Overview
An enlarged prostate is often called benign prostatic hyperplasia (BPH). It is not cancer, and it does not raise your risk for prostate cancer.
The prostate is a gland that produces some of the fluid that carries sperm during ejaculation. The prostate gland surrounds the urethra, the tube through which urine passes out of the body. An enlarged prostate means the gland has grown bigger. Prostate enlargement happens to almost all men as they get older. If you have BPH, you should have a yearly assessment to monitor your symptoms and see if you need changes in treatment.
Many treatments can help BPH. These include medicines, surgery and other procedures. Your health care provider can help you choose. The right option depends on things such as:
- Your symptoms.
- The size of your prostate.
- Other health problems you might have.
Causes
The actual cause of prostate enlargement is unknown. Factors linked to aging and changes in the cells of the testicles may have a role in the growth of the gland, as well as testosterone levels. Men who have had their testicles removed at a young age (for example, as a result of testicular cancer) do not develop BPH.
Also, if the testicles are removed after a man develops BPH, the prostate begins to shrink in size. However, this is not a standard treatment for an enlarged prostate.
Symptoms
Common symptoms of BPH include:
- Dribbling at the end of urinating
- Inability to urinate (urinary retention)
- Incomplete emptying of your bladder
- Incontinence
- Needing to urinate 2 or more times per night
- Pain with urination or bloody urine (these may indicate infection)
- Slowed or delayed start of the urinary stream
- Straining to urinate
- Strong and sudden urge to urinate
- Weak urine stream
Diagnosis
Your health care provider likely will start by asking questions about your symptoms. You’ll also get a physical exam. This exam is likely to include:
- Digital rectal exam. The provider inserts a finger into your rectum to check if your prostate is enlarged.
- Urine test. A lab checks a sample of your urine to find out if you have an illness or other problems that can cause the same symptoms as those of BPH.
- Blood test. The results can show if you have kidney problems.
After that, you might need other tests that can help confirm an enlarged prostate. These tests include:
- Prostate-specific antigen (PSA) blood test. PSA is a protein made in the prostate. PSA levels go up when the prostate becomes enlarged. But higher PSA levels also can be due to recent procedures, illnesses, surgery or prostate cancer.
- Urinary flow test. You pee into a container attached to a machine. The machine measures how strong your urine flow is and how much urine you pass. Test results can show over time whether your condition is getting better or worse.
- Postvoid residual volume test. This test measures whether you can empty your bladder fully. The test can be done using an imaging exam called ultrasound. Or it can be done with a tube called a catheter placed into your bladder after you pee to measure how much urine is left in the bladder.
- 24-hour voiding diary. This involves noting how often and how much you pee. It might be extra helpful if you make more than a third of your daily urine at night.
Treatment
Many treatments are available for enlarged prostate. These include medicines, surgery and procedures that involve smaller, fewer or no cuts. The best treatment choice for you depends on:
- The size of your prostate.
- Your age.
- Your overall health.
- How serious your symptoms are.
If your symptoms don’t get in the way of your life, you might decide to put off treatment. Instead, you could wait to see if your symptoms change or get worse. For some people, symptoms of BPH can ease without treatment.
SELF-CARE
For mild symptoms:
- Urinate when you first get the urge. Also, go to the bathroom on a timed schedule, even if you don’t feel a need to urinate.
- Avoid alcohol and caffeine, especially after dinner.
- Do not drink a lot of fluid all at once. Spread out fluids during the day. Avoid drinking fluids within 2 hours of bedtime.
- Try not to take over-the-counter cold and sinus medicines that contain decongestants or antihistamines. These medicines can increase BPH symptoms.
- Keep warm and exercise regularly. Cold weather and lack of physical activity may worsen symptoms.
- Reduce stress. Nervousness and tension can lead to more frequent urination.
