The Facts

The prostate gland is a small, round lump of tissue located behind the base of the penis. Its function is to add fluid to the semen, the liquid that carries the sperm. It tends to grow bigger as men enter middle age, and continues to grow with age. In some men the prostate gland can grow to be more than seven times its original size. This runaway growth is called hyperplasia, or sometimes hypertrophy, and results in the condition benign prostatic hyperplasia (BPH).

BPH causes no symptoms or problems in two-thirds of men over the age of 50 years, but the chance of developing symptoms increases with each additional year. The prostate surrounds the top of the urethra, the tube through which we urinate, just where it meets the bladder. If the prostate gets too big, it can squeeze the urethra, partly closing it. This can lead to various bladder problems.

Having BPH doesn't increase your chances of getting prostate cancer. The two diseases can have similar symptoms, although prostate cancer often has no symptoms. It's also possible to have BPH and prostate cancer at the same time.

Causes

We don't know why the prostate grows larger in older men, but it's believed to be linked to hormonal changes associated with aging.

Symptoms and Complications

At first, you may find you have to strain harder when you are urinating. Over time, this straining can affect the bladder muscles, causing them to become oversensitive. Often, no matter how much you strain, the bladder still contains urine. The urge to urinate comes with increasing frequency. This can be a particular nuisance at night.

Other symptoms you can have include:

• feeling that you must urinate right away (urgency)
• a delay when you start urinating
• weak or interrupted stream of urine
• tendency to dribble after urination
• feeling your bladder isn't empty after urination
• pain in the lower back, pelvis, or upper thighs

A bladder that won't empty properly encourages infection of the urinary tract. A few men get urinary stones or repeated infections. Sometimes BPH causes urinary retention, a condition where you cannot empty your bladder completely when urinating. Rarely, it produces complete blockage of the urethra, which is a medical emergency.

Making the Diagnosis

The standard test for BPH is the digital rectal exam, in which the doctor feels for the prostate with a gloved finger to check its size and texture. There's also a blood test that measures a specific protein that is secreted by the prostate gland (also known as prostate specific antigen, or PSA) - the higher the level of the protein, the larger the prostate gland.

Treatment and Prevention

Many people can avoid surgery using the latest medical treatments. Medications called alpha-blockers (e.g., terazosin*, prazosin, tamsulosin) can help relax the bladder outlet, allowing easier passage of urine, especially if the obstruction of the urethra isn't too severe. Other medications (e.g., dutasteride, finasteride) help reduce the size of the prostate by counteracting testosterone hormones.

These medications can remove the need for surgery in many people with BPH. However, surgery is the only way to eliminate the problem completely. The most commonly used technique is called a TURP (transurethral resection of the prostate), which can be used for most cases except those with extremely large prostate glands. A tube equipped with a camera and a scalpel is inserted into the urethra (the tube that runs the length of the penis and back to the bladder) to remove strips of enlarged prostate. TURP causes fewer postoperative problems than open surgery, which can lead to erectile dysfunction (difficulty getting or maintaining an erection) or incontinence (bladder leaking).

Other techniques like TUIP (transurethral incision of the prostate) and radiofrequency ablation aim to reduce the size of the prostate, often with fewer side effects than TURP. Electricity and heat are also sometimes used to destroy excess tissue. Only a specialist can decide which technique is most appropriate in each case.

*All medications have both common (generic) and brand names. The brand name is what a specific manufacturer calls the product (e.g., Tylenol®). The common name is the medical name for the medication (e.g., acetaminophen). A medication may have many brand names, but only one common name. This article lists medications by their common names. For more information on brand names, speak with your doctor or pharmacist.