Is it normal for your prostate to enlarge as you get older?

Over half of men show signs of prostate enlargement by age 50, and about 80% by age 70. So, is it normal for your prostate to enlarge as you get older? Yes, this condition, known as Benign Prostatic Hyperplasia (BPH), is a very common part of the male aging process and a significant quality of life issue for many.

Quick Summary

Prostate enlargement, medically termed Benign Prostatic Hyperplasia (BPH), is a normal and highly common biological process for men as they age. While not cancerous, it often leads to uncomfortable and disruptive urinary symptoms that can be effectively managed with lifestyle changes or medical treatment.

Key Points

• Prevalence Increases with Age: Benign Prostatic Hyperplasia (BPH), or an enlarged prostate, is a very common condition that affects the majority of men over 50.

• Not Cancerous: Despite similar symptoms, BPH is not prostate cancer and does not increase your risk of getting cancer.

• Variety of Symptoms: Common symptoms include increased urinary frequency, urgency, a weak stream, and waking up at night to urinate.

• Multiple Treatment Options: Depending on symptom severity, treatments range from watchful waiting and lifestyle changes to medications and minimally invasive or surgical procedures.

• Early Intervention is Key: Don't ignore symptoms. Seeking medical advice for an accurate diagnosis allows for effective management and improved quality of life.

• Lifestyle Matters: Healthy habits, including diet, exercise, and fluid management, can help alleviate BPH symptoms.

Understanding Benign Prostatic Hyperplasia (BPH)

As men age, hormonal shifts contribute to the growth of the prostate gland, a condition known as Benign Prostatic Hyperplasia (BPH). While the prostate normally functions to produce fluid for semen, its growth in later years can cause significant issues. When it enlarges, the gland squeezes the urethra, the tube through which urine and semen pass. This pressure obstructs the flow and can lead to a host of frustrating urinary symptoms.

What Causes an Enlarged Prostate?

The exact cause of BPH isn't fully understood, but experts point to several key factors that influence its development.

• Hormonal Changes: As men get older, the balance between their hormone levels changes. A reduction in testosterone relative to a constant level of estrogen can trigger prostate cell growth. Additionally, a hormone called dihydrotestosterone (DHT) is known to stimulate prostate cell multiplication and can lead to enlargement over time.
• Genetics: A family history of BPH significantly increases a man's risk of developing the condition. If a father or brother has had an enlarged prostate, a man is more likely to experience it as well.
• Aging: Age is the most prominent risk factor for BPH. The likelihood of developing symptoms increases substantially after age 50.
• Lifestyle Factors: Certain habits and health conditions are associated with a higher risk of BPH, including obesity, a sedentary lifestyle, type 2 diabetes, and heart disease.

Common Symptoms of Benign Prostatic Hyperplasia

The symptoms of BPH are often related to urinary function and can range from mild to severe, affecting a man's quality of life. Many men with BPH ignore their symptoms, assuming they are just a normal part of aging. However, effective treatments are available.

• Urinary frequency and urgency: A persistent or sudden need to urinate, often more than eight times per day.
• Nocturia: Waking up frequently during the night to urinate.
• Weak or interrupted urine stream: A stream that starts and stops, or is noticeably weaker than it used to be.
• Difficulty starting urination: Hesitancy or straining to begin urinating.
• Feeling of incomplete bladder emptying: A sensation that the bladder is never fully empty.
• Dribbling at the end of urination: Leakage after finishing.

BPH vs. Prostate Cancer: A Crucial Distinction

It is common for men to confuse BPH with prostate cancer, especially since both conditions can produce similar urinary symptoms. It is vital to understand that BPH is non-cancerous and does not increase the risk of developing prostate cancer. However, because symptoms overlap, it is important to see a doctor for a proper diagnosis.

Feature	Benign Prostatic Hyperplasia (BPH)	Prostate Cancer
Nature	Non-cancerous growth of normal cells.	Malignant growth of cancerous cells.
Risk Factor	Common with age (over 50).	Most common after age 50, but risk factors differ.
Spread	Does not spread to other parts of the body.	Can spread outside the prostate gland.
Symptoms	Primarily urinary symptoms (frequency, urgency, weak stream).	Often asymptomatic in early stages. Can cause similar urinary issues, along with back pain, painful ejaculation, or blood in semen in later stages.

