PROSTATE ENLARGEMENT (BPH)

Prostate enlargement, also known as benign prostatic hyperplasia (BPH), is a common condition among aging men. It occurs when the prostate gland, which surrounds the urethra, grows larger than normal. While BPH is not cancerous, it can cause bothersome urinary symptoms that affect a man’s quality of life.

Causes of Prostate Enlargement BPH

The exact cause of BPH is not fully understood, but it is believed to be primarily linked to hormonal changes associated with aging. Notably, during puberty, the prostate gland undergoes a significant increase in size, and this growth continues in adulthood, particularly after the age of 25. While this ongoing growth is a normal part of aging for most men, in some cases, it can result in BPH. Testosterone, the male sex hormone, is converted into dihydrotestosterone (DHT) in the prostate gland, which stimulates prostate cell growth. As men age, the balance of hormones changes, leading to an increase in DHT levels and subsequent prostate enlargement.

Prevalence of Prostate Enlargement/BPH

BPH is incredibly common among aging men, with prevalence increasing with age. It is estimated that by the age of 60, more than half of men will have some degree of prostate enlargement. By age 85, this number rises to nearly 90%.

Symptoms of Prostate Enlargement/BPH

As the prostate enlarges, it puts pressure on the urethra, leading to symptoms that affect urine flow, such as:

Dribbling at the end of urination
Difficulty initiating urination
Weak urine stream, or intermittent flow

The constriction of the urethra also results in increased effort for the bladder to expel urine. Over time, this can weaken the bladder muscles, making it more challenging to empty the bladder. Consequently, individuals may experience:

Persistent sensation of needing to urinate shortly after urination
Frequent urination, often exceeding eight times a day
Urinary incontinence, characterized by a lack of control over urination
Sudden and urgent urge to urinate
Multiple Nocturia (waking up at night to urinate)

Additionally, complications may arise, including:

Urinary tract infections
Bleeding
Bladder damage
Formation of bladder stones.

While BPH typically doesn’t lead to other conditions, in rare instances, it can result in serious complications such as kidney damage or urinary retention, where the inability to urinate occurs.

It’s important to note that the severity and manifestation of symptoms can vary from person to person, regardless of prostate size. Some individuals with significantly enlarged prostates may experience minimal or no symptoms at all.

Risk Factors for Prostate Enlargement/BPH

Several factors may increase the risk of developing BPH, including:

Aging
Family history of BPH
Obesity
Lack of physical activity
Erectile dysfunction
Certain medications, such as antihistamines and decongestants

Diagnosis of Prostate Enlargement/BPH

To diagnose benign prostatic hyperplasia (BPH), your doctor will undertake several steps:

Medical History: Your doctor will discuss your personal and family medical history, and you may be asked to complete a questionnaire detailing your symptoms and their impact on your daily life.
Physical Examination: A physical examination will be conducted, which may include a digital rectal exam. During this exam, the doctor inserts a gloved finger into the rectum to assess the size and shape of the prostate gland.
Basic Tests: Initial tests may include:
- Blood tests: These are conducted to check for kidney function and overall health.
- Urine tests: These help identify any infections or other issues contributing to your symptoms.
- PSA (prostate-specific antigen) blood test: Elevated PSA levels can indicate an enlarged prostate, and it may also be used for prostate cancer screening.
Advanced Tests: Depending on the results of the initial tests, your doctor may recommend further assessments to confirm the diagnosis or gain a clearer understanding of your condition. These tests may include:
- Ultrasound: Various types of ultrasound imaging may be used to measure the size of the prostate and assess its health.
- Bladder ultrasound: This test evaluates bladder emptying to determine how well your bladder functions.
- Biopsy: A biopsy may be performed to rule out prostate cancer.
- Urine flow test: This test measures the strength of your urine stream and the volume of urine produced.
- Urodynamics testing: These tests assess bladder function and may involve measuring pressure and flow rates during urination.
- Cystourethroscopy: This procedure utilizes a camera to examine the inside of the prostate, urethra, and bladder, providing detailed images of these structures.

