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Alternative Names Return to topBPH; Benign prostatic hypertrophy (hyperplasia); Prostate - enlarged
Definition Return to top
The prostate is a male reproductive gland that produces the fluid that carries sperm during ejaculation. It surrounds the urethra, the tube through which urine passes out of the body.
An enlarged prostate means the gland has grown bigger. Prostate enlargement happens to almost all men as they get older. As the gland grows, it can press on the urethra and cause urination and bladder problems.
An enlarged prostate is often called benign prostatic hyperplasia (BPH) or benign prostatic hypertrophy. It is not cancer, and it does not raise your risk for prostate cancer.
Causes Return to top
The actual cause of prostate enlargement is unknown. It is believed that factors linked to aging and the testicles themselves may play a role in the growth of the gland. Men who have had their testicles removed at a young age (for example, as a result of testicular cancer) do not develop BPH.
Similarly, if the testicles are removed after a man develops BPH, the prostate begins to shrink in size.
Some facts about prostate enlargement:
Symptoms Return to top
Less than half of all men with BPH have symptoms of the disease, which include:
Exams and Tests Return to top
After taking a complete medical history, your doctor will perform a digital rectal exam to feel the prostate gland. The following tests may also be performed:
In addition, you may be asked to complete a form to evaluate the severity of your symptoms and their impact on your daily life. Your score may be compared to past records to determine if the condition is getting worse.
Treatment Return to top
The choice of a treatment is based on the severity of your symptoms, the extent to which they affect your daily life, and the presence of any other medical conditions. Treatment options include "watchful waiting," lifestyle changes, medication, or surgery.
If you are over 60, you are more likely to have symptoms. But many men with an enlarged prostate have only minor symptoms. Self-care steps are often enough to make you feel better.
If you have BPH, you should have a yearly exam to monitor the progression of your symptoms and determine if any changes in treatment are necessary.
For mild symptoms:
Many herbs have been tried for treating an enlarged prostate. Saw palmetto has been used by millions of men to ease BPH symptoms and is often recommended as an alternative to medication. Some studies have shown that it helps with symptoms, but there is evidence that this popular herb is no better than a dummy pill in relieving the signs and symptoms of BPH. Further studies are needed. If you use saw palmetto and think it works, ask your doctor if you should still take it.
Prostate surgery may be recommended if you have:
The choice of a specific surgical procedure is usually based on the severity of your symptoms and the size and shape of your prostate gland.
Most men who have prostate surgery have improvement in urine flow rates and symptoms. See prostate removal for a description of complications.
Other, less invasive procedures are available. These use different forms of heat to destroy prostate tissue, including:
None of these techniques have been proven to better than TURP. Patients who receive these less-invasive procedures are more likely to need surgery again after 5 or 10 years. However, these procedures may be a choice for:
Robot-guided prostatectomy is another newer technique. However, the technology is not widely available, and surgeon experience should be taken into consideration. In addition, there are no long-term studies of this surgery.
Another form of treatment is prostatic stents.
For more information, see prostate surgery.
Support Groups Return to top
See: BPH support groups
Possible Complications Return to top
Men who have had long-standing BPH with a gradual increase in symptoms may develop:
Even after surgical treatment, a recurrence of BPH may develop over time.
When to Contact a Medical Professional Return to top
Call your doctor right away if you have:
Also call your doctor if:
References Return to top
Bent S, Kane C, Shinohara K, et. al. Saw palmetto for benign prostatic hyperplasia. NEJM. 2006; 354:557-566.
Kirby R, Lepor H. Evaluation and Nonsurgical Management of Benign Prostatic Hyperplasia. In: Wein AJ, Kavoussi LR, Novick AC, Partin AW, Peters CA, eds. Campbell-Walsh Urology. 9th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 87.
Roehrborn CG, Siami P, Barkin J, Damiao R, Major-Walker K, Morrill B, et al. The effects of dutasteride, tamsulosin, and combination therapy on lower urinary tract symptoms in men with benign prostatic hyperplasia and prostatic enlargement. 2-year results from the CombAT study. J Urol. 2008;179:616-621.
Roehrborn CG, McConnell JD. Benign Prostatic Hyperplasia: Etiology, Pathophysiology, Epidemiology, and Natural History. Wein AJ, Kavoussi LR, Novick AC, Partin AW, Peters CA, eds. Campbell-Walsh Urology. 9th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 86.
Rich KT, Safranek S. PPIN's clinical inquiries. Medical treatment of benign prostatic hyperplasia. Am Fam Physician. 2008;77:665-666.Update Date: 9/7/2008 Updated by: Louis S. Liou, MD, PhD, Assistant Professor of Urology, Department of Surgery, Boston University School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.