Fact Sheet

BPH Prostate Enlargement

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What is the prostate? 6
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The prostate is a small but important gland (organ) 7 10
2 12 1
in the male reproductive system. The main role 8
5 6
of the prostate is to make fluid that protects and 11
gives nutrients to sperm. The prostate 3makes 7
2 12
about one third of the fluid that is ejaculated 8
(released) from the penis at orgasm (sexual9
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climax). 3
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10 1 Bladder
Where is the prostate? 9 2 Vas deferens
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In young men the prostate is about the size of a 4 3 Urethra
walnut, but it gets bigger with age. The prostate 10
4 Penis
sits underneath the bladder, and surrounds the
top part of the urethra. Urine passes through the 5 5 Scrotum
urethra on its way from the bladder to the penis. 6 Seminal vesicle
1 Bladder 7 Rectum
How does the prostate gland change
2 Vas deferens 8 Prostate gland
with age?
3 Urethra Epididymis
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1 Bladder
The male sex hormone testosterone makes the 4 Penis 10 Testicle
prostate grow in size. As men get older, the 2 Vas deferens
5 Scrotum 11 Cowper’s gland
prostate grows larger. At puberty, testosterone 3 Urethra
Seminal vesicle 12 Ejaculatory duct
levels in boys start to increase and the prostate 6
4 Penis
grows to about eight times its size. It continues to 7 Rectum
grow, doubling in size between the ages of 21 and
5 Scrotum
8 Prostate gland
50 years, and almost doubles again in size between Seminal vesicle 6

the ages of 50 and 80 years. The reasons for this 9 Epididymis

7 Rectum
ongoing growth are not fully understood. BPH is not usually life-threatening but symptoms
10 Testicle

can have a major effect8 onProstate

11 Cowper’s gland
quality gland
of life.
What is BPH? 9 Epididymis
How common is BPH?
12 Ejaculatory duct
10 Testicle
BPH (benign prostatic hyperplasia) is the most
common prostate disease. BPH is a non-cancerous BPH is more common in11older Cowper’s gland starting
men, usually
enlargement or growth of the prostate gland. As after 40 years of age; it12affects nearly
Ejaculatory all men at
duct
the prostate surrounds the top part of the urethra, some time in their lives. Some men do not have any
enlargement of the prostate makes the urethra symptoms even though their prostate has grown
narrower and puts pressure on the base of the larger. BPH usually becomes more of a problem
bladder. Narrowing of the urethra can affect the over time, with symptoms getting worse if they are
passing of urine in a number of ways. not treated.

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 SYMPTOMS OF BPH

Lower urinary tract • Hesitancy a longer than usual wait for the stream of urine to begin
symptoms voiding or • Weak and poorly directed stream of urine
obstructive
• Straining to urinate
• Dribbling after urination has finished or an irregular stream
• Urinary retention not all the urine is passed from the bladder causing a need to urinate more often
• Overflow or paradoxical incontinence urine overflows from a full bladder uncontrollably even though
normal urination cannot be started

Lower urinary tract • Urgency an urgent feeling of needing to urinate

symptoms storage • Frequency a short time between needing to urinate
or irritative
• Nocturia a need to pass urine more than twice at night.

Other symptoms • Perineal pain pain in the perineum (the area between the scrotum and the anus)
• Dysuria painful urination
• Haematuria blood in the urine.

