Benign Enlargement

Introduction: Benign enlargement of the prostate, also called benign prostatic hyperplasia or BPH, is a noncancerous growth of the prostate gland that becomes more common with age. This article explains what BPH is, how the prostate normally grows in two phases during life, and why enlargement often appears late in the second phase. It covers how common BPH is, including estimates for men aged 40 to 64 and those 65 and older, and outlines key risk factors such as age, family history, and certain health conditions. It describes typical lower urinary tract symptoms, how clinicians diagnose BPH with history, physical exam, and tests like urinalysis and PSA, and reviews the main treatment approaches from watchful waiting and medicines to minimally invasive therapies and surgery.

What Benign Enlargement Means and Who Develops It

The prostate sits below the bladder and surrounds the urethra — BPH is noncancerous enlargement

Benign prostatic hyperplasia is a condition in which the prostate gland grows larger than normal, but the growth is not caused by cancer. The prostate has two main growth phases. The first happens early in puberty, when the prostate doubles in size. The second growth phase starts around age 25 and continues throughout life, and BPH often occurs late in this second phase.

BPH is also called enlarged prostate, benign prostatic hypertrophy, or benign prostatic obstruction. Histologically, BPH refers to nonmalignant growth of prostate tissue, while benign prostatic enlargement describes the increased size of the gland, and bladder outlet obstruction describes blockage to urinary flow caused by that enlargement.

Experts estimate that BPH affects 5% to 6% of men ages 40 to 64 and 29% to 33% of those ages 65 and older. It is the most common prostate problem in men older than age 50, and rarely causes symptoms in men younger than age 40. Histological prevalence at autopsy is as high as 50% to 60% for males in their 60s, increasing to 80% to 90% of those older than 70 years.

• Not cancer: BPH is nonmalignant and occurs mainly in the central and transition zones
• Age-related: prevalence rises steadily with age
• Multifactorial risks: diabetes, obesity, metabolic syndrome, and family history increase likelihood

Symptoms, Diagnosis, and Treatment Options

BPH can cause weak stream, frequency, and urgency — evaluation includes history and exam

An enlarged prostate can squeeze the urethra, so bladder muscles must work harder to push urine through. Eventually the bladder may not empty completely, leaving urine behind, a condition called urinary retention. Other complications can include blood in the urine, urinary tract infections, bladder stones, and kidney disease.

Health care professionals diagnose BPH based on personal and family medical history, physical exam including digital rectal exam, and medical tests such as urinalysis, PSA blood test, urodynamic tests, and ultrasound. Treatment depends on severity and includes watchful waiting, alpha blockers, 5-alpha reductase inhibitors, minimally invasive therapies, and surgery.

• Watchful waiting: appropriate when symptoms are mild
• Medical therapy: alpha blockers for quick relief, 5-ARIs for long-term shrinkage
• Procedural options: for bothersome symptoms or complications

References

1. NIDDK: Enlarged Prostate (BPH)
2. StatPearls: Benign Prostatic Hyperplasia