BPH (Benign Prostatic Hyperplasia): Causes, Symptoms, and Treatment Options
Benign Prostatic Hyperplasia (BPH) affects over 50% of men by age 60. Learn about the causes, symptoms, and evidence-based treatment options for this common condition.
Dr. Michael Chen
MD, Urology
Benign Prostatic Hyperplasia (BPH) affects over 50% of men by age 60 and up to 90% by age 85. This comprehensive guide examines the causes, symptoms, and evidence-based treatment options for this common condition.
What is Benign Prostatic Hyperplasia (BPH)?
Benign Prostatic Hyperplasia (BPH), also known as an enlarged prostate, is a non-cancerous growth of the prostate gland. The prostate is a walnut-sized gland located below the bladder that surrounds the urethra, the tube that carries urine from the bladder out of the body.
As men age, the prostate naturally grows larger. This growth is called hyperplasia (an increase in the number of cells) and is considered normal. However, when the enlarged prostate begins to squeeze the urethra and interfere with urinary function, it becomes a medical condition requiring attention.
Key Facts About BPH
- BPH is not cancer and does not increase your risk of developing prostate cancer
- It is extremely common, affecting approximately 50% of men between ages 51-60 and up to 90% of men over 80
- BPH is a progressive condition that typically worsens gradually over time if left untreated
- While it cannot be prevented, its symptoms can be effectively managed with various treatments
- Untreated severe BPH can lead to complications including urinary tract infections, bladder stones, and kidney damage
Causes and Risk Factors
The exact cause of BPH remains unclear, but research points to several factors that contribute to its development:
Hormonal Changes
The primary driver of prostate growth appears to be hormonal changes that occur as men age:
- Dihydrotestosterone (DHT) - This potent hormone derived from testosterone promotes prostate cell growth. As men age, even with decreasing testosterone levels, DHT concentrations in the prostate remain high and continue stimulating growth.
- Estrogen - The ratio of estrogen to testosterone increases with age, which may enhance the activity of substances that promote cell growth in the prostate.
- Growth factors - Various growth factors and signaling pathways become dysregulated with age, contributing to prostate enlargement.
Risk Factors
Several factors increase the likelihood of developing BPH:
- Age - The most significant risk factor; BPH rarely causes symptoms before age 40
- Family history - Men with a family history of BPH, particularly in first-degree relatives, have an increased risk
- Metabolic factors - Obesity, diabetes, and metabolic syndrome are associated with larger prostate volume and increased BPH risk
- Heart disease and hypertension - These conditions share common pathophysiological pathways with BPH
- Lack of physical activity - Sedentary lifestyle is associated with increased BPH risk
- Diet - Diets high in red meat and fat and low in vegetables may increase risk
Recognizing BPH Symptoms
BPH symptoms develop gradually as the prostate enlarges and compresses the urethra. They are often categorized as storage symptoms (problems related to bladder storage) and voiding symptoms (problems related to bladder emptying).
Storage Symptoms
- Frequent urination, especially at night (nocturia)
- Urgent need to urinate (urgency)
- Difficulty postponing urination
- Involuntary leakage of urine (overflow incontinence)
- Suprapubic pain or discomfort
Voiding Symptoms
- Weak urine stream
- Intermittent stream (starting and stopping)
- Straining to urinate
- Difficulty starting urination (hesitancy)
- Prolonged urination time
- Sensation of incomplete emptying
- Dribbling at the end of urination
Symptom severity is typically assessed using standardized questionnaires such as the International Prostate Symptom Score (IPSS), which helps healthcare providers determine the appropriate treatment approach.
Potential Complications
If left untreated, severe BPH can lead to several complications:
- Urinary retention - Complete inability to urinate, requiring emergency catheterization
- Urinary tract infections (UTIs) - Incomplete bladder emptying creates an environment for bacterial growth
- Bladder stones - Formed from minerals in residual urine
- Bladder damage - The bladder wall becomes thicker and irritable from straining
- Kidney damage - Severe, prolonged obstruction can cause hydronephrosis (swelling of the kidneys) and kidney dysfunction
- Hematuria - Blood in urine from dilated blood vessels in the prostate
Diagnosis
Diagnosing BPH typically involves several steps:
Diagnostic Process
- Medical history - Your doctor will ask detailed questions about your symptoms, their duration, severity, and impact on quality of life
- Symptom assessment - Using questionnaires like the International Prostate Symptom Score (IPSS)
- Physical examination - Including a digital rectal examination (DRE) to assess prostate size, shape, and consistency
- Urinalysis - To rule out infection or other conditions
- Blood tests - Including PSA (prostate-specific antigen) to help rule out prostate cancer
- Uroflowmetry - Measures the speed and volume of urine flow
- Post-void residual volume - Ultrasound measurement of urine remaining in the bladder after urination
- Urodynamic studies - For complex cases, these tests evaluate bladder function and urinary flow
- Cystoscopy - Visual examination of the urethra and bladder using a thin, lighted scope
- Transrectal ultrasound - Provides detailed images of the prostate to measure its size
Treatment Options
Treatment approaches for BPH range from watchful waiting to medication to surgical intervention, depending on symptom severity, prostate size, and patient preference.
