An Overview of Enlarged Prostate

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An enlarged prostate is a common problem among men over the age of 50. It may cause bladder-related symptoms such as urinary frequency and urgency. There are several causes of an enlarged prostate, including hormonally-mediated enlargement, inflammation, and cancer.

The treatment of prostate enlargement varies depending on the cause. You may need blood tests or imaging studies to identify the reason for your prostate enlargement. The outcome is usually very good after treatment—but since cancer is one of the possible causes it is important not to ignore signs and symptoms of prostate enlargement.

Symptoms

An enlarged prostate does not always cause symptoms, and about half of men who have this condition do not experience any symptoms at all. Some men develop symptoms early, while others do not develop any effects until the prostate becomes significantly enlarged. This has to do with the position of the enlarged area (or areas) of the prostate in relation to the bladder.

If you develop symptoms of an enlarged prostate, you may frequently feel a sudden need to rush to the bathroom. But then when you are there, you only urinate a little and may have a weak stream. You may also continue to leak or dribble when you have stopped urinating.

The most common symptoms of prostate enlargement are:

  • Urinary frequency: Urinating much more frequently than normal
  • Urinary urgency: Having an urgent sensation that you need to urinate immediately
  • Nocturia: Getting up to urinate multiple times during the night
  • Hesitancy: Difficulty starting the urine stream
  • Bladder retention: Incomplete emptying of the bladder
  • Incontinence: Losing bladder control

Complications

Incomplete emptying of the bladder can result in a urinary tract infection (UTI), which causes pain and burning with urination. You are more likely to experience incontinence if you develop a UTI.

A UTI or cancer can result in blood in the urine. Be sure to talk to your doctor if you have occasional blood-tinged urine. If you have blood clots in your urine, you should get urgent medical attention.

If you are completely unable to urinate, you should get urgent medical attention. If the obstruction is severe enough, it can result in kidney damage.

Causes

Men have a prostate gland and women do not. The prostate is located just below the area where the bladder empties into the urethra. The urethra is a thin tube that carries urine from the bladder. In men, the urethra runs inside the penis to outside the body. As the prostate enlarges, it impinges the flow of urine through the urethra.

There are several reasons why the prostate may become enlarged.

Benign Prostatic Hyperplasia (BPH)

Benign prostatic hyperplasia (BPH) is a non-cancerous increase in prostate size. Fifty percent of men in their 50s and 90 percent of men over age 80 have BPH.

The prostate enlarges when exposed to male hormones such as testosterone. During adolescence, the prostate goes through a phase of very rapid enlargement, but this levels off after puberty. The prostate continues to grow, but very slowly.

Due to the slow progression of growth during adulthood, most men do not notice any symptoms of BPH until they are older and the prostate has grown to such a size that it impinges on the outflow of urine from the bladder.

Prostate Cancer

Prostate cancer may result in an enlarged prostate, although it doesn't always cause symptoms. Prostate cancer can often be diagnosed early and treated successfully. However, if left untreated, prostate cancer can metastasize (spread) to other areas of the body.

Prostate Cancer Doctor Discussion Guide

Get our printable guide for your next doctor's appointment to help you ask the right questions.

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Prostatitis

Prostatitis is inflammation of the prostate. This may occur as the result of an infection, an inflammatory process, irritation, or an injury.

Diagnosis

If you have developed the effects of prostate enlargement, it can be difficult to determine the cause based on your symptoms alone. And because symptoms of BPH and the symptoms of prostate cancer are very similar, it is important that you work with your medical team to get to the bottom of the situation.

Keep in mind that it is often recommended that older men have screening tests, such as a digital rectal examination (DRE) or a prostate-specific antigen (PSA) test if there is a risk of prostate cancer—even in the absence of symptoms.

Physical Examination

As part of your physical examination, you may need to undergo a digital rectal examination (DRE). The prostate is not visible from outside the body, but it can be examined with a simple test. During this examination, your doctor would insert a lubricated gloved finger into your rectum to evaluate the size and consistency of the prostate.

A DRE should not be painful or produce any bleeding—if it does, this is a sign that you may have a prostate problem that requires further evaluation. An enlarged, lumpy, or asymmetric prostate may indicate the need for further testing.

