Benign Prostatic Hyperplasia (Enlarged Prostate): A Patient Guide

Overview

Benign prostatic hyperplasia (BPH), also called an enlarged prostate, is a common non-cancerous condition that affects people assigned male at birth as they age. The prostate is a small gland that sits below the bladder and surrounds the urethra, the tube that carries urine out of the body. As the prostate grows larger, it can press on the urethra and block urine flow, leading to uncomfortable urinary symptoms. BPH is very common: about half of people with prostates ages 51 to 60 have it, and that number rises to 90% by age 80. While BPH is not life-threatening and does not increase prostate cancer risk, it can significantly impact quality of life if symptoms are not managed.

Signs & Symptoms

BPH causes a group of symptoms called lower urinary tract symptoms (LUTS). These symptoms often start slowly and get worse over time, though some people have mild symptoms that never become severe. Common symptoms include:

• Weak or slow urine stream
• Trouble starting urination
• Frequent need to urinate, especially at night (nocturia)
• Feeling like your bladder is not completely empty after urinating
• Dribbling of urine after you finish urinating
• Urgent, sudden need to urinate that is hard to control

Causes & Risk Factors

The exact cause of BPH is not fully understood, but it is strongly linked to aging and changes in male sex hormones, particularly testosterone and its byproduct dihydrotestosterone (DHT). As you age, DHT levels may rise, causing the prostate to grow larger. Key risk factors for developing BPH include:

• Age over 50 (risk increases with each decade of life)
• Family history of BPH
• Diabetes or heart disease
• Obesity
• Lack of regular physical activity

Diagnosis

If you have urinary symptoms, your primary care provider or a urologist (a doctor who specializes in urinary tract health) will work to confirm BPH and rule out other conditions like prostate cancer or UTIs. Diagnosis typically starts with a review of your symptoms, medical history, and a physical exam including a digital rectal exam (DRE), where the provider gently inserts a gloved finger into the rectum to check the size and shape of your prostate.

• Urine test: To check for infection or blood in the urine
• Blood test for prostate-specific antigen (PSA): High PSA levels can be a sign of prostate cancer, so this test helps rule out cancer
• Uroflowmetry: A test that measures the speed and amount of urine you release when you urinate
• Post-void residual test: An ultrasound or catheter test that measures how much urine is left in your bladder after you finish urinating
• Transrectal ultrasound: A sound wave test that creates an image of your prostate to check its size
• Cystoscopy: A thin, flexible camera is inserted through the urethra to look for blockages in the urinary tract

Treatment & Management

Treatment for BPH depends on how severe your symptoms are, your overall health, and your personal preferences. Many people with mild symptoms only need lifestyle changes and regular monitoring, while people with more severe symptoms may need medications or procedures. Most medications for BPH start working within a few days to weeks, and 5-alpha reductase inhibitors may take up to 6 months to fully shrink the prostate. Your provider will work with you to find the right treatment plan and adjust it as needed over time.

Living With It

BPH is a chronic, long-term condition, but most people are able to manage their symptoms effectively and maintain a high quality of life. Regular follow-up appointments with your provider are important to monitor changes in your symptoms and prostate health over time. Many people with BPH never need invasive procedures, and symptoms may stay mild for years.