Benign prostatic hyperplasia (BPH) is a condition in which the prostate, a walnut-sized body part made of glandular and muscular tissue, grows in size. The prostate surrounds part of the urethra, which is the tube that carries urine and sperm out of the body. The benign (noncancerous) condition is also called benign prostatic enlargement (BPE).
The prostate is located directly beneath the bladder and in front of the rectum. The urethra passes through the prostate, so if the prostate becomes enlarged, it can keep urine or semen from passing through the urethra.
The main function of the prostate is to produce fluid for the semen, the milky fluid in which sperm swims. Sperm is produced in the testicles, which also make the main male hormone testosterone. During puberty, testosterone stimulates the growth and function of the prostate, and helps with the production of fluid for semen.
BPH is the most common prostate problem in men. Almost all men will develop some enlargement of the prostate as they grow older. By age 60, 50% of men will have some signs of BPH; by age 85, 90% of men will have signs of the condition. About half of these men will develop symptoms that need to be treated.
Based on research to date, having BPH does not seem to increase the risk of developing prostate cancer. However, BPH and prostate cancer have similar symptoms, and a man who has BPH may have undetected cancer at the same time.
To help detect prostate cancer in its early stages, the American Urological Association and the American Cancer Society recommend a prostate screening every year for men ages 55 to 69. They also recommend that men who are at high risk – such as African-American men and men who have a family history of prostate cancer – begin screening at age 40. Screening tests for prostate cancer include a blood test for a substance called prostate-specific antigen (PSA) and the digital rectal exam (DRE).
Since the prostate gland surrounds the urethra (the tube that carries urine outside the body), it is easy to understand that enlargement of the prostate can lead to blockage of the tube. Therefore, you may develop:
The enlargement of the prostate can lead to blockage of the urethra.
As symptoms get worse, you may develop:
If you have any of these symptoms, see your doctor right away:
Your doctor will look at your medical history and give you a complete physical examination.
Your doctor will perform a digital rectal examination by inserting a gloved, lubricated finger into your rectum to feel the prostate, estimate its size and detect any hard areas that could be cancer.
Several studies may be performed to help diagnose your condition:
Patients who have mild symptoms may not require treatment other than continued observation to make sure their condition doesn't get worse. This approach is sometimes called "watchful waiting" or surveillance. There are a number of treatment options available if your symptoms are severe.
Finasteride (Proscar®) and dutasteride (Avodart®) work by decreasing the production of the hormone dihydrotestosterone (DHT), which affects the growth of the prostate gland. These appear to be most beneficial for men with larger prostates.
Drugs that relax the muscle in the prostate (to reduce the tension on the urethra) are more commonly used. These include terazosin (Hytrin®), doxazosin (Cardura ®), tamsulosin (Flomax®), alfuzosin (Uroxatral®), and silodosin (Rapaflo®). The most common side effects are lightheadedness, weakness and retrograde ejaculation.
Medications are sometimes combined to help treat symptoms and improve the flow of urine. One such medication is dutasteride and tamsulosin (Jalyn®).
Several different types of surgery can be used to remove the prostate tissue that blocks the flow of urine, including:
Minimally invasive treatments
New treatments for BPH have been developed that are less invasive and less damaging to healthy tissue than surgery. In general, minimally invasive procedures are done on an outpatient basis, result in fewer side effects, are less costly and allow for quicker recovery. The most common side effects reported with these treatments include urinary frequency and irritation while the prostate is healing. Because these techniques are new, little is known about their long-term effectiveness and complications.
Minimally invasive treatments include:
© Copyright 1995-2020 The Cleveland Clinic Foundation. All rights reserved.
This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or healthcare provider. Please consult your healthcare provider for advice about a specific medical condition. This document was last reviewed on: 03/10/2020