- Aging: BPH rarely causes symptoms before age 40, but more than half of men in their 60s and up to 90% in their 70s and 80s have some symptoms of BPH.
- Hormonal Changes:
- Dihydrotestosterone (DHT): A powerful male hormone that stimulates prostate growth. Even with declining testosterone levels as men age, DHT levels remain high or even increase in the prostate, contributing to its enlargement.
- Estrogen: As men age, the proportion of estrogen relative to testosterone increases, which may also play a role in prostate cell growth.
- Family History: Having a close relative (father or brother) with BPH increases your risk.
- Testicular Function: Men who have had their testicles removed at a young age (before puberty) do not develop BPH, suggesting a role for testicular hormones.
- Chronic Medical Conditions: Conditions like heart disease, circulatory disease, and diabetes may be associated with an increased risk, though the link is not fully clear.
- Obesity: Some studies suggest a correlation between obesity and an increased risk of BPH.
- Frequent or Urgent Need to Urinate: Especially at night (nocturia).
- Difficulty Starting Urination: Hesitancy.
- Weak Urine Stream: Or a stream that stops and starts.
- Dribbling at the End of Urination.
- Inability to Completely Empty the Bladder: Leading to residual urine.
- Straining During Urination.
- Painful Urination (Dysuria): Less common, but can occur with complications like infection.
- Blood in the Urine (Hematuria): Also less common, but can be a sign of complications.
- Urinary Tract Infections (UTIs): Due to incomplete bladder emptying.
- Acute Urinary Retention: A sudden inability to urinate, which is a medical emergency.
- Medical History: The doctor will ask about your urinary symptoms, their severity, duration, and impact on your quality of life. They will also inquire about any other medical conditions or medications.
- Digital Rectal Exam (DRE): The doctor inserts a gloved, lubricated finger into the rectum to feel the prostate gland. This allows them to assess its size, shape, and consistency, and check for any abnormal areas.
- Urine Test (Urinalysis): To check for infection, blood, or other abnormalities in the urine.
- Blood Test (Prostate-Specific Antigen - PSA): PSA is a protein produced by prostate cells. Elevated PSA levels can indicate BPH, prostate cancer, prostatitis, or other prostate conditions. While not diagnostic for cancer, it's used as a screening tool.
- Urinary Flow Test (Uroflowmetry): You urinate into a special device that measures the speed and volume of your urine flow. A reduced flow rate can indicate an obstruction.
- Post-Void Residual (PVR) Volume Test: Measures the amount of urine remaining in your bladder after you urinate, usually with an ultrasound or catheter. High residual volume suggests incomplete emptying.
- Urodynamic Studies: A series of tests that evaluate bladder and urethra function, often used for more complex cases.
- Cystoscopy: A thin, flexible scope is inserted into the urethra and bladder to visualize the urinary tract and prostate.
- Prostate Biopsy: If there are concerns about prostate cancer (e.g., very high PSA or abnormal DRE), a biopsy may be performed to obtain tissue samples for microscopic examination.
- Watchful Waiting: For mild symptoms that are not bothersome. Involves regular check-ups and monitoring of symptoms without immediate intervention.
- Lifestyle Changes:
- Reduce fluid intake: Especially before bedtime or going out.
- Avoid caffeine and alcohol: These can irritate the bladder and increase urine production.
- Avoid decongestants and antihistamines: Can worsen urinary symptoms by constricting the urethra.
- Timed voiding: Urinate on a schedule, even if you don't feel the urge.
- Double voiding: Urinate, wait a few minutes, then try to urinate again to fully empty the bladder.
- Exercise regularly: Can help manage symptoms.
- Medications:
- Alpha-Blockers: Relax muscles in the prostate and bladder neck, making it easier to urinate. Examples include tamsulosin (Flomax), alfuzosin (Uroxatral), silodosin (Rapaflo), and doxazosin (Cardura).
- 5-alpha Reductase Inhibitors: Shrink the prostate gland by blocking the production of DHT. Examples include finasteride (Proscar) and dutasteride (Avodart). These take longer to work (up to 6 months) and are often used for larger prostates.
- Combination Therapy: Often, alpha-blockers and 5-alpha reductase inhibitors are used together for better symptom relief and to reduce BPH progression.
- PDE5 Inhibitors: Tadalafil (Cialis) is approved to treat BPH symptoms and erectile dysfunction.
- Minimally Invasive Procedures:
- Transurethral Microwave Therapy (TUMT): Uses microwave heat to destroy excess prostate tissue.
- Transurethral Needle Ablation (TUNA): Uses low-level radiofrequency energy delivered by needles to burn away prostate tissue.
- Prostatic Urethral Lift (PUL or UroLift): Implants are used to hold open the enlarged prostate lobes, relieving compression on the urethra.
- Water Vapor Thermal Therapy (Rezum): Uses steam to destroy obstructive prostate tissue.
- Prostate Artery Embolization (PAE): Blocks blood flow to the prostate, causing it to shrink.
- Surgical Procedures:
- Transurethral Resection of the Prostate (TURP): The most common surgical procedure for BPH. A scope is inserted into the urethra, and excess prostate tissue is removed piece by piece.
- Transurethral Incision of the Prostate (TUIP): Small incisions are made in the prostate gland and bladder neck to widen the urethra.
- Laser Surgery: Uses various types of lasers (e.g., HoLEP, PVP, GreenLight) to vaporize or remove obstructive prostate tissue.
- Open Prostatectomy (Simple Prostatectomy): For very large prostates, involves an incision in the abdomen to remove the inner part of the prostate.