What Is Benign Prostatic Hyperplasia?

Benign prostatic hyperplasia (BPH) is a condition in which a man’s prostate enlarges abnormally due to an overgrowth of prostate tissue.

When the prostate enlarges, it pushes against the urethra and bladder, potentially blocking the flow of urine and causing urinary problems.

Prostate enlargement, however, is not cancerous (it’s “benign”) and is not associated with a higher risk for cancer. But prostate cancer and BPH can occur at the same time.

Prostate enlargement is the most common prostate issue in men over 50. (1,2)

What Is the Prostate Gland?

The prostate gland is part of the male reproductive system. And though it is not essential for survival, it is essential for reproduction.

The prostate gland produces prostatic fluid, which accounts for 20 to 30 percent of the volume of seminal fluid (semen).

Without prostatic fluid, sperm would not function properly — the fluid contains vital enzymes, proteins, and minerals that protect and nourish sperm. (3)

The prostate fluid’s alkalinity also helps sperm survive in the acidic environment of the vagina. (4)

During an orgasm, prostate muscles squeeze the gland’s fluid into the urethra, where it mixes with sperm cells and other semen components. This contraction also helps propel the seminal fluid out of the body. (5)

The prostate goes through two main growth cycles throughout a man’s life. The first occurs in early puberty, during which the prostate doubles in size; and the second begins around age 25 and continues for the rest of a man’s life.

Benign prostatic hyperplasia can occur in either stage of growth, but it most often occurs in the second phase. (2)

The causes of BPH are not well understood, but experts believe they’re related to aging and hormones.

One theory, for example, suggests that the accumulation of high levels of dihydrotestosterone (DHT) — a hormone involved in prostate development and growth — in older men may encourage prostatic cells to continue to grow. Another suggests that a high proportion of estrogen to testosterone (which decreases as men age) may to be blame. (6)

Benign Prostatic Hyperplasia Prevalence and Risk Factors

The risk of BPH increases year by year after a man turns 40, but estimates on the prevalence of BPH among age groups vary.

Twenty percent of men in their fifties have BPH, while 60 percent of men in their sixties have it, and 70 percent of men in their seventies do. (1)

However, the American Society of Andrology states that about 50 percent of men have BPH at age 50 and 90 percent at age 90. (7) A 2017 review of the relevant research, on the other hand, noted that 8 to 60 percent of men have BPH at age 90. (8)

Aside from increased age, risk factors for BPH include:

• Family history of BPH
• Obesity
• Lack of physical activity
• Diabetes and heart disease (9)

Enlarged prostate can cause a number of related lower urinary tract symptoms, most often due to a blocked or pinched urethra or an overworked bladder, which continually attempts to pass urine through the blockage. (6)

These symptoms can include:

• Urgent need to urinate
• Weak or interrupted urine stream
• Difficulty starting urination and needing to push or strain to urinate
• Pain after ejaculation or during urination
• Dribbling after urination
• Urine with an odd color or smell
• Feeling that the bladder is full, even right after urinating
• Urinary incontinence (2,6)
• Erectile dysfunction (13)

By age 55, 25 percent of men experience symptoms related to BPH. By age 80, up to 30 percent of men have symptoms severe enough to require treatment. (10)

Though severe complications are not common, BPH may lead to:

• Acute or chronic urinary retention (inability to completely empty the bladder)
• Bloody urine
• Urinary tract infections
• Bladder or kidney damage
• Bladder stones

Doctors advise men to seek medical care if they experience the above complications. (6)

Diagnosis of BPH begins with your doctor getting your personal and family medical history. Your doctor will inquire about your:

• Symptoms, including when they began and how often they occur
• History of urinary tract infections
• Medication you take
• Liquid drinking habitats, including often you drink caffeine and alcohol
• General medical history, including significant illnesses or surgeries

Next, your doctor will likely give you a physical exam. They will tap your abdomen and groin, look for signs of discharge from your urethra, and assess for swollen or tender groin lymph nodes, and a swollen or tender scrotum.

