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Enlarged Prostate: Causes, Symptoms and Treatment

An enlarged prostate is a common condition in older men where the prostate gland grows and restricts urine flow, causing urinary symptoms.

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Things worth knowing about "Enlarged Prostate"

An enlarged prostate is a common condition in older men where the prostate gland grows and restricts urine flow, causing urinary symptoms.

What Is an Enlarged Prostate?

An enlarged prostate, medically known as benign prostatic hyperplasia (BPH), is a non-cancerous enlargement of the prostate gland. The prostate is a walnut-sized gland located just below the bladder, surrounding the urethra. As men age, the prostate can grow larger and begin to squeeze or partially block the urethra, leading to urinary symptoms. BPH is not a form of cancer and does not directly increase the risk of prostate cancer, but it can significantly affect quality of life.

Causes

The exact causes of BPH are not fully understood. Key contributing factors include:

Hormonal changes: As men age, the balance between testosterone and estrogen shifts, which may stimulate prostate cell growth.
Age: BPH is rare in men under 40 but becomes increasingly common with age, affecting more than 50% of men in their 60s.
Family history: Men with a family history of BPH are at higher risk.
Metabolic conditions: Obesity, type 2 diabetes, and cardiovascular disease may increase the likelihood of developing BPH.

Symptoms

Symptoms of an enlarged prostate are often grouped as lower urinary tract symptoms (LUTS) and may include:

Frequent or urgent need to urinate, especially at night (nocturia)
Weak or interrupted urine stream
Difficulty starting urination
Feeling that the bladder has not fully emptied after urinating
Dribbling at the end of urination
Urge incontinence (sudden, uncontrollable urge to urinate)

In severe cases, complete urinary retention may occur, which is a medical emergency requiring immediate treatment.

Diagnosis

Diagnosis of an enlarged prostate involves several assessments:

Symptom assessment: Standardized questionnaires such as the International Prostate Symptom Score (IPSS) help evaluate symptom severity.
Digital rectal examination (DRE): A doctor manually examines the prostate through the rectum to assess its size and texture.
PSA test: A prostate-specific antigen blood test helps distinguish BPH from prostate cancer.
Ultrasound: Transrectal or abdominal ultrasound is used to measure prostate volume and assess bladder function.
Uroflowmetry: Measures the speed and volume of the urine stream.
Post-void residual measurement: Determines the amount of urine remaining in the bladder after urination.

Treatment

Watchful Waiting

For mild symptoms, a strategy of active monitoring without immediate treatment may be appropriate. Lifestyle changes such as reducing fluid intake in the evening, limiting caffeine and alcohol, and practicing pelvic floor exercises can help manage symptoms.

Medications

Alpha-blockers (e.g., tamsulosin, alfuzosin): Relax the muscles in the prostate and bladder neck, improving urine flow.
5-alpha reductase inhibitors (e.g., finasteride, dutasteride): Reduce the size of the prostate by blocking the conversion of testosterone to dihydrotestosterone (DHT).
PDE5 inhibitors (e.g., tadalafil): May improve urinary symptoms and are also effective for accompanying erectile dysfunction.
Herbal remedies: Saw palmetto and other plant-based products are widely used, though scientific evidence remains limited.

Surgical and Minimally Invasive Procedures

Transurethral resection of the prostate (TURP): The gold standard surgical procedure, in which excess prostate tissue is removed through the urethra.
Laser therapy: Procedures such as HoLEP (Holmium Laser Enucleation of the Prostate) offer effective and less invasive alternatives to TURP.
Prostatic artery embolization (PAE): A minimally invasive procedure that reduces blood supply to the prostate, causing it to shrink.

References

Roehrborn CG. - Benign Prostatic Hyperplasia: An Overview. Reviews in Urology, 2005;7(Suppl 9):S3-S14. Available on PubMed.
McVary KT et al. - Update on AUA Guideline on the Management of Benign Prostatic Hyperplasia. Journal of Urology, 2011;185(5):1793-1803.
World Health Organization (WHO) – Global data on lower urinary tract symptoms and benign prostatic hyperplasia in men, WHO Technical Report Series.

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