An enlarged prostate, known in medical circles as benign prostatic hyperplasia, is a health issue for many men over the age of 50. A prostate increasing in size becomes more common with age. By age 60 about 50% of men will have some signs of benign prostatic hyperplasia and by age 85 about 90% will have signs of the condition. About half of the men with benign prostatic hyperplasia will develop symptoms that require treatment.
What is the prostate’s function?
The prostate is a walnut-sized gland located just below the bladder and in front of the rectum in men. It surrounds the top part of the urethra, the tube which runs through the center of the prostate. The urethra drains urine from the bladder and also carries sperm (via ejaculation) through the penis and out of the body.
The prostate’s most important function is the production of a fluid that combines sperm cells from the testicles and fluids from other glands to make up semen. Prostate muscles contract to ensure that semen is forcefully pressed into the urethra and expelled outwards during ejaculation. The prostate plays a crucial role in the male reproductive system.
The prostate is enclosed in a capsule and composed of the peripheral, central, and transition zones. It has a rich supply of blood vessels and nerves.
Conditions and disorders that affect the prostate:
The most common conditions that affect the prostate include:
- Prostate cancer. This is the second most common type of cancer amongst males.
- Prostatitis (inflammation). Prostatitis manifests in four different conditions, namely acute bacterial prostatitis, chronic bacterial prostatitis, chronic pelvic pain syndrome, and asymptomatic inflammatory prostatitis. Prostatitis is the most common urinary tract issue in men younger than 50, and the third most common in males over 50.
- Benign prostatic hyperplasia. This condition causes the prostate to grow, which can result in blockages in the urethra. As this condition affects such a high percentage of men, it needs to be highlighted in more detail.
Symptoms of benign prostatic hyperplasia:
An enlarged prostate can cause bothersome symptoms, such as restricting or blocking the flow of urine out of the bladder, as well as causing bladder, urinary tract, or kidney problems. Symptoms tend to slowly get worse with aging. The prostate can enlarge from the size of a walnut to the size of a lemon over time, although the size of the prostate doesn’t always determine how serious the symptoms are.
Common symptoms include:
- Urinating often at night.
- Urgent or frequent need to urinate.
- Weak urine stream.
- Urine stream that stops and starts.
- Trouble starting to urinate.
- Dribbling at the end of urination.
- Inability to fully empty the bladder.
- Blood in the urine.
- Urinary tract infection.
- Leaking (incontinence).
- Pain after ejaculation, or while urinating.
Without treatment, benign prostatic hyperplasia can cause further blockage of the urethra and symptoms may worsen, resulting in urinary tract infections, bladder stones, bladder damage (a bladder that does not empty fully can stretch and weaken over time), blood in the urine, and even kidney damage caused by backflow from the bladder, increasing pressure on the kidneys.
Causes of benign prostatic hyperplasia:
The prostate is a gland that typically keeps growing and risk factors for benign prostatic hyperplasia increases with aging. Medical researchers and healthcare providers are not sure exactly what causes benign prostatic hyperplasia and suspects it might be due to changes in the balance of sex hormones as men grow older.
One theory is that the amount of testosterone in the body decreases with aging, while estrogen levels remain the same. These hormonal changes may result in prostate cells to grow. To supplement testosterone is not the answer, as it may result in developing or worsening benign prostatic hyperplasia. A contributing factor is that older males have higher levels of dihydrotestosterone, a more potent form of testosterone which may enlarge the prostate.
Treatments for benign prostatic hyperplasia:
There isn’t a cure for benign prostatic hyperplasia, but treatments are available that can help to alleviate symptoms, such as medicines, surgery, and some other procedures. Options would depend on the nature of the symptoms, the size of the prostate, and any other health problems that the patient may have.
Depending on the nature of the problem, treatment options include:
Medications: The most commonly prescribed medication relaxes the muscle in the prostate, which reduces the tension on the urethra. Certain medication decreases the production of the hormone dihydrotestosterone, which can slow prostate growth in men with larger prostates.
Minimally invasive procedures:
Certain lifestyle changes can help to manage the symptoms of an enlarged prostate, such as:
- Limit the consumption of alcohol and caffein.
- Avoid or drink less fluids in the evening.
- Manage stress levels.
- Exercise regularly.
- Maintain a healthy weight.
- Eat healthily and follow a diet such as the Mediterranean diet. Eat more salmon, berries, tomatoes, broccoli, nuts, and citrus. Avoid or limit red meat, alcohol, caffein, and salt.
