Benign Prostatic Hyperplasia, Causes, Symptoms and Treatment Options prostatic hyperplasia

Benign prostatic hyperplasia (BPH) is a condition that leads to an enlarged prostate. It is a common issue among men as they get older with symptoms such as difficulty urinating and a sudden urge to urinate. Treatments range from medications and surgery to minimally invasive procedures.

What is Benign Prostatic Hyperplasia?

CDR462221 benign prostatic hyperplasia

Benign prostatic hyperplasia (BPH) involves the enlargement of the prostate gland. The prostate is a gland about the size of a walnut that encircles part of the urethra, located below the bladder and in front of the rectum. The urethra is a tube that transports urine and sperm out of the body. However, an enlarged prostate can obstruct the flow of urine and sperm through the urethra. While BPH is not cancerous, its symptoms can be similar to more serious conditions, including prostate cancer.

Does Benign Prostatic Hyperplasia Increase the Risk of Prostate Cancer?

Studies indicate that having BPH does not raise the likelihood of developing prostate cancer. However, the symptoms of BPH and prostate cancer can overlap. It’s possible to have undiagnosed prostate cancer alongside BPH.

To detect prostate cancer early, it’s recommended that everyone with a prostate disorder undergo annual prostate screenings from ages 55 to 69. Individuals at higher risk for prostate cancer, such as those with a family history of the disease, should start screenings at age 40.

Who is Affected by Benign Prostatic Hyperplasia?

BPH is a common prostate issue in males. Nearly all individuals with a prostate will experience some enlargement as they age. Benign prostatic hyperplasia is quite common with 50% of men acquiring the condition by the age of 60. By the age of 85, about 90% will display signs of the condition. Approximately half of all individuals with BPH will develop symptoms requiring treatment.

Signs and Symptoms of Benign Prostatic Hyperplasia?

The prostate surrounds the urethra. When BPH causes the prostate to enlarge, it can lead to a blockage in the urethra. Early symptoms of BPH include:

  • Slow or dribbling urine flow.
  • Difficulty starting urination.
  • Leakage (incontinence).
  • Changes in urine color.
  • Foul-smelling urine.
  • Urgent need to urinate.
  • Frequent nighttime urination.
  • Inability to completely empty the bladder.
  • Pain after ejaculation or during urination.

Causes of Benign Prostatic Hyperplasia

The exact cause of BPH is unknown. One theory suggests that as men age, testosterone levels decrease while estrogen levels remain constant, possibly leading to prostate cell growth. However, individuals taking supplemental testosterone may experience the development or worsening of BPH.

Older individuals may also have higher levels of dihydrotestosterone (DHT), a more potent form of testosterone that enlarges the prostate.

What are the Consequences of Leaving an Enlarged Prostate Untreated?

If left untreated, BPH can lead to further blockage in the urethra and worsening symptoms. It can also result in:

  • Bladder stones.
  • Blood in the urine (hematuria).
  • Urinary tract infections (UTIs).
  • Kidney damage due to urine backflow from the bladder to the kidney increases pressure on the kidney.

BPH is not contagious and cannot be spread to others.

Diagnosing BPH

To diagnose BPH, the urologist will review your medical history, ask you a few questions, and conduct a physical examination, which includes a digital rectal exam.

In a digital rectal exam, the urologist gently inserts a gloved finger into your rectum to feel your prostate’s edges and surface, estimate its size, and check for any hard areas that might indicate cancer.

Additional tests may include:

  • An ultrasound to determine how much urine remains in your bladder after urinating.
  • A urine flow test to check and record the speed of your urine stream.
  • A cystoscopy to examine your bladder.
  • A questionnaire to assess symptom severity.

Management and Treatment of Benign Prostatic Hyperplasia:

While there is no cure for BPH, various treatment options can relieve symptoms. If your symptoms are mild, you might not need treatment. Your urologist may suggest “watchful waiting,” with regular check-ups to monitor your condition.

However, standard treatment options include:


Common medications like alpha blockers relax your prostate muscle, easing pressure on your urethra. These include medications containing:

  • Terazosin 
  • Doxazosin 
  • Tamsulosin 
  • Alfuzosin 
  • Silodosin 

Other medications like 5-alpha reductase inhibitors reduce the hormone DHT production, slowing prostate growth or shrinking the prostate. These are especially helpful for those with larger prostates, such as:

  • Finasteride 
  • Dutasteride 

Some medications, like dutasteride and tamsulosin, combine treatments to ease symptoms and improve urine flow. They might take up to six months to work well and can cause sexual side effects


Various surgical procedures can remove prostate tissue obstructing your urethra, including:

GreenLight laser treatment: Involves using a laser to evaporate enlarged prostate tissue, also known as photoselective vaporization of the prostate (PVP) or prostate photo vaporization.

