Enlarged prostate (benign prostatic hyperplasia, BPH)
Benign prostatic hyperplasia, or BPH, is a non-cancerous enlargement of the prostate. It becomes more common with age. As the prostate grows, it can press on the urethra. This is the tube that carries urine out of the bladder, so pressure on it can make it harder to pass urine. You might notice a weaker urine stream or difficulty getting started. You may also need to urinate more often, including during the night. These symptoms can have other causes, so an assessment is important before you decide whether you need treatment. Dr Ryan McConnell assesses men with urinary symptoms related to an enlarged prostate. Once the cause of the symptoms is clear, he can discuss whether prostate artery embolisation may be an option.
What are the symptoms of an enlarged prostate?
An enlarged prostate (BPH) can gradually squeeze or block the urethra, resulting in noticeable changes in your urination patterns. These symptoms generally fall into two categories.
Urine flow
- Difficulty starting urination
- Weak or interrupted urine stream
- Straining to begin or maintain flow
- Dribbling at the end of urination
- Sensation of incomplete bladder emptying
Frequency & urgency
- Needing to urinate much more frequently
- Sudden, strong, and uncontrollable urgency
- Frequent urination during the night (nocturia)
- Inability to delay urination once it starts
Aetiology & risk factors
Researchers are still studying the exact cause of benign prostatic hyperplasia (BPH). However, doctors agree that several natural changes over time play a part.
What causes an enlarged prostate?
Researchers are still studying the exact cause of benign prostatic hyperplasia (BPH). However, doctors agree that several natural changes over time play a part.
- Ageing: the prostate keeps growing slowly through adult life, and for most men this speeds up after the age of 40.
- Hormone changes: shifts in the balance of testosterone, oestrogen and DHT (dihydrotestosterone) cause cells in the prostate to multiply.
- Family history: if close relatives have had BPH or severe lower urinary tract symptoms (LUTS), your own risk is higher.
Important medical distinction
Benign prostatic hyperplasia (BPH) is entirely non-malignant. BPH is not cancer, and having an enlarged prostate does not increase your risk of developing prostate cancer. However, because symptoms can mirror each other, a definitive professional diagnosis is essential.
How is BPH diagnosed?
Diagnosing benign prostatic hyperplasia (BPH) involves assessing your urinary symptoms, medical history and relevant investigations. Depending on your symptoms, further assessment may include measuring prostate size and checking your urine flow. It also aims to rule out other conditions that can cause similar symptoms. Assessment begins with a consultation to review your medical history, urinary symptoms and any previous investigations or treatments. This helps your doctor decide whether you need further tests and which treatment options may suit you.
Assessment may include
- a symptom score (IPSS) and review of your medical history and medications
- physical examination
- a urine test to check for infection or blood
- blood tests, which may include kidney function and, after discussion with your doctor, a PSA test
- ultrasound to measure the size of the prostate and check how well the bladder empties
- urine flow testing
- CT angiography to assess the prostate arteries, if prostate artery embolisation is being considered
An ultrasound scan commonly measures the size of the prostate. It also shows how much urine is left in the bladder after you pass urine. These measurements help guide which treatment options may be suitable.
When should you seek medical advice?
Many prostate and urological conditions develop gradually, often presenting with subtle, easily overlooked changes. Seeing your general practitioner (GP) is an important first step. They can help decide whether you need a specialist opinion. Your GP can carry out an initial assessment and arrange tests such as a PSA blood test. They can also provide the referral you need to see Dr Ryan McConnell and for any later treatment.
Urgent warning signs
- Sudden or complete inability to urinate (acute urinary retention)
- Visible blood in your urine or semen (haematuria)
- Severe, unexplained pelvic, lower back, or flank pain
- High fever, chills, or systemic lethargy accompanied by painful urination
What treatments are available for BPH?
Treatment for benign prostatic hyperplasia (BPH) depends on how severe your symptoms are and how much they affect your quality of life. It also depends on your prostate size and anatomy, and your overall health. Options range from monitoring and medication to minimally invasive procedures and surgery.
1
Active monitoring & medication
For mild symptoms, your doctor may first suggest monitoring, lifestyle measures and medication. Medicines such as alpha-blockers and 5-alpha-reductase inhibitors may improve urinary symptoms or reduce prostate enlargement in appropriate patients.
2
Surgical & minimally invasive treatments
If symptoms are more troublesome or medication does not help enough, a procedure may be the next step. Options include transurethral resection of the prostate (TURP) and laser procedures such as HoLEP. Other options are minimally invasive urological treatments and prostate artery embolisation (PAE).
3
Prostate artery embolisation (PAE)
PAE is a minimally invasive, image-guided procedure performed through a small artery in the wrist or groin. Dr McConnell uses tiny particles to reduce blood flow to the prostate. As a result, the prostate gradually shrinks, which may improve urinary symptoms. PAE may be an alternative to surgery for appropriately selected patients.Could PAE be an option?
PAE is a minimally invasive treatment option for some men with symptomatic BPH. Whether it is suitable depends on factors including your symptoms, prostate size and anatomy, previous treatments and overall health. Dr Ryan McConnell can assess whether PAE may be appropriate for you and discuss how it compares with other treatment options.Discuss your treatment options with Dr Ryan McConnell
If you have symptoms of an enlarged prostate, a consultation can help find the cause. It can also show which treatment options may suit you. Dr Ryan McConnell can review your symptoms, test results and past treatment. He can then discuss whether prostate artery embolisation or another treatment may be suitable.
Frequently asked questions about BPH
What is an enlarged prostate (BPH)?
Benign prostatic hyperplasia (BPH) is a common condition as men age, characterised by the non-cancerous enlargement of the prostate gland. This enlargement can compress the urethra, obstructing the normal flow of urine and leading to various urinary symptoms.
What are the common symptoms of BPH?
Common symptoms include a frequent or urgent need to urinate, especially at night. Other symptoms are difficulty starting, a weak or interrupted urine stream, and being unable to empty the bladder completely.
Does an enlarged prostate affect a man sexually?
An enlarged prostate does not directly cause erectile problems. However, urinary symptoms and erectile difficulties often occur together in older men. Poor sleep and urinary urgency can also affect sexual wellbeing. Some medications and surgical treatments for BPH can affect ejaculation or erections. If sexual function is important to you, raise it with your doctor when comparing treatment options.
Are there foods to avoid or natural remedies for an enlarged prostate?
No food or supplement has been shown to shrink an enlarged prostate. Some simple measures can help manage urinary symptoms. For example, drink less in the evening and avoid constipation. It also helps to limit caffeine and alcohol, which can increase urine production and irritate the bladder. Herbal supplements have not been shown to reliably improve symptoms in well-designed studies. Speak with your GP before starting any supplement, as some can interact with other medications.
Is BPH a precursor to prostate cancer?
No. BPH is entirely benign and does not increase your risk of developing prostate cancer. However, BPH symptoms can sometimes mimic those of more serious conditions. For this reason, a thorough assessment by Dr McConnell is important.
What treatment options are available?
Treatment depends on the severity of your symptoms, prostate size and anatomy, previous treatments and your overall health. For milder symptoms, options may include lifestyle measures and medication. Other options include prostate artery embolisation (PAE) and urological procedures, such as TURP, HoLEP and other surgical or minimally invasive treatments. The most appropriate option depends on your individual circumstances and treatment goals.
When should I seek medical advice for an enlarged prostate?
You should schedule a consultation if urinary symptoms begin to disrupt your sleep, daily activities, or overall quality of life. Immediate medical attention should be sought if you experience a complete inability to urinate or see blood in your urine.