Enlarged Prostate (BPH):
Symptoms, Diagnosis and Treatment
A common age-related condition that can affect urinary flow, bladder emptying, and quality of life.
Learn about the symptoms of an enlarged prostate (benign prostatic hyperplasia or BPH), how it is assessed, and the treatment options available—from lifestyle changes and medication to minimally invasive BPH treatments and surgery.
Enlarged Prostate at a Glance
- Benign prostatic hyperplasia (BPH) is a non-cancerous enlargement of the prostate gland.
- BPH becomes more common with age and can affect urinary flow and bladder emptying.
- Symptoms may include a weak stream, urinary urgency, frequent urination, and waking at night to pass urine.
- Not all enlarged prostates require treatment.
- Management ranges from lifestyle changes and medication to minimally invasive procedures and surgery.
- Treatment decisions are guided by symptoms, prostate size, bladder function, and individual priorities.
What Is an Enlarged Prostate?
An enlarged prostate, also known as benign prostatic hyperplasia (BPH), is a non-cancerous enlargement of the prostate gland.
The prostate sits below the bladder and surrounds the urethra, the tube that carries urine out of the body. As the prostate enlarges, it may narrow the urethra and affect the normal flow of urine.
BPH is not prostate cancer and does not increase the risk of developing prostate cancer. However, both conditions can occur in the same individual, which is why assessment is important when urinary symptoms develop.
What Causes the Prostate to Enlarge?
The exact cause is not fully understood, but age-related hormonal changes are thought to play an important role.
BPH becomes increasingly common with age. Some men develop only mild enlargement with minimal symptoms, while others experience significant urinary difficulties that affect daily activities and sleep.
Risk factors may include:
- Increasing age
- Family history of prostate enlargement
- Obesity
- Diabetes
- Metabolic syndrome
- Lack of physical activity
What Symptoms Can an Enlarged Prostate Cause?
Symptoms may develop gradually and can vary considerably between individuals.
Common urinary symptoms of BPH include:
- Difficulty starting urination
- Weak urine stream
- Interrupted or stop-start urine flow
- Straining to pass urine
- A feeling that the bladder does not empty completely
- Frequent urination during the day
- Frequent urination at night (nocturia)
- Urgency to urinate
- Urinary leakage associated with urgency
- Dribbling after urination
Some men may also experience recurrent urinary tract infections, bladder stones, blood in the urine, or episodes of urinary retention where they are unable to pass urine.
The severity of symptoms does not always reflect the size of the prostate. A relatively small enlargement may sometimes cause significant symptoms, while a larger prostate may cause surprisingly few problems.
How Is an Enlarged Prostate Assessed?
The aim of assessment is not only to confirm prostate enlargement but also to identify other possible causes of urinary symptoms.
Assessment may include:
Physical Examination
This may include a digital rectal examination (DRE), which allows the prostate to be assessed through the rectum.
Urine Tests
Urine testing may help identify infection, blood in the urine, or other abnormalities.
Blood Tests
A prostate-specific antigen (PSA) blood test may sometimes be recommended depending on age, symptoms, family history, and individual circumstances.
Ultrasound
Ultrasound may be used to assess:
- Prostate size
- Bladder emptying
- Residual urine after urination
- Kidney health
Additional Investigations
In selected cases, further investigations may include:
- Uroflowmetry (urine flow testing)
- Urodynamic studies
- Flexible cystoscopy
- Additional imaging studies
Do All Enlarged Prostates Need Treatment?
No.
Enlarged prostate treatment is guided by symptoms and their impact on quality of life rather than prostate size alone.
Men with mild symptoms that are not affecting quality of life may not require immediate treatment and can often be monitored.
Treatment is generally considered when symptoms become bothersome, complications develop, or bladder emptying becomes impaired.
Lifestyle Measures That May Help
Some men notice improvement with simple lifestyle adjustments, including:
- Reducing evening fluid intake
- Limiting caffeine and alcohol
- Avoiding excessive fluids before bedtime
- Maintaining a healthy weight
- Regular physical activity
- Managing constipation
Lifestyle measures may not eliminate symptoms but can help reduce their impact.
Medications for Enlarged Prostate
Several medications may help relieve symptoms. Medication is often the first step in BPH treatment for men with mild to moderate urinary symptoms.
Alpha-Blockers
These medications relax the muscles around the prostate and bladder neck, helping urine flow more easily.
They often provide relatively rapid symptom improvement.
5-Alpha Reductase Inhibitors
These medications may gradually shrink the prostate over time and are often considered for larger prostates.