Your doctor will also likely recommend conducting a digital rectal exam, in which they insert a gloved, lubricated finger into your rectum to feel your prostate. This exam allows a doctor to feel if a prostate is enlarged and potentially discover lumps or bumps that may be associated with prostate cancer.

Your doctor may also order one or more medical tests, such as:

• Urinalysis (urine test) to detect infections
• Urodynamic tests to determine issues with urine flow, pressure in the bladder during urination, and how much urine remains in the bladder after urination
• Prostate-specific antigen (PSA) blood test to detect elevated PSA levels, which may indicate BPH or prostate cancer
• Cystoscopy — in which a tube-like instrument is inserted into the urethra — to detect blockages in the urethra or bladder
• Image tests of the bladder, including ultrasound and magnetic resonance imaging (MRI) (2,6,11)

Depending on the severity of symptoms, there are a variety of ways that BPH can be managed and treated.

Lifestyle Changes for Benign Prostatic Hyperplasia

If you have only very mild symptoms from BPH, your doctor may recommend certain lifestyle changes to manage your BPH. These include:

• Reducing your liquid intake, especially before leaving the house or sleeping
• Avoiding caffeine, alcohol, and certain medication (decongestants, antihistamines, antidepressants, and diuretics) that may make you urinate more
• Training the bladder to keep urine flowing longer
• Exercising your pelvic floor muscles
• Preventing or treating constipation

Some supplements or herbal therapies — like saw palmetto, lycopene, and beta-sitosterol — may also be recommended, but while they’re generally considered safe, the research is mixed as to their effectiveness.

Benign Prostatic Hyperplasia Medication

If you have mild to moderate BPH, your doctor will likely prescribe one or more drugs to stop the growth of or shrink the prostate and reduce symptoms.

Alpha blockers are a type of medication that relax the smooth muscles of the bladder neck and prostate, helping to improve urine flow and reduce blockage. These medicines include alfuzosin (Uroxatral), doxazosin (Cardura), tamsulosin (Flomax), and silodosin (Rapaflo).

Typically prescribed for erectile dysfunction, phosphodiesterase-5 inhibitors like tadalafil (Cialis) can help reduce lower urinary tract symptoms by relaxing smooth muscles.

Another type of drug called 5-alpha reductase inhibitors — such as finasteride (Propecia) and dutasteride (Avodart) — can slow and even reverse prostate growth by blocking the production of DHT. Your doctor may also recommend a combination of an alpha blocker and a 5-alpha reductase inhibitor. (2,6,12)

Procedural and Surgical Benign Prostatic Hyperplasia Treatment Options

If you have moderate to severe BHP, you’re unresponsive to medication, or you have BPH complications, your doctor will likely recommend minimally invasive treatments or surgery.

Minimally invasive procedures, which can destroy enlarged prostate tissue or widen the urethra, include:

• Transurethral microwave thermotherapy
• High-intensity focused ultrasound
• Transurethral electrovaporization
• Water-induced thermotherapy
• Prostatic stent insertion
• Prostatic Urethral Lift (PUL), also known as UroLift
• Transurethral needle ablation (TUNA) (9)

Surgery may be necessary if medication and minimally invasive procedures are ineffective. Surgical procedures for BPH include:

• Transurethral resection of the prostate (TURP)
• Laser surgery
• Open and, more commonly, laparoscopic or robot-assisted prostatectomy
• Transurethral incision of the prostate (TUIP) (2,6,10,12)

There is no definitive way to prevent BPH, but you can potentially reduce your chances of getting it by managing certain BPH risk factors.

For example, remaining active and losing weight may help reduce your chances of getting BPH. Having too much body fat can increase hormone levels, which may stimulate the growth of prostate cells and lead to BPH. (2)

There are recent literature reviews that have found that diet may play a role in the development and prevention of BPH, in addition to being a potential way to reduce worsening for mild BPH.

In summary, they found that eating a lot of fat and red meat or too little protein and vegetables are both associated with an increased risk of BPH. Additionally, eating a Mediterranean diet with ample vegetables, flaxseed, and vitamin D may be associated with a reduced risk of BPH.