Benign Prostatic Hyperplasia (BPH): Symptoms & Treatment

Benign prostatic hyperplasia (BPH) is nonmalignant enlargement of the prostate gland, a walnut-sized gland surrounding the urethra in men. As men age, the prostate naturally grows, and this enlargement can obstruct urinary flow, causing lower urinary tract symptoms (LUTS). BPH is very common in older men but does not increase prostate cancer risk.

The prostate produces fluid that makes up part of semen and aids sperm function.

Risk factors include:

• Age (increases with age)
• Testosterone exposure
• Family history
• Obesity
• Metabolic syndrome
• Sedentary lifestyle

The exact mechanism remains incompletely understood but involves epithelial and stromal proliferation.

Lower urinary tract symptoms (LUTS) include:

• Urinary frequency (especially nocturia)
• Urinary urgency
• Weak urinary stream
• Hesitancy (difficulty initiating)
• Straining
• Incomplete emptying
• Post-void dribbling

Symptoms range from mild to severely bothersome.

Evaluation includes:

• Symptom assessment (IPSS score)
• Digital rectal examination (DRE)
• Urinalysis
• PSA testing (optional for risk stratification)
• Post-void residual assessment
• Uroflowmetry if outlet obstruction suspected

Watchful waiting:

• Appropriate for mild symptoms
• Lifestyle modifications (fluid restriction, caffeine avoidance)
• Regular follow-up

Pharmacological treatment:

• Alpha-blockers (doxazosin, tamsulosin)
• 5-alpha reductase inhibitors (finasteride, dutasteride)
• Combination therapy

Surgical interventions:

• Transurethral resection of prostate (TURP)
• Laser vaporization
• Robot-assisted prostatectomy

While BPH cannot be prevented, maintaining healthy lifestyle may slow progression:

• Regular physical activity
• Healthy diet
• Weight management
• Limited fluid before bed

Seek evaluation for bothersome lower urinary tract symptoms. Discuss treatment options and expectations. Regular monitoring helps assess response and disease progression.