About Enlarged prostate

An enlarged prostate, termed benign prostatic hyperplasia (BPH), describes a non-cancerous growth in the size of the prostate gland. Located between the bladder and penis in the pelvic region, an expanding prostate may compress the bladder and urethra, causing problems with urination and ejaculation. 

While the precise cause remains unclear, BPH is commonly linked to aging and hormonal shifts, specifically reduced testosterone and elevated dihydrotestosterone (DHT) levels. Lifestyle factors and heredity may also influence its onset. If left unmanaged, BPH can result in complications such as bladder stones, urinary infections, hematuria, and potential kidney damage.

Enlarged Prostate Symptoms :

Common symptoms of an enlarged prostate include:

• Increased Urinary Frequency: More frequent trips to the restroom
• Difficulty Starting Urination: Discomfort or struggle when initiating urination
• Weak Urinary Stream: Noticeable reduction in the strength of the urine flow
• Interrupted Urination: Inconsistency in urine flow during urination
• Frequent Nighttime Urination: Repeatedly waking up at night to urinate
• Urinary Incontinence: Unintentional urine leakage due to loss of bladder control
• Post-Ejaculation Pain: Discomfort or pain after ejaculation
• Painful Urination: Stinging or burning sensation during urination
• Urinary Retention: Inability to completely empty the bladder

In cases of mild symptoms from an enlarged prostate, immediate medical treatment may not be necessary; instead, lifestyle adjustments, like adopting a prostate-friendly diet, are often sufficient to manage symptoms and promote prostate health. For more severe symptoms, a combination of medical treatments and lifestyle changes might be required. Regardless of the chosen BPH treatment, urologists recommend that patients adhere to dietary guidelines to aid in their recovery and support long-term prostate health..

Enlarged Prostate Causes :

Hormonal Changes

Hormonal shifts play a central role in the development of an enlarged prostate, a condition known as benign prostatic hyperplasia (BPH). As men age, their hormone levels undergo significant changes that can stimulate prostate tissue growth. Specifically:

• Increase in Dihydrotestosterone (DHT): DHT, a potent derivative of testosterone, is produced by the enzyme 5-alpha-reductase in the prostate. With age, even though total testosterone levels may decline, DHT levels often remain high or increase relative to other hormones. DHT binds to androgen receptors in prostate cells, promoting cell proliferation and leading to glandular and stromal tissue overgrowth. This hormonal trigger is a key driver of BPH.
• Testosterone-Estrogen Imbalance: In younger men, testosterone dominates, while estrogen (produced in small amounts via aromatization of testosterone) remains low. As men age, testosterone production decreases, but estrogen levels may stay stable or rise due to increased fat tissue (which converts testosterone to estrogen). This relative increase in estrogen can enhance the sensitivity of prostate tissue to DHT, further encouraging growth. The interplay between these hormones disrupts the prostate’s normal regulation, causing it to enlarge over time.
• Other Hormonal Factors: Aging also affects growth factors and inflammatory pathways tied to hormonal signaling. For example, insulin-like growth factor (IGF) and chronic low-grade inflammation may amplify the effects of DHT, contributing to progressive prostate enlargement.

This hormonal cascade doesn’t happen overnight—it’s a gradual process, often starting in a man’s 30s or 40s, with symptoms becoming noticeable later in life.

Enlarged Prostate Risk Factors :

Age is the most significant and well-established risk factor for developing an enlarged prostate, with the prevalence of BPH rising sharply as men get older:

• Age Threshold: Men over 50 are at notably higher risk, and the likelihood climbs with each decade. Studies show that about 50% of men in their 50s have some degree of prostate enlargement, increasing to 70-80% by age 70, and up to 90% by age 85. Most symptomatic cases emerge after 50, making it a hallmark of aging in men.
• Why Age Matters: The prostate grows in two phases first during puberty, then again starting in the mid-20s to 30s due to hormonal shifts. This second, slower growth phase accelerates with age as DHT accumulates and hormonal balance tilts. Over decades, this leads to a larger prostate that can press on the urethra, causing urinary symptoms like weak flow or frequent urination.
• Cumulative Exposure: Aging exposes the prostate to prolonged hormonal and environmental influences (e.g., diet, inflammation), compounding the risk. Unlike acute conditions, BPH is a chronic, progressive process tied to the natural wear of time.

Not Universal: While age increases risk, not all men develop symptomatic BPH genetics, lifestyle, and overall health also play roles, but age remains the strongest predictor.

Complications of BPH :

If untreated, an enlarged prostate can lead to serious complications by obstructing urine flow or straining the urinary system:

• Urinary Retention: The prostate’s pressure on the urethra can block urine outflow, causing acute urinary retention (sudden inability to urinate)—a painful emergency requiring catheterization—or chronic retention, where the bladder never fully empties, raising infection risk.
• Bladder Damage: Incomplete emptying over time weakens the bladder muscle, reducing its ability to contract effectively. This can lead to a distended, flabby bladder that worsens urinary symptoms.
• Urinary Tract Infections (UTIs): Stagnant urine in the bladder breeds bacteria, increasing UTI frequency. Recurrent infections may spread to the kidneys if severe.

Bladder Stones: Concentrated urine from poor emptying can crystallize into stones, causing pain, bleeding, or further obstruction.

Enlarged Prostate Diagnosis & Treatment:

Medical History Review:

• Doctor asks about symptoms (e.g., difficulty urinating, frequent urination, weak stream), medical history, and family history of prostate issues.

Symptom Assessment:

• Often uses the International Prostate Symptom Score (IPSS), a questionnaire to evaluate the severity of urinary symptoms.

