Enlarged Prostate (BPH)

What is an "enlarged prostate"?

The prostate is a small gland that sits below the bladder and around the tube that carries urine out of the body. It often grows larger as men get older. When this growth starts to squeeze the urine tube, it can change how a man passes urine. This is called BPH, which stands for benign prostatic hyperplasia.

"Benign" means it is not cancer. BPH and prostate cancer are different conditions, although a person can have both at the same time.

Common symptoms

• A weaker stream of urine.
• Trouble starting to pass urine.
• Needing to go more often, especially at night.
• Feeling like the bladder is not fully empty.
• A sudden, strong need to pass urine.

Some men have only mild symptoms. Others find their daily life is affected. Treatment is based on how much the symptoms bother you, not on prostate size alone.

How is it checked?

Your doctor will usually ask about your symptoms, do a simple physical exam, and arrange tests such as:

• A urine test, to rule out infection.
• A PSA blood test.
• A urine flow test (uroflowmetry).
• An ultrasound of the bladder and prostate.
• Sometimes a flexible cystoscopy, where a thin telescope is used to look inside the bladder.

The main treatments

Lifestyle changes and medicines

For mild symptoms, simple changes can help, such as drinking less in the evening and limiting caffeine. There are also medicines that can relax the prostate or shrink it over time. Medicines work for many men, but they can have side effects and may stop working over time.

Newer minimally invasive treatments

If medicines are not working well, or you would prefer not to take them long term, there are newer treatments that are gentler than traditional surgery. They include:

• iTind - a temporary device placed for about a week to reshape the channel through the prostate.
• Rezum - small puffs of steam used to shrink prostate tissue.
• UroLift - tiny implants that hold the prostate lobes apart, like curtains pulled aside.

Laser and surgical treatments

For larger prostates or more severe symptoms, surgery may be a better option:

• Holmium laser (HoLEP) - a laser is used to lift out the inner part of the prostate from inside the urine tube. No outside cuts are made.
• TURP - the inner part of the prostate is shaved away with a small tool through the urine tube.
• Greenlight laser - a different laser used to vaporise prostate tissue.
• Open surgery - now used only for very large prostates.

Choosing a treatment

The best treatment depends on prostate size, how bad the symptoms are, your general health, and what side effects you most want to avoid (for example, effects on ejaculation). There is rarely a single "best" answer, only the best fit for you.