Treatment Options for Prostate Enlargement/BPH

Treatment options for benign prostatic hyperplasia (BPH) are tailored to individual factors such as age, overall health, prostate size, and the impact of symptoms. Here’s a breakdown of the available treatments:

Lifestyle Changes: Initially, lifestyle modifications may be recommended, including:
- Pelvic floor muscle exercises to strengthen muscles supporting the bladder and urethra.
- Limiting fluid intake, especially before outings or bedtime.
- Reducing consumption of caffeine and alcohol, which can irritate the bladder.
Medications: For mild to moderate BPH symptoms, medications may be prescribed. These can include:
- Alpha-blockers: Relax muscles in the prostate and bladder, improving urine flow.
- 5-alpha reductase inhibitors: Reduce the size of the prostate gland over time.
- Combination therapy: A combination of medications may be necessary for optimal symptom relief.
Procedures: If lifestyle changes and medications are ineffective, various minimally invasive procedures or surgeries may be considered to alleviate symptoms. These include:
- Transurethral microwave therapy (TUMT), Rezūm, and laser therapy: Minimally invasive procedures that target and remove part of the enlarged prostate using probes or scopes.
- Transurethral resection of the prostate (TURP): A surgical procedure where the doctor removes portions of the prostate gland using a wire loop inserted through a scope.
- Transurethral incision of the prostate (TUIP): Small incisions are made in the prostate to alleviate pressure on the urethra.
- UroLift system: A device implanted to lift and hold enlarged prostate tissue away from the urethra, relieving obstruction.
- Traditional open surgery or robotic-assisted surgery: In some cases, traditional or robotic procedures may be recommended to remove part or all of the prostate gland.

Home Care Tips for Managing Prostate Enlargement/BPH

In addition to medical treatment, individuals with BPH can take steps at home to alleviate symptoms, such as:

Limiting fluids before bedtime to reduce nocturia
Avoiding caffeine and alcohol, which can irritate the bladder
Double voiding to ensure the bladder is fully emptied
Practicing pelvic floor exercises (Kegels) to improve bladder control

Drink or food you can and can’t take if you have BPH

If you have benign prostatic hyperplasia (BPH), making dietary choices that support prostate health can be beneficial. Here are some foods to include in your diet:

Berries: Blueberries, strawberries, and raspberries are rich in antioxidants that may help reduce inflammation and support prostate health.
Broccoli: Cruciferous vegetables like broccoli contain compounds that may have protective effects against prostate enlargement.
Citrus fruits: Oranges, grapefruits, and lemons are high in vitamin C, which is associated with a lower risk of BPH.
Nuts: Almonds, walnuts, and pistachios are good sources of healthy fats, which can support overall prostate health.
Tomatoes: Tomatoes contain lycopene, a powerful antioxidant that may reduce the risk of prostate enlargement.
Turmeric: This spice contains curcumin, which has anti-inflammatory properties and may help alleviate BPH symptoms.

Following a Mediterranean diet, which emphasizes fruits, vegetables, whole grains, and healthy fats like olive oil, may also be beneficial for prostate health.

Conversely, certain dietary choices may exacerbate BPH symptoms. It’s advisable to limit or avoid:

Processed foods: These often contain high levels of unhealthy fats, sugars, and additives that can worsen inflammation.
Sugars and large amounts of carbohydrates: These can lead to spikes in blood sugar levels, which may negatively impact prostate health.
Alcohol: Alcohol can irritate the bladder and worsen urinary symptoms associated with BPH.
Caffeine: Caffeinated beverages like coffee and tea can increase urinary frequency and urgency.
Dairy: Some studies suggest that high dairy consumption may be associated with an increased risk of BPH.
Red meat: Red meat is high in saturated fats, which may contribute to inflammation and prostate enlargement.
Sodium (salt): Excessive sodium intake can lead to fluid retention and may worsen urinary symptoms.

Complications

While these treatments can effectively relieve BPH symptoms, they may be associated with potential side effects or complications, including:

Bleeding
Urethral stricture (narrowing of the urine tube)
Urinary incontinence
Erectile dysfunction
Retrograde ejaculation

It’s important to note that BPH itself does not increase the risk of prostate cancer, and treatment for BPH does not make an individual more susceptible to developing prostate cancer.

