Benign prostatic hyperplasia (BPH) is a non-cancerous enlargement of the prostate gland that commonly occurs in men over age 50 due to hormonal changes and aging.
Common symptoms:
BPH presses on the urethra, causing lower urinary tract symptoms such as:
- Frequent or urgent need to urinate, especially at night (nocturia).
- Weak or interrupted urine stream, trouble starting urination, or dribbling.
- Feeling of incomplete bladder emptying, which can lead to infections or stones if untreated.
Causes and risk factors:
- The prostate grows larger as cells multiply in response to dihydrotestosterone (DHT), starting around age 30-50 but often symptom-free until later. Risk increases with age, family history, obesity, diabetes, and heart disease.
- BPH is not prostate cancer but can elevate PSA levels and shares symptoms, so exams distinguish them; treatments range from watchful waiting to medications or surgery if bothersome
Treatment Options
BPH treatment starts with watchful waiting for mild symptoms, progressing to medications, minimally invasive procedures, or surgery based on symptom severity, prostate size, and response to prior options.
Medications:
Alpha-blockers (e.g., tamsulosin, alfuzosin) relax prostate and bladder neck muscles for quicker urine flow improvement.
5-alpha reductase inhibitors (e.g., finasteride, dutasteride) shrink the prostate over months by blocking DHT hormone production, best for larger glands.
Combination therapy uses both for better symptom relief and reduced progression risk.
Minimally invasive procedures:
- UroLift: Implants lift prostate tissue away from the urethra without cutting or heating; quick recovery, low sexual side effects.
- Rezūm: Steam injections shrink prostate tissue; office-based, resumes normal activities in days.
- Prostate artery embolization (PAE): Blocks blood supply to shrink the prostate.
Surgical options:
Transurethral resection of the prostate (TURP) remains the gold standard, removing blocking tissue endoscopically; alternatives like holmium laser enucleation (HoLEP) or GreenLight laser suit larger prostates with less bleeding.
Consult a urologist to match options to your symptoms and health.
