doctor recommends.