What is Benign Prostatic Hyperplasia (BPH)

Benign prostatic hyperplasia (BPH) is a non-cancerous condition where the prostate becomes enlarged. BPH does not cause cancer, but BPH and Prostate cancer can occur at the same time – they are two, unrelated conditions. BPH is related to the normal aging process and is influenced by the levels of the male hormone, testosterone, in the body. The prostate gland sits below the bladder, surrounds the urethra (urine tube), and is similar to a walnut in size and in shape. Its function is to produce semen, which is the fluid that transports sperm.

The prostate goes through two separate growth phases in a man’s lifetime. The first growth phase occurs early on in puberty where the gland doubles in size and reaches the walnut-size at this time. After about the age of 25, the second phase will start and the gland will continue to grow slowly throughout the rest of the man’s life. During this second growth phase is when BPH often occurs. When the prostate grows enough, usually in older aged men, it can squeeze the urethra so that it becomes difficult for urine to pass through and out of the body. If not treated, the bladder may lose its ability to empty completely, which causes many problems.

Symptoms of BPH

Symptoms of BPH may be different for each man. Some may actually experience no symptoms, and many others may experience a wide-range of symptoms. One of the more common symptoms includes the feeling of needing to urinate often, every one-to-two hours, and especially waking up at night to urinate. In severe cases, you might not be able to urinate at all, which is called urinary retention. This is an emergency, and it must be treated right away. It is important to call your urologist if this happens. In most men, BPH will get worse as you age and it is important to get treated. If left untreated, BPH can lead to bladder damage and infection and can also cause blood in the urine as well as kidney damage.

  • Feeling that the bladder is full, even right after urinating
  • Recurring feeling that urinating “can’t wait”
  • Weak / interrupted urine flow
  • Dribbling of urine
  • The need to stop and start urinating several times
  • Trouble starting to urinate
  • The need to push or strain to urinate
  • Increasingly frequent need to urinate, especially at night
  • Urine leakage (urinary incontinence)
  • Inability to completely empty the bladder

Causes of BPH are not well known or understood

There have been many studies and research done in an attempt to identify causes. We do know that BPH does occur mainly in older men and does not develop in men whose testicles (where testosterone is produced) were removed before puberty. Factors such as aging and testosterone levels in the body may be related to the causes of BPH. As mentioned above, the amounts of testosterone in the body of men declines with age. With the decline of testosterone as a man ages, the gradual increase of the female hormone estrogen develops. Studies have suggested that this rise in estrogen may lead to a higher occurrence of BPH. Other studies have shown that the continued and higher levels of another male hormone, dihydrotestosterone (DHT), could contribute to excess growth of the prostate. It is noted that men who do not produce DHT do not develop BPH.

Diagnosing BPH

The first step in diagnosing BPH is to see your urologist where he or she will take a complete medical history, physical exam, International Prostate Symptom Score (IPSS) survey (link to PDF here) and perform a digital rectal exam (DRE). A blood test that measures the prostate enzyme, Prostate Specific Antigen (PSA) may also be ordered. If the bloodwork comes back showing elevated PSA levels, this can be an indication of BPH, prostatitis, or prostate cancer. From there, your urologist will be able to know more if your urinary symptoms are caused by BPH and proceed with next steps to make the most accurate diagnosis.

Treating BPH

Yes, BPH can be treated and there are many treatment options. Once diagnosed with BPH, and dependent on the severity of symptoms, and the outcomes of the diagnostic tests, you and your urologist will determine the best treatment plan for you. The main treatments for BPH are:

  • Watchful waiting / active surveillance
  • Medical Therapies
  • Minimally-invasive procedures
  • Surgeries