The prostate gland is located just below a male’s bladder and surrounds the top portion of the tube that drains urine from the bladder (urethra). The gland’s primary function is to produce most of the fluids in semen, the fluid that nourishes and transports sperm. From birth to young adulthood, the prostate grows from about the size of a pea to about the size of a walnut. Most men experience a second period of prostate growth in their mid- to late 40s. At this time, cells in the central portion of the gland — where the prostate surrounds the urethra — begin to reproduce more rapidly. As tissues in the area enlarge, they often compress the urethra and partially block urine flow. Benign prostatic hyperplasia (BPH) is the medical term for this condition. Prostate gland enlargement affects about half of men in their 60s and up to 90 percent of men in their 70s and 80s. The presence or absence of prostate gland enlargement is not related to the development of prostate cancer.
Treatment depends on your signs and symptoms and may include medications, surgery or nonsurgical therapies.
Prostate gland enlargement varies in severity from man to man, and doesn’t always pose a problem. Only about half the men with prostate gland enlargement experience signs and symptoms that become noticeable or bothersome enough for them to seek medical treatment. Benign prostate hypertrophy signs and symptoms may include:
The main risk factor for prostate gland enlargement is aging. Prostate gland enlargement rarely causes signs and symptoms in men younger than 40, but approximately half the men in their 60s experience some signs and symptoms. In addition to age, other benign prostate hypertrophy risk factors include:
A family history of prostate gland enlargement can increase the odds of developing problems from prostate gland enlargement.
Prostate gland enlargement is more common in American and European men than in Asian men.
For unknown reasons, married men are more likely to experience prostate gland enlargement than are single men. There’s no evidence that supports a link between sexual activity and prostate growth.
To diagnose prostate gland enlargement, your doctor will likely begin by asking you what your symptoms are, when they developed and how often they occur. Your doctor will also want to know about other health problems, medications you’re taking and whether there’s a history of prostate problems in your family. Over-the-counter (OTC) drugs, such as aspirin, decongestants and antacids, are considered medications, so tell your doctor about those too. The history of when you start and stop medications is also important for your doctor to know about. In addition, your checkup may include:
To perform this exam, your doctor puts on an examination glove, applies a lubricant to one finger, and then gently inserts the lubricated finger into your rectum. Because the prostate gland is located adjacent to the rectum, your doctor can feel the back wall of the gland. This allows your doctor to determine whether your prostate is enlarged and to help rule out prostate cancer.
Prostate-specific antigen is naturally produced in your prostate gland to help liquefy semen. A small amount circulates in your blood. Higher-than-normal levels in your blood can indicate BPH, prostate cancer or prostatitis.
If the results of these tests suggest prostate gland enlargement, your doctor may want to perform additional exams. The following can help confirm the diagnosis of prostate gland enlargement and determine its severity:
A short questionnaire, developed by the American Urological Association (AUA), asks you about specific urinary symptoms associated with prostate gland enlargement and how often they occur. In addition to helping determine the severity of prostate gland enlargement, this symptom index is helpful in monitoring the progression of the condition over time.
This test measures the strength and amount of your urine flow. By charting the results of this test, your doctor can determine if your urinary flow patterns change over time and at what rate. Keep in mind that your peak flow rate normally decreases as you age. Restricted urine flow can also be a sign of other problems, such as a weakened bladder muscle.
This test measures whether you can empty your bladder. The test is done one of two ways: by inserting a thin, soft tube (catheter) into your urethra and up into your bladder or by using ultrasound imaging to see inside your bladder.
The ultrasound method is more common and less uncomfortable, but often less accurate. Because the results of this test can vary, you may need to have it done more than once to get an accurate reading.
Imaging through ultrasound is used to estimate the size of your prostate gland.
In addition, it can help detect problems such as an obstruction of your kidney, stones in your kidneys or prostate, or a tumor in the prostate.
If your doctor suspects that your symptoms may be related to a bladder problem rather than prostate gland enlargement, he or she may recommend a series of tests to measure bladder pressure and function. These tests are done by threading a small catheter through the urethra and into your bladder. Water is gently injected into your bladder to measure internal bladder pressure and to determine how effectively your bladder contracts. Bladder pressure is measured during bladder filling and urination.
This procedure involves the use of a thin tube containing a lens with a light system (cystoscope) that’s gently inserted into the urethra under local anesthesia. It allows your doctor to see inside the urethra and bladder. The procedure can detect problems including enlargement of the prostate, compression of the urethra due to enlarged prostate, obstruction of the urethra or bladder neck, an anatomical abnormality, and the development of stones in your bladder. These disorders may cause your bladder to weaken.
An intravenous pyelogram is an X-ray image of the urinary tract used to help detect an obstruction or abnormality. Dye is injected into a vein, and an X-ray is taken of your kidneys, bladder and tubes that attach your kidneys to your bladder (ureters). The dye makes it possible to identify urinary stones, tumors or a blockage above your bladder.
Treatment for benign prostate hyperplasia is determined by your signs and symptoms and their severity. If you have significant problems, such as urinary bleeding, persistent urinary tract infections, bladder and kidney damage, your doctor generally will recommend treatment. If your prostate is enlarged but you experience little or no discomfort, treatment often isn’t necessary.
A wide variety of treatments are available to ease the signs and symptoms of an enlarged prostate. They include medications, other nonsurgical therapies and surgical procedures.
