Benign Prostatic Hyperplasia

By their 50s, half of men have some degree of BPH. And by their 80s, an estimated 90% of men have BPH. A larger prostate, by itself, isn’t something you need to worry about — unless the enlargement disturbs the normal function of the urinary system. In other words, it isn’t a problem until it’s a (urinary) problem. This guide will help you understand what BPH is, what causes it, how it’s diagnosed, what to expect in the future, and the range of options for living better with this condition. The choices are many, and the differences between them are sometimes subtle. We will guide you through the decision process.

By their 50s, half of all men have BPH. By your 80s, it’s 90%. For men, BPH — also called benign prostatic hyperplasia or enlarged prostate — comes with the territory. BPH can trigger ongoing urinary problems, incontinence, and even chronic infections.

You can be free from the constraints and embarrassment of BPH!

More than ever, it is possible to effectively treat and manage BPH. But which treatments are best for you? This guide will tell you.

You’ll know BEFORE you say “Yes.”

When treating BPH the most important consideration is which approach best addresses your condition, your expectations, and your reservations.

In this Guide, Harvard doctors present and assess today’s treatment options. From watchful waiting to medication, to surgery, the guide explains the benefits, risks, and side-effects you can anticipate from each approach.

You’ll appreciate how all things are considered — especially you. Which protocols can effectively reduce the symptoms that bother you most…which have the fewest complications…which offer you the most lasting improvement? You’ll get the answers fully and clearly.

You’ll find practical steps and proven measures.

You’ll read how simple changes in behavior can ease urinary symptoms. You’ll discover two controllable risk factors. You’ll learn about medications for the “going” problem…the ”growing” problem…and a new combination pill to solve both. You’ll find the medication with the fewest sexual side effects…and one that can more successfully reduce future need for surgery.

You’ll discover advances that are erasing fears and extending relief.

You’ll be briefed on a durable surgical procedure that improves urine flow for 90% of patients. You’ll read about an alternative for men taking blood thinners. The guide shines a light on today’s competing laser surgical options. You’ll learn about three outpatient procedures…the prospects for Botox BPH therapy…and the six questions to ask before any BPH surgery.

Prepared by the editors of Harvard Health Publishing in consultation with Anurag K. Das, MD, FACS, Assistant Professor of Surgery, Harvard Medical School Director, Center for Neurourology and Continence, Beth Israel Deaconess Medical Center (2022)

About Harvard Medical School Guides

Harvard Medical School Guides delivers compact, practical information on important health concerns. These publications are smaller in scope than our Special Health Reports, but they are written in the same clear, easy-to-understand language, and they provide the authoritative health advice you expect from Harvard Health Publishing.

Causes and effects

In benign prostatic hyperplasia (BPH), cells in the prostate gland start to divide and grow again for the first time since young adulthood. That’s what causes the gland to expand in size, from an average of 30 grams in a normal prostate (about an ounce) up to, not uncommonly, 140 or even 150 grams (up to five ounces). In rare cases, prostate size may exceed 300 grams (10 ounces).

The prostate is made up of muscle tissue and a network of tiny tubes (ducts) lined with cells that produce prostatic fluid. During ejaculation, the prostate pushes that fluid through those ducts and into the urethra, where it mixes with sperm cells and exits through the penis. BPH is the result of cell overgrowth in the muscle as well as the lining of the ducts.

What exactly switches prostate growth back on in middle age remains a bit of a mystery, although there are theories. Prostate enlargement may have something to do with an age-related buildup of dihydrotestosterone, a hormone that plays a central role in the development of the penis and prostate as the fetus grows during pregnancy. Certain factors are linked to a higher risk of BPH. These risk factors include increasing age, a family history of BPH, higher body weight, and lack of exercise. It’s not clear whether losing weight or exercising more actually prevents BPH, but these factors can identify men who are the most likely to develop prostate enlargement with bothersome urinary problems.

Crowded anatomy

Part of the reason prostate enlargement causes problems is the crowded anatomy of the pelvic region. Notably, the bladder is sandwiched between the pubic bone and the wall of the rectum, the last part of the colo. The prostate also sits just below the bladder. All of this doesn’t give the bladder much room to move if the prostate begins to expand.

Another problem: the prostate wraps entirely around the urethra at the point where it exits the bladder. As the prostate grows, it starts to press in on the urethra and restrict the flow of urine (see Figure 2, page 5). As a result, it gets harder to empty your bladder. In some cases, the impingement can get so extreme that you can’t urinate at all—a medical emergency that poses the risk of kidney damage.

Bladder malfunction

With continued obstruction to urine flow, the muscles in the bladder wall have to work much harder to push urine out of the body. Straining to urinate eventually starts to affect the function of the bladder itself. As the bladder wall thickens and loses some of its natural “give,” it can store less urine. That means more frequent trips to the bathroom.

In addition, the nerves that sense a full bladder and coordinate the normal emptying of the bladder may start to malfunction. Known as overactive bladder, this condition causes abnormal contractions of the bladder wall that unleash a sudden and disruptive urge to urinate.

BPH or prostate cancer?

It’s important to know that prostate cancer can also cause lower urinary tract symptoms very similar to those of BPH, though usually at a relatively advanced stage of the disease. This is why men being evaluated for BPH undergo a blood test to screen for possible prostate cancer.

If you start to notice bothersome urinary symptoms, there is no need to worry unduly about prostate cancer. Noncancerous BPH is the far more likely explanation, but you should check it out. Urinary problems are common, and there are many ways to treat them.

2022 Annual Report on Prostate Diseases

Most men eventually develop some type of prostate problem, and when they do there are usually no easy solutions. More than a primer on prostate conditions, this Special Health Report, the Annual Report on Prostate Diseases, includes roundtable discussions with experts at the forefront of prostate research, interviews with men about their treatment decisions, and the latest thinking on complementary therapies. This report will provide you with the information you need to understand the current controversies, avoid common pitfalls, and work with your doctor to make informed choices about your prostate health.

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Benign Prostatic Hyperplasia