It is common for the prostate gland to become enlarged as a man ages. Doctors call this condition either:

Is prostate growth normal?

As a man matures, the prostate goes through two main periods of growth. The first occurs early in puberty, when the prostate doubles in size. At around age 25, the gland begins to grow again. This second growth phase often results, years later, in BPH.

Though the prostate continues to grow during most of a man’s life, the enlargement doesn’t usually cause problems until later in life. BPH rarely causes symptoms before age 40, but more than half of men in their sixties and as many as 90% in their seventies and eighties have some BPH-related symptoms.

Many people feel uncomfortable talking about the prostate since the gland plays a role in both sex and urination. Still, prostate enlargement is as common a part of ageing as grey hair. As life expectancy rises, so does the occurrence of BPH.

Common symptoms of BPH

The symptoms of BPH vary, but the most common ones involve changes or problems with urination, such as:

‘Obstructive’ bladder symptoms

‘Irritative’ bladder symptoms

Other BPH symptoms

Sometimes, a man may not know he has any obstruction until he suddenly finds himself unable to urinate at all. This condition, called acute urinary retention, needs to be treated immediately.

Severe symptoms or complications

Severe BPH can cause serious problems over time and should, therefore, be investigated and treated as soon as symptoms are noticed.

Urine retention and strain on the bladder can lead to urinary tract infections, bladder or kidney damage, bladder stones and incontinence – the inability to control urination. 

If the bladder is permanently damaged, treatment for BPH may be ineffective. However, when BPH is found in its earlier stages, the risk of developing such complications is lower.

What causes BPH?

As the prostate enlarges, the layer of tissue surrounding it stops it from expanding, causing the gland to press against the urethra like a clamp on a garden hose. The bladder wall becomes thicker and irritable.

The bladder begins to contract even when it contains small amounts of urine, causing more frequent urination. Eventually, the bladder weakens and loses the ability to empty itself, so some of the urine remains in the bladder. The narrowing of the urethra and partial emptying of the bladder cause many of the problems associated with BPH.

How is BPH diagnosed?

The key diagnostic tests for patients with prostate enlargement are:

Digital Rectal Examination (DRE)

This examination is usually the first test done. The doctor inserts a gloved finger into the rectum and feels the part of the prostate next to it. This examination gives the doctor a general idea of the gland’s size and condition.

Dynamic urine flow study and bladder ultrasound

Your doctor may ask you to urinate into a special device that measures how quickly the urine is flowing. A reduced flow often suggests BPH.

It is always advisable to see your urologist with a relatively full bladder, as this test is often required. Following the urine flow test, an ultrasound scan of your bladder will determine whether your bladder is still retaining significant volumes of urine.

Urodynamics

Urodynamics testing may be indicated if you have a problem with frequent voiding, an urgent or difficult-to-control desire to void, urine leakage or reduced urine flow.

This is the “gold standard” assessment of lower urinary tract symptoms and helps your specialist measure how much urine your bladder can hold, how the pressure changes inside your bladder with increasing volume, and how these factors relate to your urge to urinate.

We can tell you the results of the tests immediately afterwards and decide on a treatment plan.

Cystoscopy

Cystoscopy (telescopic inspection) of the bladder is usually performed in patients with ‘irritative’ bladder symptoms to exclude physical bladder irritants. It can be performed awake using a local anaesthetic gel and using a flexible telescope. This procedure is well tolerated by most patients, however, on some occasions a general anaesthetic may be required.

Treatments for BPH

Medical treatments

Over the years, researchers have tried to find a way to shrink or at least stop the growth of the prostate without using surgery. There are currently two classes of medical therapy available to relieve common symptoms associated with an enlarged prostate known as the group 5 alpha reductase inhibitors.

These medications inhibit the production of the hormone DHT, which is involved with prostate enlargement. The use of either of these drugs can either prevent the progression of growth of the prostate or actually shrink the prostate in some men.

Alpha Blockers

The other class of drugs are called alpha-blockers. These drugs act by relaxing the smooth muscle of the prostate and bladder neck to improve urine flow and reduce bladder outlet obstruction.

Combining Medication

The Medical Therapy of Prostatic Symptoms (MTOPS) Trial, supported by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), recently found that using 5 alpha reductase inhibitors together is more effective than using either drug alone to relieve symptoms and prevent BPH progression.

Surgical treatments

Most doctors recommend removing the enlarged part of the prostate as the best long-term solution for patients with BPH.

With surgery for BPH, only the enlarged tissue pressing against the urethra is removed; the rest of the inside tissue and the outside capsule are left intact. Surgery usually relieves the obstruction and incomplete emptying caused by BPH.

