by Trevor A. Flood, MD FRCPC
March 7, 2023

Background:

Benign prostatic hyperplasia (BPH) is a non-cancerous enlargement of the prostate gland and one of the most common conditions that affect men as they get older.

What are the symptoms of benign prostatic hyperplasia?

The symptoms of BPH develop because the prostate increases in size, and this growth compresses the urethra.  This compression makes it more difficult for urine to flow through the narrowed urethra. This is because the prostate wraps around the urethra, which is the tube that conducts urine from the bladder (and semen from the ejaculatory ducts) out of the body.

Symptoms of benign prostatic hyperplasia include:

• A weak stream of urine.
• Straining and pushing to start urination.
• The sensation of incomplete bladder emptying.
• Dribbling at the end of urination (post-void dribbling).
• Having to urinate more than eight times per day (frequency).
• Sudden and strong need to urinate (urgency).
• Waking up in the middle of the night to urinate (nocturia).
• Stopping and starting urination several times.

What causes benign prostatic hyperplasia?

We do not know exactly what causes BPH at present. However, current evidence suggests that hormones such as dihydrotestosterone (DHT) and testosterone play a role. In particular, DHT is known to stimulate the growth of the prostate gland, and older men have higher levels of DHT.

Who is at risk of getting benign prostatic hyperplasia?

Most men who develop BPH have no known risk factors.  BPH is a very common condition, and 9 in 10 men will have it if they live for 80 years or more. However, the following risk factors are associated with a small increased risk of developing BPH:

• Age – BPH becomes more common as men get older, and BPH is rare in men under the age of 40 years.
• Family history – Men who have family members with BPH may be more likely to develop BPH.
• Ethnicity – Asian men are less likely to develop BPH compared to black and white men.

Microscopic features of benign prostatic hyperplasia

The prostate gland is made up of glands that produce fluids used to help nourish and transport sperm from the testicles and a type of connective tissue called the stroma. In BPH, the number of glands and the amount of stroma in the prostate gland increase. Pathologists describe this change as hyperplasia.

How is benign prostatic hyperplasia diagnosed?

The diagnosis of BPH is usually made based on the symptoms that the man is experiencing. Your doctor may perform a digital rectal exam (DRE) to see if your prostate is enlarged. A tissue sample and microscopic examination of the prostate are not required to make the diagnosis of BPH. However, if you had your prostate removed (either partially or completely) as a treatment for BPH, the tissue will be examined under the microscope for features of BPH.

What can happen if benign prostatic hyperplasia is not treated?

If left untreated, BPH can block the flow of urine from the bladder, which results in the inability to empty the bladder fully.  As a result, it may become difficult to control urination.  This can lead to wetting the bed at night or not being able to get to the bathroom quickly enough to urinate. The bladder can also become infected, leading to a urinary tract infection (UTI).  UTIs can cause pain during urination and result in blood in the urine.  Other complications of BPH include the formation of stones within the bladder and the complete obstruction of urine.

How is benign prostatic hyperplasia treated?

Although BPH is a non-cancerous condition, the symptoms can cause significant discomfort, and serious complications are possible. Talking to your doctor to see if your symptoms require treatment is important.

Treatment options for patients with BPH include:

• Medical therapy.
• Minimally invasive therapies include high-intensity focused ultrasound (HIFU), laser therapy, transurethral balloon dilatation thermotherapy, and transurethral needle ablation of the prostate.
• Surgical therapy includes transurethral resection of the prostate (TURP) and open (simple prostatectomy).