What is Benign Prostatic Hyperplasia (BPH)?

Symptoms

What Are The Symptoms of BPH?

When the prostate is enlarged, it can bother or block the bladder. Needing to urinate often is a common symptom of BPH. This might be every 1 to 2 hours, mainly at night.

Other symptoms include:

  • Feeling that the bladder is full, even right after urinating
  • Feeling that urinating "can't wait"
  • A weak flow of urine
  • Needing to stop and start urinating several times
  • Trouble starting to urinate
  • Trouble starting to urinate
  • Needing to push or strain to urinate

If BPH becomes severe, you might not be able to urinate at all. This is an emergency that must be treated right away.

How Can BPH Affect Your Life?

In most men, BPH gets worse with age. It can lead to bladder damage and infection. It can cause blood in the urine and cause kidney damage.

Causes

What Causes BPH?

The causes of BPH are not well-understood. Some researchers believe that factors related to aging and the testicles may cause BPH. This is because BPH does not develop in men whose testicles were removed before puberty.

Throughout their lives, men produce both testosterone, a male hormone, and small amounts of estrogen, a female hormone. As men age, the amount of active testosterone in the blood lowers, leaving a higher share of estrogen. Studies have suggested that BPH may happen because the higher share of estrogen in the prostate adds to the activity of substances that start prostate cells to grow.

Another theory points to dihydrotestosterone (DHT), a male hormone that plays a role in prostate development and growth. Some research has shown that, even when testosterone levels in the blood start to fall, high levels of DHT still build up in the prostate. This may push prostate cells to continue to grow. Scientists have noted that men who do not produce DHT do not develop BPH.

Who is at Risk for BPH?

Aging and a family history of BPH increase a man’s risk for BPH. Obesity, lack of staying active, and erectile dysfunction can also increase risk.

Can BPH be Prevented?

There is no sure way to stop BPH, but losing weight and eating a healthy diet that involves fruits and vegetables may help. This may relate to having too much body fat, may increase hormone levels and other factors in the blood, and stimulate the growth of prostate cells. Staying active also helps control weight and hormone levels.

Diagnosis

How is BPH Diagnosed?

See your doctor if you have symptoms that might be BPH. See your doctor right away if you have blood in your urine, pain or burning when you urinate, or if you cannot urinate.

Your doctor can diagnose BPH based on

  • Personal or family history
  • A physical exam
  • Medical tests

The American Urological Association (AUA) has built a BPH Symptom Score Index. It’s a series of questions about how often urinary symptoms happen. The score rates BPH from mild to severe. Take the test and talk with your doctor about your results.

Your doctor will review your Symptom Score and take a medical history. You will also have a physical exam that involves a digital rectal exam (DRE). Your doctor may also want you to have some or all of these tests:

  • Cystoscopy to look at the urethra or bladder with a scope
  • Post-void residual volume to measure urine left in the bladder after urinating
  • PSA blood test to screen for prostate cancer
  • Ultrasound of the prostate
  • Urinalysis (urine test)
  • Uroflowmetry to measure how fast urine flows
  • Urodynamic pressure to test pressure in the bladder during urinating
  • Urinary blood test to screen for bladder cancer

PSA Blood Test

Prostate-specific antigen (PSA) is a protein that is made only by the prostate. When the prostate is healthy, very little PSA is found in the blood.

The PSA blood test measures the level of PSA in the blood. The test can be done in a lab, hospital, or doctor's office. No special preparation is needed. The PSA test should be done before the doctor does a DRE. You should not ejaculate for 2 days before a PSA test. That’s because ejaculation can raise the PSA level for 24 to 48 hours.

A low PSA is better for prostate health. A rapid rise in PSA may be a sign that something is wrong. BPH is one possible cause of a high PSA level. Inflammation of the prostate, or prostatitis, is another common cause of a high PSA level.

Digital Rectal Exam of the Prostate
Digital Rectal Exam of the Prostate

Digital Rectal Exam

The DRE is done with the man bending over or lying curled on his side. The doctor puts a lubricated, gloved finger into the rectum to feel the shape and thickness of the prostate. The DRE can help your doctor find prostate problems.

Treatment

After Treatment

What Happens After Treatment?

For most men, symptoms of BPH improve after treatment. Infection, bleeding, incontinence, and erectile dysfunction may occur after some treatments. In some cases, scar tissue may form.

What are the Long–Term Side Effects of Treatment?

Side effects vary with the type of treatment you choose. Most side effects are temporary. It may take a while for sexual function to fully return. Most experts agree that if you were able to have an erection shortly before surgery, you will probably be able to do so after surgery. Most men find little or no difference in orgasm. You may have retrograde ejaculation (when semen enters the bladder rather than being sent out through the penis). For most men, side effects lessen with time. Some treatments may cause long-term side effects for some men.

How Can You Prevent a Recurrence of BPH?

Once you have been treated for BPH, taking medication can prevent symptoms from returning or getting worse. Some men may need additional treatment. Some men need repeated treatment to get rid of bothersome symptoms. In older men, it may be possible to control BPH symptoms to the end of life.

Experimental Therapies without Proven Benefit

Prostate Artery Embolization (PAE)

PAE is a new procedure for treating BPH that is still being tested in clinical trials in the United States. Clinical trials are research studies that test how well new treatments work in people.

In PAE, tiny round particles are injected through a catheter into the vessels that supply blood to the prostate. The particles block blood flow to the large blood vessels (arteries) of the prostate. This causes the prostate to shrink.

Because PAE is new and still being tested, little is known for sure about how well it works and what side effects it may cause. At this time, the American Urological Association advises that patients should be treated with PAE only in a clinical (experimental) trial.

Updated May 2019