Transurethral electrovaporization: Using an electrode to heat and vaporize prostate tissue.

Transurethral resection of the prostate (TURP): Inserting a resectoscope through your urethra to remove prostate tissue.

Transurethral incision of the prostate (TUIP): Making small incisions in your prostate and bladder neck to widen your urethra.

Aquablation: Using high-pressure water jets to remove prostate tissue.

You should be able to return to normal activities within a few days to a week after surgery.

New Minimally Invasive Treatments

New treatments for BPH are less invasive and harm healthy tissue less than surgery. Generally, these treatments are outpatient procedures, allowing you to return home on the same day. They are typically more affordable, have fewer side effects, and require a shorter recovery period. However, because they are new treatment methods, there is limited long-term data on their effects and potential complications.

Examples of minimally invasive treatments include:

Prostatic Urethral LiftThis procedure widens your urethra by separating the enlarged prostate lobes. A special instrument (UroLift) is inserted into the urethra and up to the prostate. Tiny implants are then ejected to pull the prostate lobes apart, opening the urethra. The number of implants used depends on the prostate’s size.

Rezūm Therapy: An instrument is inserted into the urethra and positioned at the prostate. A needle is then ejected into the prostate, releasing steam vapor that turns into water. The thermal energy from the water destroys prostate cells, which are then reabsorbed by the body, reducing prostate size.

Common side effects of these treatments include increased urination frequency and discomfort or irritation during prostate healing. After a minimally invasive procedure, normal activities can usually be resumed within a few days, with symptom improvements expected within three to six weeks.

Best Treatment for Benign Prostatic Hyperplasia

TURP is considered the most effective treatment for most BPH cases. For adults aged 65 and older, medications and minimally invasive treatments are often preferred due to the higher risk of complications and longer recovery time associated with surgery in this age group.

Dietary Considerations for Benign Prostatic Hyperplasia

A diet rich in fruits, vegetables, and healthy fats may benefit prostate health. Following the Mediterranean diet or incorporating more berries, broccoli, citrus, nuts, tomatoes, and turmeric into your meals is recommended.

To avoid worsening BPH symptoms, it’s advisable to limit processed foods, sugars, and high carbohydrate intake, as well as:

  • Dairy
  • Red meat
  • Sodium (salt)
  • Caffeine
  • Alcohol

Can an Enlarged Prostate Return to Normal?

In some cases of mild BPH, symptoms have resolved without treatment. Discussing treatment options with your doctor or a urologist is essential if symptoms persist during a watchful waiting approach.

Reducing the Risk of Developing Benign Prostatic Hyperplasia

To lower your risk of BPH, focus on lifestyle changes that benefit your prostate and heart health, and consider taking supplements. Exercising for at least 30 minutes daily can help prevent BPH or slow its progression. Keeping cholesterol, blood pressure, and blood sugar levels in check is also crucial.

Herbs and  Supplements that May Reduce BPH Risk Include

Pumpkin seed oil: Derived from pumpkin seeds, it may assist in shrinking the prostate.

Saw Palmetto: Some studies show that saw palmetto might have properties to manage prostate enlargement

Pygeum africanum: An African cherry tree bark extract that may help reduce prostate size.

Zinc: The prostate gland stores zinc, which not only prevents prostate enlargement but may also help to shrink a prostate gland that’s already swollen.

Consult your doctor or urologist before starting any new supplements, as they could interact with other medications or supplements, you’re taking.

Outlook and Prognosis for Benign Prostatic Hyperplasia

The outlook for individuals with BPH is generally positive. Although there’s no cure, various treatments can alleviate symptoms. Mild cases may not need treatment, while medications, surgery, and minimally invasive procedures can manage more severe symptoms.

Living with Benign Prostatic Hyperplasia

Consult your doctor or urologist if you experience:

  • Blood in your urine.
  • Difficulty urinating or complete inability to urinate.
  • Pain in the lower abdomen or genitals while urinating.
  • Fever or chills during urination.

Consider asking a doctor or urologist:

  • How to reduce prostate size?
  • How is BPH diagnosed?
  • If it’s not BPH, what else could it be?
  • What are the treatment options for you?
  • When to consult a urologist?
  • What supplements do you recommend, and will they interact with any current medications or other supplements?

Benign prostatic hyperplasia (BPH) commonly affects individuals assigned male at birth and typically develops around age 55. If your BPH is mild, you and your doctor may opt to monitor your symptoms with regular check-ups. If BPH impacts your quality of life, treatments are available to reduce prostate size. If you experience BPH symptoms, talk to your doctor or a urologist to determine the best course of action.