Benign prostatic hyperplasia (BPH), also known as benign prostatic hypertrophy, is a non-cancerous enlargement of the prostate, a small gland that encircles the urethra in males and produces a fluid that makes up part of semen. As the volume of the prostate increases, it can put pressure on the urethra, causing a slowdown in the urine stream, hesitancy in urinating, a frequent and urgent need to urinate, and sometimes dribbling of urine at the end of the flow. It can also cause urine retention, which can weaken the bladder muscle and increase the risk of developing a urinary tract infection (UTI) or kidney stones. In severe cases of BPH, urine may back up into and damage the kidneys. Rarely, BPH may prevent a man from urinating at all, a situation that requires immediate medical attention. BPH can also affect sexual functioning, leading to reduced sexual ability, painful orgasm, and impotence.
Benign Prostatic Hyperplasia
Signs and Symptoms
The type and severity of symptoms experienced will vary from man to man and may vary over time. For many men, BPH never progresses beyond a minor to moderate annoyance; for others, it may represent a significant challenge to their quality of life. BPH becomes a very common condition in men as they age. According to the National Association for Continence, about 50% of men will have some degree of BPH by the time they are 60 years old, and up to 90% will be affected by age 85. While BPH does not cause prostate cancer, both may be found together.
Evaluation for BPH involves a discussion of the man's medical and family history, a physical examination, a digital rectal examination (DRE), and an analysis of his symptoms. Laboratory, imaging, and other types of tests may be used to determine the size of the prostate and to rule out other diseases or conditions that may be causing or exacerbating the symptoms.
Laboratory tests may include:
- Prostate specific antigen (PSA) – a test that measures the level of PSA, a protein produced by prostate cells, in the blood; it is often elevated in men with prostate cancer but can also be elevated in those with BPH, although levels are usually only slightly elevated. When evaluating the results, the doctor must consider both the concentration of PSA in the blood and the size of the man's prostate; an elevated PSA with a very large prostate is less concerning than the same value when the prostate is only slightly enlarged.
- Urinalysis – a group of tests used to look for signs of a urinary tract infection (UTI)
- Urine culture – another test used to look for indication of a UTI
- Blood urea nitrogen (BUN) and Creatinine – blood tests to evaluate kidney function
Non-laboratory tests may include:
- Ultrasound – to help measure the size of the prostate and evaluate the volume of urine retained in the bladder
- Cystoscopy – an evaluation of the urethra and/or bladder using a thin, flexible scope
- Urine flow and/or pressure studies – to evaluate how fast urine can travel through the urethra and how much pressure is being put on the bladder by urine retention
- Prostate biopsy – collection of one or more small samples of prostate tissue and evaluation of its cellular structure under the microscope for abnormal cells and any signs of prostate cancer
In many cases, treatment for BPH is not necessary. However, because BPH can be progressive, men with this condition should be followed to watch for complications, such as infections and kidney stones. It is recommended that a man consult his doctor if he has bothersome symptoms and immediately if he has blood in his urine, pain during urinating, or cannot urinate.
Treatment options for BPH should be discussed with a urologist and may include surgery or medications.