Benign prostatic hyperplasia (BPH) — also called prostate gland enlargement — is a common condition as men get older. An enlarged prostate gland can cause uncomfortable urinary symptoms, such as blocking the flow of urine out of the bladder. It can also cause bladder, urinary tract or kidney problems.
There are several effective treatments for prostate gland enlargement, including medications, minimally invasive therapies and surgery. To choose the best option, you and your doctor will consider your symptoms, the size of your prostate, other health conditions you might have and your preferences.
The severity of symptoms in people who have prostate gland enlargement varies, but symptoms tend to gradually worsen over time. Common signs and symptoms of BPH include:
Less common signs and symptoms include:
The size of your prostate doesn't necessarily determine the severity of your symptoms. Some men with only slightly enlarged prostates can have significant symptoms, while other men with very enlarged prostates can have only minor urinary symptoms.
In some men, symptoms eventually stabilize and might even improve over time.
Conditions that can lead to symptoms similar to those caused by enlarged prostate include:
If you're having urinary problems, discuss them with your doctor. Even if you don't find urinary symptoms bothersome, it's important to identify or rule out any underlying causes. Untreated, urinary problems might lead to obstruction of the urinary tract.
If you're unable to pass any urine, seek immediate medical attention.
The prostate gland is located beneath your bladder. The tube that transports urine from the bladder out of your penis (urethra) passes through the center of the prostate. When the prostate enlarges, it begins to block urine flow.
Most men have continued prostate growth throughout life. In many men, this continued growth enlarges the prostate enough to cause urinary symptoms or to significantly block urine flow.
It isn't entirely clear what causes the prostate to enlarge. However, it might be due to changes in the balance of sex hormones as men grow older.
At normal size, the prostate gland is about the size and shape of a walnut or golf ball. When enlarged, the prostate may obstruct urine flow from the bladder and out the urethra.
Risk factors for prostate gland enlargement include:
Complications of an enlarged prostate can include:
Most men with an enlarged prostate don't develop these complications. However, acute urinary retention and kidney damage can be serious health threats.
Having an enlarged prostate is not believed to increase your risk of developing prostate cancer.
Your doctor will start by asking detailed questions about your symptoms and doing a physical exam. This initial exam is likely to include:
After that, your doctor might recommend additional tests to help confirm an enlarged prostate and to rule out other conditions. These tests include:
If your condition is more complex, your doctor may recommend:
A wide variety of treatments are available for enlarged prostate, including medication, minimally invasive therapies and surgery. The best treatment choice for you depends on several factors, including:
If your symptoms are tolerable, you might decide to postpone treatment and simply monitor your symptoms. For some men, symptoms can ease without treatment.
Medication is the most common treatment for mild to moderate symptoms of prostate enlargement. The options include:
Minimally invasive or surgical therapy might be recommended if:
Minimally invasive or surgical therapy might not be an option if you have:
Any type of prostate procedure can cause side effects. Depending on the procedure you choose, complications might include:
There are several types of minimally invasive or surgical therapies.
A lighted scope is inserted into your urethra, and the surgeon removes all but the outer part of the prostate. TURP generally relieves symptoms quickly, and most men have a stronger urine flow soon after the procedure. After TURP you might temporarily need a catheter to drain your bladder.
A lighted scope is inserted into your urethra, and the surgeon makes one or two small cuts in the prostate gland — making it easier for urine to pass through the urethra. This surgery might be an option if you have a small or moderately enlarged prostate gland, especially if you have health problems that make other surgeries too risky.
Your doctor inserts a special electrode through your urethra into your prostate area. Microwave energy from the electrode destroys the inner portion of the enlarged prostate gland, shrinking it and easing urine flow. TUMT might only partially relieve your symptoms, and it might take some time before you notice results. This surgery is generally used only on small prostates in special circumstances because re-treatment might be necessary.
In this procedure, a scope is passed into your urethra, allowing your doctor to place needles into your prostate gland. Radio waves pass through the needles, heating and destroying excess prostate tissue that's blocking urine flow. TUNA may be an option in select cases, but the procedure is rarely used any longer.
A high-energy laser destroys or removes overgrown prostate tissue. Laser therapy generally relieves symptoms right away and has a lower risk of side effects than does nonlaser surgery. Laser therapy might be used in men who shouldn't have other prostate procedures because they take blood-thinning medications.
The options for laser therapy include:
Special tags are used to compress the sides of the prostate to increase the flow of urine. The procedure might be recommended if you have lower urinary tract symptoms. PUL also might be offered to some men concerned about treatment impact on erectile dysfunction and ejaculatory problems, since the effect on ejaculation and sexual function is much lower with PUL that it is with TURP.
In this experimental procedure, the blood supply to or from the prostate is selectively blocked, causing the prostate to decrease in size. Long-term data on the effectiveness of this procedure aren't available.
The surgeon makes an incision in your lower abdomen to reach the prostate and remove tissue. Open prostatectomy is generally done if you have a very large prostate, bladder damage or other complicating factors. The surgery usually requires a short hospital stay and is associated with a higher risk of needing a blood transfusion.
Your follow-up care will depend on the specific technique used to treat your enlarged prostate.
Your doctor might recommend limiting heavy lifting and excessive exercise for seven days if you have laser ablation, transurethral needle ablation or transurethral microwave therapy. If you have open or robot-assisted prostatectomy, you might need to restrict activity for six weeks.
To help control the symptoms of an enlarged prostate, try to:
The Food and Drug Administration hasn't approved any herbal medications for treatment of an enlarged prostate.
Studies on herbal therapies as a treatment for enlarged prostate have had mixed results. One study found that saw palmetto extract was as effective as finasteride in relieving symptoms of BPH, although prostate volumes weren't reduced. But a subsequent placebo-controlled trial found no evidence that saw palmetto is better than a placebo.
Other herbal treatments — including beta-sitosterol extracts, pygeum and rye grass — have been suggested as helpful for reducing enlarged prostate symptoms. But the safety and long-term efficacy of these treatments hasn't been proved.
If you take any herbal remedies, tell your doctor. Certain herbal products might increase the risk of bleeding or interfere with other medications you're taking.
You might be referred directly to a doctor who specializes in urinary issues (urologist).
Don't hesitate to ask other questions during your appointment.
Your doctor is likely to ask you a number of questions. Being ready to answer them might give you more time to address any concerns. You might be asked: