What Exactly is Benign Prostatic Hyperplasia (BPH)?
Benign prostatic hyperplasia, or BPH, is a non-cancerous enlargement of the prostate gland. The prostate is a walnut-sized gland located just below the bladder, surrounding the urethra. Its primary function is to produce seminal fluid.
As men age, hormonal changes can cause the prostate cells to multiply, leading to an increase in size. This can put pressure on the urethra, causing a variety of lower urinary tract symptoms (LUTS). It is important to note that while prostate enlargement is a natural part of aging for many men, it is not inevitable for all. Furthermore, BPH is not prostate cancer and does not increase the risk of developing it.
The Connection Between BPH and the Aging Process
For most men, the prostate goes through two main growth phases during their lifetime. The first occurs during puberty. The second begins around age 25 and continues throughout a man's life. It is this second phase of growth that contributes to the development of BPH. The prevalence rises steadily with age, from around half of men in their 50s and 60s to as many as 90% of men in their 80s.
Why does age increase the risk of BPH?
- Hormonal Shifts: The balance of hormones, particularly testosterone and dihydrotestosterone (DHT), changes with age. Higher levels of DHT are linked to continued prostate growth.
- Cellular Growth: As men get older, prostate cells may continue to divide, causing the gland to enlarge. This is part of the natural, non-cancerous aging process.
Symptoms of BPH: When Enlargement Becomes an Issue
An enlarged prostate doesn't always cause noticeable symptoms. For men who do experience them, they can significantly impact quality of life. The severity of symptoms often doesn't correlate with the size of the prostate, meaning a slightly enlarged prostate can cause more issues than a very large one.
Common symptoms of BPH include:
- Frequent urination, especially at night (nocturia)
- A sudden, urgent need to urinate (urinary urgency)
- Difficulty starting urination (hesitancy)
- A weak or slow urinary stream
- A urinary stream that stops and starts (intermittency)
- The feeling that you haven't fully emptied your bladder
- Dribbling at the end of urination
Diagnosis and Modern Treatment Options
Diagnosing BPH typically involves a physical exam, reviewing your medical history, and discussing your symptoms. Your doctor may also use a digital rectal exam (DRE) to feel the size and shape of the prostate. Other tests, such as a PSA blood test or a urinary flow study, may be performed to rule out other conditions and assess the severity of your BPH.
Treatment options range from simple lifestyle adjustments to medical and surgical interventions, depending on the severity of your symptoms:
- Watchful Waiting: For men with mild symptoms, a 'watchful waiting' approach is often recommended. This involves monitoring your symptoms and making lifestyle changes before pursuing medication.
- Lifestyle Modifications: Changes to daily habits can help manage symptoms. This includes limiting fluids before bed, reducing caffeine and alcohol intake, and managing stress.
- Medication: Alpha-blockers and 5-alpha reductase inhibitors are commonly prescribed medications. Alpha-blockers relax the bladder neck muscles and muscle fibers in the prostate, while 5-alpha reductase inhibitors can help shrink the prostate.
- Minimally Invasive Procedures: When medication is insufficient, a doctor might recommend a minimally invasive procedure like Rezum water vapor therapy or Urolift. These are outpatient procedures designed to reduce prostate tissue or lift the prostate to relieve pressure on the urethra.
- Surgery: For severe cases, surgical options like a Transurethral Resection of the Prostate (TURP) may be necessary to remove excess prostate tissue.
Comparison: BPH vs. Prostate Cancer
It is crucial to understand the difference between BPH and prostate cancer, as they are often confused. The table below outlines the key differences.
| Feature | Benign Prostatic Hyperplasia (BPH) | Prostate Cancer |
|---|---|---|
| Nature | Non-cancerous (benign) | Can be cancerous (malignant) |
| Growth | Enlargement of prostate cells | Uncontrolled growth of cancerous cells |
| Risk | Increases with age | Increases with age, but also influenced by genetics |
| Urinary Symptoms | Often causes bothersome urinary symptoms | Can cause urinary symptoms, but also other issues |
| Treatment | Focused on managing symptoms, shrinking the gland | Can involve surgery, radiation, chemotherapy, or active surveillance |
When to See a Doctor
Because BPH and prostate cancer can cause similar symptoms, and some men with an enlarged prostate may be asymptomatic, it is important to consult a healthcare professional for a proper diagnosis. Any new or worsening urinary symptoms, especially as you age, warrant a conversation with your doctor. Regular checkups can ensure any prostate issues are identified early and managed appropriately.
Conclusion
While it is a common part of the aging process for many men, it is not true that do all men over 60 have an enlarged prostate. A significant portion will experience some degree of benign prostatic hyperplasia (BPH), but the presence and severity of symptoms can vary widely. The good news is that for those who do experience discomfort, a range of effective treatments, from lifestyle changes to advanced medical procedures, are available to help improve quality of life. Open communication with your doctor and regular check-ups are essential for maintaining prostate health as you age. For more information, see the National Institute on Aging's overview of prostate problems.