Medications are the most common method for controlling moderate symptoms of prostate gland enlargement. Doctors use a variety of medications to treat prostate gland enlargement:
These drugs were originally developed to treat high blood pressure. They relax the muscles at the neck of your bladder, making it easier to urinate. The Food and Drug Administration has approved four alpha blockers for prostate gland enlargement: terazosin (Hytrin), doxazosin (Cardura), tamsulosin (Flomax) and alfuzosin (Uroxatral).
This drug relieves symptoms in a totally different manner than alpha blockers do. Instead of relaxing your muscles, it shrinks your prostate gland. For some men with large prostates, the drug may produce a noticeable improvement in symptoms. It’s generally not effective, though, if you have only a moderately enlarged or normal-sized prostate.
A study published in the Dec. 18, 2003, issue of the New England Journal of Medicine found that taking doxazosin and finasteride together significantly reduced the risk of further prostate gland enlargement to the point where invasive surgery was not needed. This therapy also appears to decrease urination problems often caused by an enlarged prostate.
Several nonsurgical treatment methods are available to reduce the size of the prostate. These therapies focus on enlarging the urethra, making it easier for you to urinate.
Heat therapy. Heat therapy uses heat energy delivered through the urethra to destroy excessive prostate tissue. It fills the gap between medications and invasive surgery. It’s more effective than medications for moderate to severe symptoms, and it doesn’t produce as many side effects as surgery.
Heat therapy is often performed on an outpatient basis. But depending on the procedure, your doctor and how quickly you’re able to urinate on your own, you may need to stay in the hospital overnight. Heat therapy ordinarily requires only a few days’ recovery time. An exception is laser therapy. Some older laser procedures require that you wear a catheter for up to three weeks. Newer techniques often require use of a catheter for only 24 hours.
Several types of heat therapy are available. These may include:
Transurethral microwave therapy (TUMT) uses computer-controlled heat in the form of microwave energy to safely destroy the inner portion of the enlarged gland.
Transurethral needle ablation (TUNA) works by sending radio waves through needles that are inserted into your prostate gland, heating and destroying the tissue. As in TUMT, a special catheter is inserted through your urethra. The needles are inserted into your prostate by maneuvering the catheter.
Transurethral electrovaporization of the prostate (TVP) involves a special metal instrument that emits a high-frequency electrical current to cut and vaporize excess tissue while sealing off the remaining tissue to prevent bleeding. This procedure is especially useful for men at higher risk of complications, including those who take a blood-thinning (anticoagulant) medication. As with other, newer treatments, its long-term benefits aren’t yet known.
This procedure is performed similarly to other heat therapies, except it uses a laser instead of microwave energy, radio waves or electrical current to produce heat. It generally doesn’t cause impotence or prolonged incontinence. However, some laser procedures require lengthy use of a catheter. Laser therapy includes transurethral evaporation of the prostate (TUEP), noncontact visual laser ablation of the prostate (VLAP) and interstitial laser therapy.
A drawback of heat therapies is that no tissue is taken (biopsied) from your prostate gland. During surgical treatments for an enlarged prostate, a small sample of your prostate generally is taken by your doctor and examined by a pathologist for possible cancer.
A prostatic stent is a tiny metal coil. During this procedure, it is inserted into your urethra to widen the urethra and keep it open. Tissue grows over the stent to hold it in place. This treatment produces little or no bleeding and doesn’t require a catheter. It may be an option for men who are unwilling or unable to take medications or who are reluctant or unable to have surgery. Stents often aren’t ideal for older men who have difficulty wearing or maintaining them, or who are unable to tolerate the procedure.
Some men find that the stents don’t improve their symptoms. Others experience irritation when urinating or have frequent urinary tract infections. These complications, along with the high cost and potential difficulties in removing the stents, have reduced the popularity of this treatment.
At one time surgery was the most common treatment for benign prostatic hyperplasia (BPH). But because of increased use of medications and the development of other less invasive therapies, surgery is on the decline. Today it’s used mainly for more severe signs and symptoms or if you have complicating factors, such as:
Surgery is the most effective of all therapies for relieving symptoms of an enlarged prostate. It’s the “gold standard” by which all other treatments are judged, and many doctors have extensive experience with it. However, it’s also the most likely to produce side effects.
Fortunately, most men experience few problems. Among those with certain health conditions, such as uncontrolled diabetes, cirrhosis of the liver, a major psychiatric disorder, or a serious lung, kidney or heart condition, surgery isn’t usually recommended unless absolutely necessary.
Surgery for an enlarged prostate requires a hospital stay. If you have surgery, you may need to take up to a month off from work. You’ll also need to avoid heavy lifting, jarring to your lower pelvic area or straining of your lower abdominal muscles for up to two months.
The types of surgery for an enlarged prostate include:
This is the most common surgery for an enlarged prostate. During the procedure, you’re given a general anesthesia or anesthetized from the waist down with a spinal block. A surgeon threads a narrow instrument (resectoscope) into your urethra and uses small cutting tools to scrape away excess prostate tissue. You can expect to stay in the hospital for one to three days after surgery. During your recovery, you’ll have a urinary catheter in place for a few days.
This surgery is an option if you have only a moderately enlarged or small prostate gland. It’s also an option for men who aren’t good candidates for more invasive surgery for health reasons or because they don’t want to risk sterility.
This type of surgery is generally performed only if you have an excessively large prostate, bladder damage or other complicating factors, such as bladder stones or urethral strictures. It’s called open because the surgeon makes an incision in your lower abdomen to reach the prostate rather than going up through the urethra. During an open prostatectomy, only the inner portion of your prostate gland is removed, leaving the outer portion intact.