Physical Examination:

• Digital Rectal Exam (DRE): Doctor manually checks the prostate through the rectum to assess its size, shape, and consistency.

Urine Test (Urinalysis):

• Analyzes a urine sample for signs of infection, blood, or other abnormalities that might

Blood Test:

• Prostate-Specific Antigen (PSA) Test: Measures PSA levels; elevated levels may indicate BPH, inflammation, or rule out prostate cancer.

Urine Flow Test (Uroflowmetry):

• Measures the speed and volume of urine flow to assess if the enlarged prostate is obstructing the urethra.

Post-Void Residual Volume Test:

• Uses ultrasound or a catheter to check how much urine remains in the bladder after urination, indicating obstruction severity.

Imaging Tests (if needed):

• Ultrasound: Visualizes the prostate and bladder to confirm enlargement or detect complications.
• CT/MRI: Rarely used, but may help in complex cases to rule out other conditions.

Cystoscopy (optional):

• A scope inserted through the urethra examines the bladder and prostate for blockages or structural issues.

Enlarged Prostate Treatment :

The doctor might opt for enlarged prostate or BPH medications for the followings reasons:

• Your symptoms are moderate and they are getting worse instead of getting better.
• Adoption of lifestyle changes didn’t show any results.

Your BPH might be causing complications.

The doctor might suggest one of the following categories of BPH Drugs to treat your symptoms. It is advisable to take these drugs only if your doctor prescribes you to take them.

Doctors use Alpha Blockers to relax muscles of the bladder neck muscles and prostate muscles, so that the patient can urinate with ease.

5-alpha reductase inhibitors (5-ARIs) prevent hormonal changes which cause prostate growth. Therefore, they effectively prevent the growth of the prostate. 5-ARIs also help to shrink the prostate.

It is observed that Phosphodiesterase 5 inhibitors (PDE5 inhibitors) are often used to treat erectile dysfunction, improve Benign Prostatic Hyperplasia symptoms and increase flow rate. Therefore, they are sometimes used to treat Prostate Enlargement.

*Consumption of medications under the advice of a doctor only.

Combination Drug Therapy

When neither Alpha Blockers nor 5-alpha reductase inhibitors (5-ARIs) are effective on their own, doctors may recommend using both medications together. This approach, known as Combination Drug Therapy, involves taking both Alpha Blockers and 5-ARIs simultaneously. It can help reduce the need for surgery, but there is a risk that patients may experience side effects from both medications. While this combined treatment can be effective in managing BPH symptoms, the potential side effects should be closely monitored by a healthcare provider.

*Consumption of medications only under the advice of a doctor.

Hormone Reduction Medications

Sometimes, the doctor might prescribe medications that reduce the levels of hormones produced by the prostate gland. These medications may make the prostate smaller and improve urine flow. They also lower the levels of testosterone as a result they may cause side effects like decreased sex drive and impotence.

Antibiotics

Chronic Bacterial Prostatitis is a condition where the prostate gets infected, as a result, you can see swelling, inflammation and frequent Urinary Tract Infections (UTIs). In such a situation, doctors use Antibiotics to improve the symptoms of BPH by reducing the inflammation.

Surgical Management of BPH:

If the symptoms persist even after the medical treatment of BPH, then doctors might opt for surgical intervention. There are multiple minimally invasive and surgical therapies that you can choose from, they are:

1. Transurethral Resection of the Prostate (TURP): Transurethral Resection of the prostate (TURP) is a surgical procedure where the surgeon removes the excess prostate tissue which is blocking the urine flow. After the TURP surgery, the patient will get quick relief from the symptoms. The surgeon might place a catheter to drain your bladder after the surgery which will be removed after a couple of days.

2. Transurethral Incision of the Prostate (TUIP): Unlike in TURP, In TUIP, There is no removal of tissue. In TUIP, the surgeon inserts a combined visual and surgical instrument (Resectoscope) into the urethra through penis. Then the surgeon makes one or two small grooves in the bladder neck area (the area where the prostate connects to the bladder). This relaxes the opening to the bladder hence allowing for urine to pass more easily.

3. Holmium Laser Enucleation of the Prostate (HoLEP): HoLEP offers a less invasive option for treating Benign Prostatic Hyperplasia. It can be successfully used for prostate glands of any size. The surgeon employs a laser to clear the prostate tissue causing blockage. A second instrument is then used to fragment and extract the removed tissue from the body.

4. Urolift: A urologist inserts a small device through the urethra to access the prostate. Tiny implants (typically 2–6, depending on prostate size) are placed to lift and hold the enlarged prostate tissue away from the urethra, opening the urinary passage.

The device is then removed, leaving the implants in place permanently to maintain urine flow.

5. Bladder Neck Incision (BNI) : Used when the prostate enlargement causes significant bladder outlet obstruction, leading to symptoms like difficulty urinating, weak stream, or incomplete bladder emptying.

Often considered for smaller prostates or when preserving sexual function (e.g., ejaculation) is a priority, as it’s less invasive than procedures like TURP (Transurethral Resection of the Prostate).

6. Open Surgery – Prostatectomy: Prostatectomy is a surgical procedure where the surgeon removes a part or all of the prostate. There are two types of prostatectomy, they are simple prostatectomy and radical prostatectomy. Surgeons usually perform Simple Prostatectomy to treat benign conditions like BPH where the surgeon removes a part of the prostate. Whereas in Radical Prostatectomy the surgeon removes the entire prostate gland along with vas deferens and seminal vesicles. Surgeons perform Radical Prostatectomy to treat malignant cancer.

We have covered here all treatment options for BPH. Consult our doctor to know which is the most suitable treatment option for you.