Benign Prostatic Hyperplasia (BPH)

Benign prostatic hyperplasia (BPH) is an enlargement of the prostate gland. It commonly occurs as men age. It can contribute to bothersome lower urinary tract symptoms (LUTS).

The prostate goes through two main growth cycles during a man’s life. The first occurs early in puberty, when the prostate doubles in size. The second phase of growth starts around age 25 and goes on for most of the rest of a man’s life. BPH most often occurs during this second growth phase.

As the prostate enlarges, it presses against the urethra. The bladder wall becomes thicker. One day, the bladder may weaken and lose the ability to empty fully, leaving some urine in the bladder. Narrowing of the urethra and urinary retention – being unable to empty the bladder fully – cause many of the problems of BPH.

BPH is benign. This means it is not cancer. It does not cause or lead to cancer. However, BPH and cancer can happen at the same time.

BPH is common. About half of all men between ages 51 and 60 have BPH. Up to 90% of men over age 80 have it.

The prostate is part of the male reproductive system. It is about the size of a walnut and weighs about an ounce. The prostate is found below the bladder and in front of the rectum. It goes all the way around a tube called the urethra, which carries urine from the bladder out through the penis.

The prostate’s main job is to make fluid for semen. During ejaculation, sperm made in the testicles moves to the urethra. At the same time, fluid from the prostate and the seminal vesicles also moves into the urethra. This mixture – semen – goes through the urethra and out through the penis.

When the prostate is enlarged, it can bother or block the bladder. See the symptoms of BPH here.

A detailed medical history including surveys such as the American Urological Association (AUA) Symptom Score are the most important diagnostic tool. A digital rectal exam to feel the size and texture of the prostate is also important. In addition, a urinary flow rate and the amount of urine left in the bladder after urinating (post-void residual) can be useful diagnostic tools. A urinalysis to rule out infection or possible bladder tumor as the cause of symptoms is performed and a prostate specific antigen (PSA) will often be checked to screen for prostate cancer. If these tests are non-conclusive or if surgery is planned to treat BPH, urodynamics, cystoscopy, or prostate ultrasound may be utilized.