Blood and Urine Tests

A prostate-specific antigen (PSA) blood test measures a protein that is produced by the prostate. Elevated PSA blood levels may be present if you have cancer, but they can also be elevated if you have prostatitis. And sometimes, PSA can be normal in men who have prostate cancer.

This blood test must be interpreted in light of your other diagnostic test results, and it cannot be used to rule in or rule out any specific cause of prostate enlargement.

A urinalysis can measure the volume of your urine and can be used to detect blood, inflammatory cells, or infectious organisms.

Specialized Tests

Several tests can assess your ability to urinate. These tests may involve placement of a catheter (tube) into your penis to help identify areas of obstruction or alterations in flow.

Urodynamic tests give your medical team information about the flow and stream of your urine and can help point to structural abnormalities that could be interfering with your ability to urinate. Pressure flow studies can measure the pressure in your bladder when you urinate to help identify areas of obstruction.

Uroflowmetry can measure the rate at which your bladder fills and empties. And a post void residual urine study measures the volume of urine that remains in your bladder after you urinate.

You may need a combination of these tests to help your doctors understand the anatomic structure in and around your bladder and prostate gland as well as your urinary function.

Imaging Examinations

You may need to have an imaging test, such as computerized tomography (CT) or your abdomen and pelvis. Another imaging test, a transrectal ultrasound, involves placing a device into the rectum to help in obtaining an image of the structures.

Biopsy

If there is a concern that your enlarged prostate could be caused by cancer, you may need to have a cystoscopy or a prostate biopsy. These are invasive tests in which a sample of tissue is collected and examined under a microscope to look for signs of cancer.

Treatment

There are different approaches to the treatment of an enlarged prostate. Symptomatic management is important, and treatment of the underlying cause is often vital.

At-Home Management

Some strategies that can help prevent incontinence, nocturia, and bladder infections include:

  • Urinating on a regular schedule and when you feel the urge
  • Limiting alcohol and caffeine
  • Avoiding beverages a few hours before sleep
  • Discuss your use of over-the-counter antihistamines and decongestants with your doctor—these medications can exacerbate bladder control issues

If urinary retention is a chronic problem, you may need to learn how to self-catheterize yourself. This involves placing a thin tube into the urethra to release urine.

There is no evidence that herbs or supplements can shrink an enlarged prostate or alleviate any of the symptoms.

Medication

A number of different types of prescription medications are used for symptomatic management or for treatment of bladder enlargement.

Medications described as 5-alpha-reductase enzyme inhibitors can help shrink the prostate gland. Avodart (dutasteride) and Proscar (finasteride) are used to reduce the size of the prostate gland in BPH and in prostate cancer. They reduce the action of testosterone, and they can produce reversible side effects related to this mechanism, including decreased libido and breast enlargement.

Some medications help ease urinary symptoms by relaxing the muscles around the urethra. These medications, which fall in the category of alpha blockers, include Flomax (tamsulosin), Cardura (doxazosin), Hytrin (terazosin), Rapaflo (silodosin), Minipress (prazosin), and Uroxatral (alfuzosin). These medications can cause low blood pressure and dizziness.

Prostatitis caused by a bacterial infection can be treated with antibiotics.

Surgery and Specialized Procedures

There are several procedures used to treat an enlarged prostate. These procedures can also be used to remove prostate cancer.

An open prostatectomy is a surgical procedure that involves surgical removal of a portion of the prostate gland or the whole entire gland.

Transurethral resection of the prostate (TURP) is a procedure that involves placing an endoscope (a tube connected to a camera) into the urethra to visualize the bladder and to remove excess prostate tissue.

A newer procedure, the Rezūm System, uses steam to destroy prostate cells.

A Word From Verywell

Prostate enlargement is common. Often, when there are no symptoms, treatment is not necessary for BPH. Because prostate cancer does not always cause symptoms, this condition must be treated even when it does not produce any symptoms.

Men often consider frequent urination to be a part of getting older, but you should seek medical attention if you develop these symptoms because they can be a sign of a treatable or potentially serious medical issue.

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