Diagnosing an Enlarged Prostate

To differentiate between BPH and other prostate conditions, a urologist will conduct a thorough examination. Common diagnostic tools include:

1. Digital Rectal Exam (DRE): The doctor inserts a gloved, lubricated finger into the rectum to feel the size, shape, and texture of the prostate gland.
2. PSA Blood Test: The prostate-specific antigen (PSA) test measures a protein produced by the prostate. Elevated PSA levels can indicate either BPH or prostate cancer.
3. Urinalysis: A urine sample is tested to check for infections or other conditions that might cause similar symptoms.
4. Uroflowmetry: This test measures the speed and volume of the urine stream, indicating how much obstruction is present.

Treatment Options for BPH

Treatment for BPH depends on the severity of symptoms and their impact on a man's quality of life. Options range from watchful waiting to more invasive surgical procedures.

Watchful Waiting

For men with mild symptoms, a doctor might recommend monitoring the condition without immediate treatment. This involves annual check-ups and symptom tracking.

Medications

• Alpha-blockers: These drugs relax the bladder neck and prostate muscle fibers, making urination easier.
• 5-alpha reductase inhibitors: These medications shrink the prostate by preventing the production of DHT.
• Combination therapy: In some cases, a combination of both types of drugs is used for more effective symptom relief.

Minimally Invasive Procedures

For moderate-to-severe symptoms, procedures that are less invasive than traditional surgery are now available.

• Water Vapor Thermal Therapy (Rezūm): A transurethral procedure that uses heated water vapor to destroy enlarged prostate tissue.
• Prostatic Urethral Lift (UroLift): This procedure uses small implants to hold enlarged prostate tissue out of the way, widening the urethra.

Surgical Intervention

If symptoms are severe or unresponsive to other treatments, surgical options may be considered.

• Transurethral Resection of the Prostate (TURP): The most common surgical procedure for BPH, it involves using a resectoscope to trim away excess prostate tissue blocking the urethra.

Lifestyle Changes for Prostate Health

Along with medical interventions, several lifestyle adjustments can help manage BPH symptoms and support overall prostate health.

• Diet: Focus on a diet rich in fruits, vegetables, and healthy fats, while reducing red meat and processed foods. Some studies have linked higher red meat intake to increased BPH risk.
• Hydration: Manage fluid intake, especially before bed or going out, to reduce nocturia and frequency. Limit bladder irritants like alcohol and caffeine.
• Exercise: Regular physical activity, even brisk walking, can help reduce inflammation and improve circulation, which benefits prostate health.
• Pelvic Floor Exercises: Kegel exercises can strengthen pelvic muscles and improve bladder control.

Conclusion: A Normal Part of Aging, but Not a Silent One

Yes, it is entirely normal and expected for your prostate to enlarge as you get older. However, the urinary symptoms that accompany this process—Benign Prostatic Hyperplasia (BPH)—are not something you have to endure. Understanding the difference between BPH and prostate cancer, recognizing the symptoms, and exploring modern treatment options with your doctor is key to maintaining a high quality of life. Proactive management can significantly reduce discomfort and improve your daily living.

For more information on the distinctions between BPH and prostate cancer, please visit the MUSC Health website.

Frequently Asked Questions

At what age do most men start to experience prostate enlargement?

While the prostate grows throughout a man's life, the most noticeable enlargement and associated symptoms typically begin after age 50. By age 85, up to 90% of men are affected.

Can an enlarged prostate be a sign of cancer?

No, BPH is not cancerous. However, some symptoms, such as an elevated PSA level, can be present in both conditions. Only a doctor can determine the cause of your symptoms through proper testing and diagnosis.

What is the primary cause of prostate enlargement as you get older?

The primary cause is generally linked to hormonal changes that occur with aging, specifically shifts in testosterone and DHT levels that stimulate prostate tissue growth.

What is the difference between BPH and prostate cancer?

BPH is a benign, non-cancerous growth of normal prostate cells. Prostate cancer involves the growth of malignant, abnormal cells. The key difference is that cancer cells can spread outside the prostate, while BPH cells cannot.

Are there any lifestyle changes that can help with BPH?

Yes. Limiting caffeine and alcohol, managing fluid intake, regular exercise, and a diet high in fruits and vegetables can all help manage symptoms.

When should I see a doctor for an enlarged prostate?

If you experience any urinary symptoms like frequent urination, a weak stream, or difficulty starting to urinate, you should see a doctor for an evaluation. Early intervention can lead to better management and prevent complications.

Can an enlarged prostate affect sexual function?

While BPH itself may not directly cause erectile dysfunction, some of the medications used to treat it, such as 5-alpha reductase inhibitors, can cause side effects like decreased libido or ejaculatory dysfunction. Some newer treatments are designed to minimize these side effects.