- Do bladder training, which involves postponing urination for increasing stretches of time and learning muscle and relaxation techniques.
Surgery: Several types of surgery can remove prostate tissue that blocks the urethra, such as:
- Transurethral resection of the prostate (TURP). A special instrument (resectoscope) is inserted through the urethra that allows the surgeon to see and remove prostate tissue.
- Transurethral incision of the prostate. Two small incisions are made in the bladder neck, where the urethra and bladder join, to widen the urethra, resulting in improved urine flow.
- Transurethral electrovaporization. An electrode is inserted in the urethra to heat the prostate tissue, which turns the tissue cells in the enlarged areas of the prostate into steam.
- GreenLightTM laser treatment. A special laser is used to evaporate the enlarged prostate tissue. This treatment is also called photoselective vaporization of the prostate and prostate photovaporization.
- Aquablation®. The surgeon, usually a urologist, uses precise high-pressure water jets to remove prostate tissue.
- Prostatic urethral lift. With this procedure the enlarged prostate lobes are separated to widen the urethra, making it easier to urinate. A special instrument is inserted through the urethra and ejects small implants that pull the prostate lobes apart and open the urethra. This procedure usually places two to six implants, depending on the size of the prostate.
- RezumTM therapy. A special instrument is inserted through the urethra and ejects a needle into the prostate. The needle emits steam vapor which turns into water, whose thermal energy destroys prostate cells.
Prostate removal (prostatectomy) procedures:
- Radical prostatectomy. This is a surgical procedure for the partial or complete removal of the prostate gland. A surgical incision is made in either the lower abdomen (called a retropubic procedure), or through the skin between the scrotum and the rectum (called a perineal procedure).
- Laparoscopic radical prostatectomy. This is a procedure in which the surgeon makes several small cuts in which long thin tools are inserted, one of which is a thin tube with a video camera (laparoscope) which helps the surgeon to see inside during the procedure.
- Robotic surgery system. This is a minimally invasive procedure utilizing advanced surgical systems. Miniaturized robotic instruments are passed through several tiny keyhole incisions in the abdomen to allow the surgeon to remove the prostate with great precision. This procedure requires special equipment and training.
Side effects of a prostatectomy:
The most common side effects of a prostatectomy include the following:
- Urinary incontinence: The inability to control urine can occur following a prostatectomy, but this side effect often improves over time.
- Erectile disfunction (impotence): Many factors play a role in the return of erectile function, such as the patient’s age, degree of preoperative sexual function, and if the nerves were spared during surgery. During robotic surgery, nerve-sparing techniques will be used to minimize the surgical impact on sexual function.
- Urinary leakage or dribbling: This symptom is worse after surgery but usually improves over time.
- Sterility: Radical prostatectomy cuts the connection between the testicles and the urethra, making the man unable to provide sperm to father a child. He may be able to have an orgasm but without ejaculation, meaning the orgasm is “dry.”
Conclusion:
Benign prostatic hyperplasia is a non-cancerous enlargement of the prostate and is a common condition affecting men over 50. Enlargement tends to grow with aging, eventually affecting about 90% of men 85 years and older. As the prostate grows, it can squeeze the urethra and restrict the flow of urine, resulting in mild to severe urination problems.
Treatment options vary depending on symptoms and severity and may include lifestyle changes, medications, or surgery.
References:
Benign prostatic hyperplasia. Published 24 September 2024. Mayo Clinic. USA. (www.mayoclinic.org)
Benign prostatic hyperplasia. Published online and last reviewed 18 January 2024. Cleveland Clinic. USA. (A nonprofit multi-specialty medical center that integrates clinical and hospital care with research and education.) (www.clevelandclinic.org)
Benign prostatic hyperplasia (BPH). Published online and updated September 2023. Urology Care Foundation. American Urology Association. (www.urologycare.org)
The growing problem of an enlarged prostate gland. Published 10 August 2024. Harvard Medical School. (www.health.harvard.edu)
New surgery for benign prostatic hyperplasia provides long-lasting effects. Published 23 January 2025. Harvard Medical School. (www.health.harvard.edu)
Robotic prostatectomy. Published online. Johns Hopkins Medicine. USA. (www.hopkinsmedicine.org)
What are the latest treatments for an enlarged prostate? Published 18 January 2023. Medical News Today. (www.medicalnewstoday.com)
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