An enlarged prostate is one of the most common health conditions in older men. Many men notice small changes in how they pass urine and assume they are simply part of getting older. Some are, but they are also worth understanding, because effective treatment is available and the condition is easy to confuse with more serious problems.
What BPH means
BPH stands for benign prostatic hyperplasia. "Benign" means it is not cancer. "Hyperplasia" means an increase in the number of cells. Doctors also use the term benign prostatic enlargement, or BPE. Both describe the same thing: a prostate that has grown larger than it was in early adulthood.
The prostate sits just below the bladder, and the urethra runs through the middle of it. As the gland grows, it can squeeze the urethra and make it harder for urine to flow out. Our page on benign prostatic enlargement shows how this happens.
Why it is so common after 50
The prostate grows during puberty and then stays much the same for many years. From around the age of 40 to 50, it often starts to grow again. The exact reason is not fully understood, but it is linked to changes in male hormones with age.
BPH is very common. Around half of men in their 50s have some degree of enlargement, and the proportion keeps rising with age. Not every man with an enlarged prostate has symptoms, and size alone does not predict how troublesome the symptoms will be.
The symptoms it can cause
Symptoms usually fall into two groups.
Voiding symptoms, which affect emptying the bladder:
- a weak or slow flow
- difficulty starting to pass urine
- a stop-start stream
- dribbling at the end
- a feeling that the bladder is not completely empty
Storage symptoms, which affect how the bladder holds urine:
- needing to go more often
- a sudden, strong urge to go
- getting up at night to pass urine, known as nocturia
The NHS guide to an enlarged prostate gives a good overview.
How BPH differs from prostate cancer
BPH and prostate cancer are separate conditions. BPH does not turn into cancer and does not increase the risk of cancer. However, they can exist together, and both become more common with age.
There are also some differences in how they behave:
- Where they start: BPH usually develops in the central part of the gland, around the urethra, which is why it causes urinary symptoms. Most prostate cancers start in the outer part and often cause no symptoms at first.
- PSA: both can raise PSA, which is why a raised result needs proper assessment. Our article on raised PSA without cancer explains this.
- Treatment goals: BPH treatment aims to relieve symptoms and protect the bladder. Cancer treatment aims to control or remove the disease.
When BPH needs attention
Many men with mild symptoms manage well with simple lifestyle changes. Others find their symptoms affect sleep, work and travel. Treatment is worth considering if symptoms bother you, and important if there are signs that the bladder is under strain, such as:
- being unable to pass urine at all
- repeated urine infections
- bladder stones
- blood in the urine
Treatment options
Treatment ranges from lifestyle changes and tablets to procedures that remove or reshape prostate tissue. Newer options aim to relieve symptoms while reducing side effects, such as Aquablation therapy, iTind and prostate artery embolisation. NICE guidance on urinary symptoms in men sets out how options are chosen.
Getting your symptoms checked
If you have noticed changes in how you pass urine, speak to your GP. A simple assessment can confirm the cause and rule out other conditions.
Professor Prokar Dasgupta treats men with an enlarged prostate at The London Clinic, 145 Harley Street. Please contact the clinic to arrange a consultation.