What causes BPH? What happens in a physical

The causes of BPH are not well understood. There
examination?
may be genetic links, as sons of men diagnosed A digital rectal examination (DRE) is the main
with BPH are more likely to develop prostate part of a physical examination when checking for
disease. prostate disease. The doctor places a gloved finger
in the rectum (back passage) to check the size,
Older age and the male sex hormone testosterone
shape and feel of the prostate.
are linked with BPH but may not be the cause. It is
known that BPH only happens when testosterone,
Are blood tests needed to diagnose
which is made in the testes, is present.
BPH?
What are the symptoms of BPH? A blood test to measure the level of prostate
Some men with BPH do not have many or any specific antigen (PSA) in the blood is often done
symptoms. Men who do have symptoms of BPH for prostate disease. PSA is a protein made in the
usually notice changes to their urination because prostate gland and low levels of PSA are normally
BPH affects the part of the prostate that present in the blood. A high PSA level in the
surrounds the top part of the urethra. blood almost always means there is something
happening in the prostate. A PSA test is mostly
LUTS (lower urinary tract symptoms) is a used as a marker of prostate cancer risk, but BPH
common term used to describe a range of urinary can also raise PSA levels two to three times higher
symptoms. LUTS linked to BPH can be obstructive than normal.
or irritative, but other symptoms may also happen.
Could it be prostate cancer?
Obstructive symptoms include a delay or straining
when starting to urinate, and slow or dribbling flow If there is an abnormal PSA and/or DRE result,
of urine. Irritative symptoms include urgent or prostate cancer may be present. The only way
frequent urination during the day and night. to confirm whether prostate cancer is present is
by prostate biopsy. The biopsy, to remove small
How is BPH diagnosed? samples of tissue from the prostate, is usually
done by a urologist. The samples are sent to a
If you have urinary symptoms, a doctor may do pathologist to be looked at under a microscope to
a number of things to find the cause, including: see if cancer is present.
taking a medical history and description of
symptoms; a physical examination; blood or urine How is BPH treated?
tests; and sometimes biopsy or ultrasound. These
tests are used to find out the type of prostate If you have LUTS linked with BPH, when deciding
disease (to check if it is BPH, prostate cancer or on the best treatment it’s important to think about
prostatitis). BPH is more likely to be the cause of how much the symptoms are bothersome or affect
urinary problems than prostate cancer. your quality of life.

In some cases of BPH, when the symptoms are

mild, no treatment may be the best option. Oral
medicines (tablets) can help men with moderate

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 These treatments use different lasers to kill
TREATMENT OPTIONS FOR BPH
off, vaporise or remove the enlarged part of the
No treatment • Sometimes
 BPH does not need prostate. As a result, pathology testing of the
medical treatment as the symptoms tissue cannot always be done. If the doctor wants
do not affect the man’s quality of life
to check that the enlargement is not caused by
Oral • Alpha-blockers cancer, these options may not be recommended.
medicines • Phosphdiesterase-5
 inhibitors (when
(tablets) also treating erectile dysfunction) The ‘UroLift® System’ is a newer treatment for
• 5-alpha
 reductase inhibitors
BPH being used by some urologists instead of
medicines or major surgery but is not suitable for
Surgery • Transurethral resection of the prostate all prostate conditions.
(TURP)
• Transurethral incision of the prostate Can I do anything to prevent BPH?
(TUIP)
• Open or retropubic prostatectomy As there are no known causes of BPH there are
• UroLift® System no known ways to prevent it. However, lifestyle
changes may help to stop the symptoms of BPH
Laser • Holmium
 laser enucleation (HoLEP)
getting worse and may even help to improve
treatments • Green light laser (PVP)
symptoms.

Reducing caffeine and alcohol intake (these

can irritate the bladder), avoiding constipation
symptoms. Surgery is an option for men whose
(straining to pass stools can affect pelvic floor
BPH symptoms are severe.
muscles, which are important for both bowel and
You should talk with your doctor and think bladder control), reducing body weight, and good
carefully about the risks and benefits before control of diabetes and blood pressure may be
making a decision on a treatment. helpful. Stopping smoking and increasing exercise
levels may also help symptoms.
BPH is a disease that affects quality of life and
may affect relationships; including partners in Visit healthymale.org.au
decision-making can be helpful. or speak to your doctor for more info.

What treatments for BPH are available?

While TURP (transurethral resection of the

prostate) is the most common and reliable surgical
treatment, some newer less invasive treatments
can involve shorter stays in hospital and a faster
recovery. However, with these less invasive
treatments there is a greater chance that the
symptoms will come back and further treatment
will be needed.

EXPERT REVIEWER

A/Prof Peter Royce

MBBS FRACS FACS
Alfred Hospital, Melbourne
D AT E R E V I E W E D : J U N E 2 0 1 8

The information in this fact sheet has been provided for

educational purposes only. It is not intended to take the
place of a clinical diagnosis or proper medical advice from
a fully qualified health professional. Healthy Male urges
readers to seek the services of a qualified medical
practitioner for any personal health concerns.

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© Healthy Male (Andrology Australia) 2018