As men age, it is normal for the prostate gland to gradually enlarge. This usually begins about the age of 40 years and is thought to be caused by hormonal changes. This enlargement can cause difficulties with urinating and can lead to problems with the bladder and kidneys. The enlargement can come about as a result of hyperplasia (an increase in cell numbers) and hypertrophy (an increase in cell size).
An enlarged prostate does not cause prostate cancer. However, prostate cancer can occur in men with an enlarged prostate.
Signs and symptoms
As the prostate gland enlarges it narrows the urethra (the tube that drains urine from the bladder) and can obstruct the flow of urine. This can lead to difficulties with urinating such as:
- Increased frequency – having to urinate more often
- Urinary urgency – having a sudden need to urinate
- Nocturia – having to get up frequently in the night to urinate
- Difficulty with getting the urine stream started (hesitancy)
- Poor flow of urine - weak flow or stop/start stream
- Dribbling of urine – particularly at the end of urination
- Incomplete emptying of the bladder.
The term LUTS (lower urinary tract symptoms) is commonly used to refer to the range of urinary symptoms associated with BPH.
Symptoms can fluctuate in nature and severity. Some men may have no symptoms at all, while for others, symptoms may be very problematic. An enlarged prostate, if severe, can also lead to:
- Back up of urine into the kidneys
- Enlargement and thickening of the bladder
- Bladder stones
- Urinary tract infections (UTIs)
- Bleeding from the urethra
- An inability to urinate at all.
Including the nature, duration and severity of the current symptoms, the presence of any other medical conditions, and family history of prostate problems.
During a physical examination the doctor will feel the abdomen for signs of an enlarged bladder and perform a digital rectal examination (DRE) to check for enlargement or irregularity of the prostate gland.
These will be performed to check kidney function and to check the PSA (prostate specific antigen). PSA is a protein released into the blood by the prostate gland. Higher than normal levels can indicate an enlarged prostate, prostate inflammation (prostatitis) or prostate cancer. The PSA level tends to be significantly elevated in prostate cancer, but not always.
This can show infection or the presence of blood in the urine. Other urine tests can measure strength and volume of flow and whether the bladder can be emptied completely.
This approach may be advised if the symptoms are mild and not adversely affecting quality of life. The condition is regularly monitored and treatment will be advised if symptoms worsen.
There are a number of medications that can be used to treat enlarged prostate. Some medications work by relaxing the muscle inside the prostate, making it easier for the urethra to open, while others have the effect of shrinking the prostate. Medications commonly used in New Zealand to treat enlarged prostate include terazosin, doxazosin and finasteride.
Up to 25% of men with enlarged prostate will require surgical treatment, usually because they are experiencing severe symptoms that are negatively affecting their quality of life. Some less invasive procedures have been developed in recent times but, because the longer-term outcomes of these newer treatments are not yet known, transurethral resection of the prostate (TURP) remains the most commonly performed procedure.
Transurethral Resection of the Prostate (TURP)
The specialist inserts a resectoscope (a thin tube-like telescope with a light at its tip) through the urethra and up into the prostate gland. The specialist can view the prostate gland and bladder, either through the resectoscope or on a television monitor.
A hospital stay of between one and five days may be required after a TURP. Prior to going home the specialist will recommend recovery and activity guidelines and it is important to follow these carefully.
This surgery involves removing part, or all of the prostate gland via an incision in the lower abdomen or the perineum (the area between the scrotum and anus). It is also performed by a specialist urologist and it may be recommended in cases where the prostate gland is significantly enlarged. It is usually performed under a general anaesthetic. A hospital stay of up to five days is common after open prostatectomy. Again, the specialist will recommend recovery and activity guidelines.
Further information and support
Freephone: 0800 4 PROSTATE OR 0800 477 678
Andrology Australia (2016). Prostate enlargement (BPH) (Web Page). Melbourne, VIC: Andrology Australia. https://www.andrologyaustralia.org/prostate-problems/prostate-enlargement-or-bph/ [Accessed: 07/07/17]
Mayo Clinic (2016). Benign prostatic hyperplasia (BPH) (Web Page). Rochester, NY: Mayo Foundation for Medical Education and Research. http://www.mayoclinic.org/diseases-conditions/benign-prostatic-hyperplasia/basics/definition/con-20030812 [Accessed: 07/07/17]
O'Toole, M.T. (Ed) (2013). Benign prostatic hyperplasia (BPH). Mosby's Dictionary of Medicine, Nursing & Health Professionals (9th ed.) St. Louis, MI: Elsevier Mosby.