MEDICINES
Alpha-1 blockers are a class of medicines, some of which have been used to treat high blood pressure. These medicines relax the muscles of the bladder neck and prostate. This allows easier urination. Most people who take alpha-1 blockers notice improvement in their symptoms, usually within 3 to 7 days after starting the medicine.
There are many types of surgeries and other procedures that can treat an enlarged prostate.
Transurethral resection of the prostate (TURP)
A thin tool with a light, called a scope, is inserted into the urethra. The surgeon removes all but the outer part of the prostate. TURP often relieves symptoms quickly. Some people have a stronger urine flow soon after the procedure too. After TURP, you might need a catheter to drain your bladder for a little while.
Transurethral incision of the prostate (TUIP)
A lighted scope is inserted into the urethra. The surgeon makes one or two small cuts in the prostate gland. This makes it easier for urine to pass through the urethra. TUIP might be an option if you have a small or slightly enlarged prostate gland. It also may be an option if you have health problems that make other surgeries too risky.
Transurethral microwave thermotherapy (TUMT)
A special catheter is placed through the urethra into the prostate area. Microwave energy from the catheter destroys the inner portion of the enlarged prostate gland. This shrinks the prostate and eases urine flow. TUMT might relieve only some of your symptoms. It also might take some time before you notice results. In general, this surgery is used only on small prostates in special situations because the treatment might be needed again.
Laser therapy
A high-energy laser destroys or removes overgrown prostate tissue. Laser therapy has a lower risk of side effects than does nonlaser surgery. It might be used in people who shouldn’t have other prostate procedures because they take blood-thinning medicines.
Laser therapy options include:
- Ablative procedures. These destroy prostate tissue that blocks urine flow. Types of these procedures include photoselective vaporization of the prostate (PVP) and holmium laser ablation of the prostate. Ablative procedures can cause irritating symptoms after surgery. In rare cases, another procedure to remove prostate tissue might be needed at some point.
- Enucleative procedures. These treatments include holmium laser enucleation of the prostate (HoLEP). In general, they remove all the prostate tissue blocking urine flow and prevent tissue from growing back. The removed tissue can be checked for prostate cancer and other health problems.
Prostate lift
Special tags are used to compress the sides of the prostate. This can improve the flow of urine. A prostate lift might be an option if the middle section of the prostate gland doesn’t get in the way of urine flow. It’s less likely to cause sexual side effects than are many other surgical treatments.
Water vapor thermal therapy (WVTT)
A device is placed in the urethra. It turns water into steam. This wears away extra prostate tissue. WVTT can ease symptoms of an enlarged prostate. It is less likely to cause sexual side effects compared with many other surgical treatments.
Robotic waterjet treatment
This procedure uses imaging tests and robotic tools to guide a device into the urethra. The device releases tiny, powerful jets of water to remove extra prostate tissue. This can ease symptoms of an enlarged prostate. Robotic waterjet treatment can cause some of the same side effects that TURP can cause.
Open or robot-assisted prostatectomy
One or more cuts are made in the lower stomach area. This lets the surgeon reach the prostate and remove tissue. In general, this type of surgery is done if you have a large or very large prostate. A short hospital stay is often needed afterward. The surgery is linked with a higher risk of needing donated blood due to bleeding.
Prostate artery embolization (PAE)
You may be offered prostate artery embolization as a treatment option for BPH. In this procedure, the blood supply to the prostate is blocked in chosen areas. This causes the prostate to get smaller. Evidence suggests there may be both short-term and long-term benefits of this procedure, including improved urinary symptoms, for certain people with BPH.
It’s important to talk with your healthcare team about the risks and benefits of this procedure. PAE should be done only by a healthcare professional who has been specially trained to perform PAE procedures. This type of healthcare professional is called an interventional radiologist. This is a doctor with special training in performing procedures done using imaging methods, such as X-ray, MRI or ultrasound, to guide them.
Follow-up care
Your follow-up care will depend on the technique used to treat your enlarged prostate. Your health care provider should tell you what activities to stay away from and for how long.
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