Introduction
The prostate gland is present in men only and is roughly the size of a walnut. It is located immediately below the bladder with the urethra, the tube connecting the bladder to the penis running through the middle of the prostate. The function of the prostate, along with the seminal vesicles, is to produce a fluid which forms a part of semen during ejaculation.
Benign prostatic hyperplasia describes an increase in the size of the prostate gland over time that is perfectly normal and may become more noticeable after the age of 40. The word 'hyperplasia' is derived from ancient Greek and literally means 'over-formation' or enlargement. Benign prostatic hyperplasia (or 'BPH') is also referred to as 'benign prostate hypertrophy' or simply as 'prostate enlargement'.
As this enlargement can impede the flow of urine from the bladder, it can cause a range of symptoms and complications.
Causes
It is normal for the prostate gland to grow in size over time. Although the precise mechanisms causing this growth are not fully understood, it is linked to testosterone production (the male sex hormone) and the prostate grows in size by a factor of eight after puberty and then continues to grow throughout life.
BPH is rare in men under the age of 40. Between a third and a half of all men over 60 have symptoms of the condition.
Symptoms
Although enlargement of the prostate may cause no symptoms, the first noticeable symptom is any change in or difficulty when urinating, due to the gland partially blocking the urethra.
Common symptoms include:
- Slow flow of urine.
- Needing to urinate but being unable to, or a delay in starting.
- Urgent need to urinate (often at night).
- Frequent need to urinate.
- Feeling that the bladder has not fully emptied after urinating.
- Urine 'dribbling' after urinating.
- Urinary tract infections.
Symptoms will determine the most appropriate treatment, which may include medication or surgery where symptoms are significantly affecting day-to-day living. Very mild symptoms may not need any treatment at all.
Tests / Diagnosis
The primary tests for BPH are:
- Digital rectal exam ('DRE') - the doctor puts on a glove and inserts his/her finger in the rectum to assess the size and consistency of the prostate gland.
- Urine test - to eliminate the possibility that symptoms are caused by an infection.
- Blood tests - there are two types, first a general blood test to check the function of the kidneys, and a second test to detect any elevation in Prostate Specific Antigen ('PSA') which may indicate the presence of prostate cancer.
Further testing may involve:
- Urine flow testing / urodynamic testing.
- Prostate biopsy.
- Transrectal ultrasound.
- Cytoscopy - where a camera and light is inserted via the urethra to examine the urethra, prostate and bladder.
Related Information
Transurethral resection of the prostate (TURP)
GreenLight Laser PVP of the Prostate
UroLift