Benign enlargement of the prostate is a common condition in which your prostate gland swells beyond normal size. It is also known as benign prostatic hyperplasia. If you have this disorder, keep in mind that it is not a cancer, although it still requires treatment.
The prostate gland is only found in men and is normally about the size of a walnut. It lies immediately below the bladder and just above the penis. A tube called the urethra, which carries urine from your bladder, passes through the center of the prostate gland.
An enlarged prostate can press on the urethra, which causes narrowing or blockage of the tube and prevents your urine from flowing normally.
Fortunately, your prostate gland is not essential to sustain life and can be removed if the problems interfere too much with your quality of life.
Once you reach age 45, you are more likely to develop an enlarged prostate, and your risk increases as you age. Around one-third of men older than 50 have an enlarged prostate. By age 85, this increases to around 90 percent.
Some research has suggested that prostate enlargement could result from hormonal changes occurring in men as they age.
If you have a close relative with benign prostate enlargement you are more likely to develop the condition yourself. The risk is higher in certain parts of the world and, for American men, the risk is higher than it would be for men from India, China, and Japan.
If your prostate becomes enlarged, you may experience some of the following symptoms, which tend to worsen as time goes on:
- a need to pass urine more often
- an increased need to urinate during the night
- finding it difficult to start urinating
- having a flow of urine that is weak and stops and starts
- feeling you have to strain to produce urine
- feeling as if your bladder has not emptied properly after urinating
- urine continues to dribble out after you have finished urinating
You may also experience complications from enlarged prostate, such as a urinary tract infection. You could also develop bladder or kidney stones.
However, not everyone experiences symptoms, and any that appear do not seem to be related to the size of your prostate gland.
Your doctor will ask questions about your symptoms and may perform a rectal examination to check the size and shape of your prostate gland.
You also may undergo urine and blood tests. These will check for infections and measure the PSA (prostate specific antigen) levels in your blood. The PSA number goes up when the prostate is enlarged.
High levels of PSA can sometimes indicate prostate cancer, and your doctor may want to check for this. If there is any doubt at all, a sample of cells from your prostate can be analyzed. You may also need an ultrasound scan.
Another test is a cystoscopy, where a slender instrument with a camera is inserted into the urethra through the end of the penis. Your doctor can use this method to inspect your prostate gland from within the body. You might also be asked to urinate into a device that measures your urine flow.
If your symptoms are mild, you may not need medical treatment. You might be able to manage your condition with lifestyle changes, such as restricting fluid intake at night and reducing alcohol and caffeine consumption. Your doctor will monitor your prostate at regular intervals.
Drugs are the most frequently used treatment when your symptoms are moderate. You may be given alpha-blockers to relax the muscles in your prostate, or drugs known as 5-alpha-reductase inhibitors, which alter your hormone balance, and encourage the prostate to reduce in size. Patients often take both types of medication.
If your prostate does not respond to drug treatment, or if it is quite large, surgery may be necessary to remove the enlarged portion of the gland. The most common operation is known as TURP, which stands for transurethral resection of the prostate. As with the cystoscopy, a long, thin instrument with a camera is inserted up the urethra to reach your prostate, where the enlarged tissues are removed using an electrical loop. The loop not only cuts, but also cauterizes the blood vessels to control bleeding.
Another type of surgery is the TUIP (transurethral incision of the prostate) procedure. TUIP widens the urethra to allow for stronger urine flow. What is called an “open” surgery requires an external incision to reach the prostate. This procedure is only used under more severe circumstances.
Non-surgical techniques use microwaves, radio waves, or lasers to remove the enlarged prostate tissue. These may cause fewer side effects, but are not as proven as conventional methods for long-term effectiveness.
With common treatment—medication, lifestyle changes, or surgery—most men find their condition greatly improves. Some men worry that prostate surgery will affect their sexual function. However, if you were capable of achieving an erection before the enlarged portion of your prostate was removed, once you have fully recovered from the procedure, you should be able to resume your normal sex life.