Prevention of Prostate Enlargement/BPH

Reducing the risk of developing benign prostatic hyperplasia (BPH) involves adopting healthy lifestyle habits and considering certain supplements. Here’s what you can do to potentially lower your risk:

Regular Exercise: Engage in at least 30 minutes of physical activity daily. Exercise can help prevent BPH or slow the growth of the prostate. Additionally, maintaining a healthy weight through regular exercise can benefit both prostate and heart health.
Eating Balanced diet: Eating a balanced diet rich in fruits, vegetables, and whole grains
Maintain Heart Health: Keep your cholesterol, blood pressure, and blood sugar levels within normal ranges. These factors not only contribute to heart health but may also influence the development of BPH.
Herbal Supplements: Consider incorporating certain herbal supplements into your routine, which may help reduce the risk of BPH:
- Beta-sitosterol: Found in plants, beta-sitosterol is a micronutrient that supports heart health and may have a beneficial effect on the prostate.
- Pygeum africanum: Derived from the bark of the African cherry tree, pygeum africanum extract is believed to have properties that can shrink the prostate gland.
- Flaxseed: Flaxseed is rich in dietary fiber and omega-3 fatty acids, which can help lower cholesterol levels and potentially reduce the risk of BPH.
- Pumpkin seed oil: Extracted from pumpkin seeds, pumpkin seed oil is thought to possess properties that may aid in shrinking the prostate.

It’s crucial to consult with your healthcare provider before starting any new supplements. They can advise you on potential interactions with other medications or supplements you’re taking and ensure that they are safe for you.

FAQs

Who is at risk of developing BPH?

Benign prostatic hyperplasia (BPH) primarily affects individuals assigned male at birth (AMAB), as they possess a prostate gland. Nearly all individuals with a prostate will experience some degree of prostate enlargement as they age. Therefore, BPH is exceedingly common among this demographic.

Does Prostrate enlargement increase your risk of developing prostate cancer?

Having benign prostatic hyperplasia (BPH) does not increase the risk of developing prostate cancer. However, it’s important to note that BPH and prostate cancer can share similar symptoms. Additionally, individuals with BPH may have undetected prostate cancer concurrently.

To aid in the early detection of prostate cancer, it’s recommended that individuals with a prostate undergo regular prostate screenings. For most individuals, annual prostate screenings are advised between the ages of 55 and 69. However, those at an increased risk of prostate cancer, such as Black individuals or those with a family history of the disease, should consider starting screenings earlier, typically at age 40.

Regular prostate screenings, which may include a prostate-specific antigen (PSA) blood test and a digital rectal exam (DRE), are essential for detecting prostate cancer in its early stages when treatment is most effective. If you fall into a high-risk category for prostate cancer, discuss with your healthcare provider about the appropriate timing and frequency of screenings tailored to your individual risk factors.

Can an enlarged prostrate shrink back to normal?

For some individuals with mild benign prostatic hyperplasia (BPH), it’s possible for symptoms to improve or even resolve without intervention. This phenomenon is observed in a subset of patients who opt for a watchful waiting approach.

During watchful waiting, individuals and their healthcare providers closely monitor symptoms and prostate health without initiating immediate treatment. If symptoms persist or worsen over time, discussions about treatment options can then be initiated.

When to See a Doctor

It’s essential to consult a healthcare provider if you experience urinary symptoms that interfere with daily life or if you notice any changes in urinary habits. Prompt evaluation can help diagnose BPH and initiate appropriate treatment to manage symptoms effectively.

Outlook/Prognosis

With proper management, the outlook for individuals with BPH is generally favorable. Many treatment options are available to alleviate symptoms and improve quality of life. However, BPH is a chronic condition that may require ongoing management and monitoring to prevent complications and ensure optimal urinary health.

Sources

Mayo Clinic. (2022). Benign Prostatic Hyperplasia (BPH).
National Institute of Diabetes and Digestive and Kidney Diseases. (2017). Prostate Enlargement (Benign Prostatic Hyperplasia).
American Urological Association. What is Benign Prostatic Hyperplasia (BPH)?
Prostate Cancer Foundation. BPH
Radiological Society of North America. BPH