Enlarged prostate is one of the top health concerns for men over the age of 60.
Normally the size and shape of a walnut, the prostate gland usually starts to become larger when men get into their early forties. It’s a process that occurs naturally with age that’s not reversible. Located between the bladder and the penis, the prostate produces the seminal fluid that travels through the urine tube (urethra).
While an enlarged prostate (benign prostatic hyperplasia or BPH) can still function normally, it can narrow the urethra or press on the bladder muscle and make it more sensitive. Men with problems related to an enlarged prostate are usually referred to a urologist to determine appropriate ways to treat issues related to this gland’s change in size.
Causes and Contributing Factors
An enlarged prostate is associated with aging. Having a family history of prostate enlargement also increases the risk of developing BPH. The prostate grows larger due to an increase in the production rate of cells (hyperplasia). It’s not clear why this happens. It’s believed certain changes with hormones may be involved. Kidney stones, scarring in part of the bladder after surgery, and prostate inflammation (prostatitis) may also contribute to BPH.
Symptoms Suggesting an Enlarged Prostate
The bladder usually makes an effort to compensate for an enlarged prostate. But if the urethra becomes severely compressed, bladder function may be affected. BPH may also cause recurring urinary tract infections, kidney problems, and urine blockages. The size of the prostate doesn’t correlate to the severity of symptoms. Men with a prostate that’s only slightly enlarged may have more related issues than someone with a gland that’s significantly enlarged. Symptoms associated with BPH, which usually become more noticeable over time, include:
- Frequent urination, oftentimes at night
- Weak urine stream
- Urine leakages
- Blood in urine
- Trouble starting to urinate
Since the symptoms often associated with an enlarged prostate may be related to other problems, diagnosis typically involves blood and urine tests, a urinary flow test, and a digital rectal exam to feel if the prostate is enlarged. A prostate-specific antigen (PSA) blood test may also be done since PSA levels increase when a prostate is enlarged. Patients are sometimes asked to keep a diary for 24 hours to document urination frequency and amount of urine produced. In some situations, a prostate biopsy may be done to rule out prostate cancer.
Enlarged Prostate Treatment
Treatment will depend on the size of the enlargement, overall health, and the severity of symptoms experienced. The most common treatment is medication that often includes alpha blockers, 5-alpha reductase inhibitors, or a combination of these two medications (combination drug therapy). If symptoms become increasingly disruptive or urine flow is blocked and medication isn’t effective, surgery may be recommended. Procedures that may be performed include:
- Minimally invasive procedures to remove tissues and ease pressure on the bladder
- Embolization to block the blood supply to the prostate to reduce its size
- Open or robot-assisted surgery to remove all or part of the prostate (prostatectomy)
- Laser therapy to remove excess tissue in the prostate
- Prostate lift to increase urine flow by compressing the sides of the prostate
- Rezūm uses the stored thermal energy in water vapor (steam) to treat the extra prostate tissue that is causing symptoms
Prostate enlargement isn’t usually something that’s preventable. Some men may be able to manage symptoms associated with BPH with lifestyle changes that include managing stress, maintaining a healthy weight, eating more vegetables and low-fat foods, avoiding red meat and sugary and salty foods, and getting regular exercise. When issues with urination become noticeable, a urologist can determine if it’s due to an enlarged prostate or a problem with other structures in this area such as the kidneys, bladder, or urinary tract.