Benefits usually develop over several months.
Combination Therapy
Some men benefit from a combination of medications depending on prostate size and symptom severity.
When Might a Procedure Be Recommended?
A procedure may be considered when:
- Symptoms remain troublesome despite medication
- Medication causes side effects
- Urinary retention occurs
- Recurrent infections develop
- Bladder stones develop
- Kidney function is affected
- Significant bladder obstruction is present
Several treatment options are available, and suitability depends on prostate size, anatomy, overall health, and treatment goals. Treatment options may include minimally invasive BPH treatments, enlarged prostate surgery, or other procedures depending on individual circumstances.
Rezūm™ Water Vapour Therapy
Rezūm™ Water Vapour Therapy is a minimally invasive treatment that uses targeted water vapour to reduce excess prostate tissue.
The procedure is performed through the urethra without external incisions. Over time, the treated tissue is gradually reabsorbed by the body, helping to improve urinary flow and reduce symptoms.
Rezūm™ may be suitable for selected men seeking a minimally invasive BPH treatment as an alternative to long-term medication or more invasive surgery.
Bipolar Plasma TURP
Bipolar Plasma TURP (Transurethral Resection of the Prostate) is an established enlarged prostate surgery for men with moderate to severe urinary symptoms caused by BPH.
The procedure is performed through the urethra without external incisions. Excess prostate tissue causing obstruction is removed to improve urinary flow and bladder emptying.
For appropriately selected men, Bipolar Plasma TURP can provide significant and durable symptom relief.
Other Treatment Options
Several other procedures may be considered depending on prostate size, anatomy, symptom severity, and individual priorities.
Optilume® BPH Catheter System
The Optilume® BPH Catheter System combines mechanical widening of the prostatic urethra with local drug delivery designed to help maintain treatment benefits.
As a newer minimally invasive option, it may be suitable for selected men seeking alternatives to traditional surgery.
Aquablation®
Aquablation® is a robotic, image-guided procedure that uses high-pressure water jets to remove excess prostate tissue.
It may be considered for selected men with BPH depending on prostate anatomy, symptom severity, and individual treatment goals.
Holmium Laser Enucleation of the Prostate (HoLEP)
HoLEP is a laser procedure that removes obstructing prostate tissue through the urethra.
It is an established treatment option, particularly for larger prostates, and may provide durable symptom relief for appropriately selected men.
Living With an Enlarged Prostate
Many men with BPH continue to lead normal and active lives.
The most appropriate approach varies between individuals and may range from observation and lifestyle measures to medication or surgery.
Regular review may be recommended when symptoms change or new concerns develop.
Frequently Asked Questions
Does an enlarged prostate mean I have prostate cancer?
No. BPH is a non-cancerous condition. However, prostate enlargement and prostate cancer can occur at the same time, which is why assessment may sometimes include PSA testing and examination.
Can an enlarged prostate shrink naturally?
Significant natural shrinkage is uncommon. Symptoms may remain stable for years in some men, while others experience gradual progression.
Is surgery always necessary?
No. Many men are successfully managed with observation, lifestyle measures, or medication. Surgery is usually considered when symptoms are troublesome or complications occur.
What happens if BPH is left untreated?
Some men remain stable for years. Others may develop worsening symptoms, urinary retention, recurrent infections, bladder stones, or bladder dysfunction.
Does prostate size determine treatment?
Not necessarily. Treatment decisions are usually based on symptom severity, bladder function, prostate size, and overall health rather than prostate size alone.
Does Rezūm™ replace TURP?
No. Rezūm™ is one of several treatment options for BPH. While it may be suitable for selected men seeking a minimally invasive approach, Bipolar Plasma TURP remains an important treatment option for men with larger prostates or more severe urinary obstruction. A specialist assessment can help determine which approach is most appropriate.
Can lifestyle changes prevent an enlarged prostate?
Lifestyle measures cannot prevent prostate enlargement, but maintaining a healthy weight, staying physically active, and reducing caffeine and alcohol intake may help improve urinary symptoms.
What is the best treatment for an enlarged prostate?
There is no single best treatment for BPH. The most appropriate option depends on symptom severity, prostate size, bladder function, overall health, and individual priorities. Treatment options may include lifestyle measures, medication, minimally invasive BPH treatments such as Rezūm™, or surgical procedures including Bipolar Plasma TURP.
Concerned About Urinary Symptoms?
If you are experiencing a weak urine stream, frequent urination, difficulty emptying your bladder, or waking several times at night to pass urine, an assessment can help identify the cause and discuss appropriate treatment options.