Transurethral Resection Of The Prostate (TURP)

TURP involves coring out the central part of the prostate to enlarge the channel that urine passes through. It is performed under general or spinal anaesthetic, usually lasts 45 minutes and involves no incisions on the outside. It is performed using an electrical loop inserted into the urethra via a telescope. It cuts tissue and seals blood vessels as it removes the prostate in slivers.

GreenLightTM Photoselective Vaporisation Of The Prostate (PVP)

PVP uses a high-energy laser to vaporise prostate tissue and seal the treated area. Its advantages over TURP are less bleeding and a much shorter catheterisation time and hospital stay. The procedure is performed via a telescope inserted into the urethra under spinal or general anaesthetic and usually lasts 30-60 minutes.

UroLift

The UroLift System is a minimally invasive treatment designed to relieve symptoms of BPH without cutting, heating, or removing prostate tissue. Small implants are placed to hold the enlarged prostate tissue away from the urethra, thus opening the urinary channel and allowing for a better flow of urine. This procedure is typically performed under local or general anaesthesia and usually takes less than an hour.

One of the key benefits of UroLift is that it has a quick recovery time and patients can often return home the same day without the need for a catheter.

Steam Treatment

Steam treatment is another minimally invasive procedure that uses the natural energy stored in water vapour, or steam, to treat the excess prostate tissue causing BPH symptoms. During the procedure, steam is injected into the prostate, where it disperses and destroys the excess tissue. The body then reabsorbs the treated tissue over time, resulting in a reduction of prostate size and symptom relief.

Steam treatment typically takes less than 10 minutes. Recovery is rapid, and patients often notice an improvement in symptoms within a few weeks.

Aquablation Therapy

Aquablation therapy is an advanced, robot-assisted treatment that uses the power of water jets to precisely remove prostate tissue. Guided by real-time imaging, the surgeon uses a robotic arm to direct a high-velocity saline stream to ablate the enlarged prostate tissue.

This procedure is conducted under general anaesthesia and is designed to provide relief from BPH symptoms with a reduced risk of side effects compared to traditional methods. Aquablation is particularly beneficial for men with larger prostates and offers a quick recovery time, with most patients returning home the same day.

Holmium Enucleation of Enlarged Prostate (HoLEP)

HoLEP uses Holmium laser technology to enucleate the enlarged adenomatous prostate. The procedure is also performed via a telescope inserted into the urethra under spinal or general anaesthetic. It usually lasts 30-60 minutes.

Alternative treatments

Nutrition and the use of supplements and herbs can be used to modify the metabolism of testosterone and oestrogen, and so reduce prostate size and hopefully symptoms.

Nutrition

Eat less dairy products, refined food, fried foods, hydrogenated oils, alcohol and caffeine. Eat more fruit, vegetables, whole grains, soy, beans, seeds, nuts, olive oil and cold-water fish (salmon, tuna, sardines, halibut and mackerel).

Supplements

30–50mg of Zinc, daily. Zinc competes with copper for absorption; therefore, when supplementing long term with zinc, copper should also be supplemented. There are supplements available that contain both zinc and copper.

Herbs

Saw palmetto – reduces the size of the prostate via its oestrogenic effect and so relieves symptoms of BPH. The recommended dosage is 320mg of extract a day.

Frequently asked questions

Are there lifestyle changes that can help manage BPH symptoms?

Yes, several lifestyle changes can help manage BPH symptoms. These include reducing fluid intake before bedtime, limiting caffeine and alcohol, regular physical activity, and maintaining a healthy diet rich in fruits and vegetables. These changes can help reduce urinary frequency and urgency.

Can prostate enlargement lead to prostate cancer?

BPH and prostate cancer are separate conditions. While they can have similar symptoms and sometimes coexist, BPH does not cause prostate cancer. However, having BPH does not rule out the possibility of prostate cancer, so regular screenings are important.

What is the role of hormones in prostate enlargement?

Hormones, particularly dihydrotestosterone (DHT), play a significant role in prostate enlargement. As men age, changes in hormone levels, including testosterone and oestrogen, can influence the growth of the prostate gland, leading to BPH.

How does BPH affect sexual health?

BPH can impact sexual health in various ways. Some men may experience erectile dysfunction or a decrease in sexual desire. Additionally, some treatments for BPH, such as certain medications, can also have side effects that affect sexual function.

Can BPH be prevented?

While BPH cannot be entirely prevented, certain measures may help reduce the risk or delay its progression. These include maintaining a healthy weight, staying physically active, avoiding excessive alcohol and caffeine, and following a balanced diet rich in vegetables and healthy fats.

When should I see a doctor about BPH symptoms?

You should see a doctor if you experience symptoms such as frequent urination, difficulty starting urination, weak urine stream, or inability to empty your bladder completely. Early diagnosis and treatment can help manage symptoms and prevent complications.