Watchful Waiting
For men with mild symptoms that don't significantly affect quality of life, watchful waiting may be appropriate. This involves:
- Regular monitoring of symptoms
- Lifestyle modifications (see below)
- Periodic checkups with your healthcare provider
Lifestyle Modifications
Several lifestyle changes can help manage mild BPH symptoms:
- Reducing fluid intake before bedtime to decrease nighttime urination
- Limiting alcohol and caffeine, which can increase urination frequency and urgency
- Avoiding decongestants and antihistamines, which can worsen BPH symptoms
- Double voiding (urinating, waiting a moment, then trying again)
- Scheduled bathroom trips rather than waiting for the urge
- Staying physically active
- Maintaining a healthy weight
- Pelvic floor exercises
Medication Therapy
Several classes of medications are used to treat BPH:
Alpha-Blockers
Relax smooth muscles in the prostate and bladder neck, improving urine flow.
- Tamsulosin (Flomax)
- Alfuzosin (Uroxatral)
- Silodosin (Rapaflo)
- Doxazosin (Cardura)
- Terazosin (Hytrin)
Benefits: Work quickly (days to weeks), effective for many men
Side effects: Dizziness, headache, retrograde ejaculation
5-Alpha Reductase Inhibitors
Block production of DHT, causing the prostate to shrink over time.
- Finasteride (Proscar)
- Dutasteride (Avodart)
Benefits: Reduce prostate size by 20-30%, may prevent progression
Side effects: Reduced libido, erectile dysfunction, decreased ejaculate volume, rare depression
Phosphodiesterase-5 Inhibitors
Originally developed for erectile dysfunction, also improve BPH symptoms.
- Tadalafil (Cialis) - FDA approved for BPH
Benefits: Improves both BPH symptoms and erectile function
Side effects: Headache, indigestion, back pain, muscle aches
Combination Therapy
Using multiple medication types together for enhanced effectiveness.
- Dutasteride + Tamsulosin (Jalyn)
- Other combinations prescribed separately
Benefits: More effective than single medications for moderate-to-severe BPH
Side effects: Combined side effects of both medication classes
Minimally Invasive Procedures
For men who don't respond to medications or have moderate-to-severe symptoms, several minimally invasive options are available:
- Transurethral Microwave Thermotherapy (TUMT) - Uses microwave energy to destroy excess prostate tissue
- Transurethral Needle Ablation (TUNA) - Uses low-level radiofrequency energy to burn away prostate tissue
- Water Vapor Therapy (Rezūm) - Delivers water vapor to destroy prostate cells
- Prostatic Urethral Lift (UroLift) - Uses small implants to lift and hold enlarged prostate tissue away from the urethra
- Temporary Implantable Nitinol Device (iTIND) - A temporary device that reshapes the prostatic urethra
- Aquablation - Uses high-velocity water jets to remove prostate tissue
Surgical Treatments
For severe symptoms or very enlarged prostates, surgical options include:
- Transurethral Resection of the Prostate (TURP) - The gold standard surgical treatment, removes prostate tissue through the urethra
- Transurethral Incision of the Prostate (TUIP) - Makes cuts in the prostate to reduce pressure on the urethra
- Laser Therapy - Several types (HoLEP, PVP, ThuLEP) use different laser technologies to remove or vaporize prostate tissue
- Simple Prostatectomy - Open or robotic-assisted removal of the inner portion of the prostate (for very large prostates)
Natural Supplements and Alternative Treatments
Several plant-based supplements have shown varying degrees of effectiveness for BPH symptoms:
- Saw Palmetto - One of the most studied supplements for BPH, may help reduce urinary symptoms and improve flow. Typical dose: 320mg daily of a standardized extract.
- Beta-sitosterol - A plant sterol that has shown improvement in urinary symptoms and flow measures in some studies. Typical dose: 60-130mg daily.
- Pygeum africanum - Derived from African plum tree bark, may reduce inflammation and improve urinary symptoms. Typical dose: 100-200mg daily.
- Rye grass pollen extract (Cernilton) - May improve overall urinary symptoms. Typical dose: 126mg, three times daily.
- Stinging nettle - Often combined with other supplements like saw palmetto. Typical dose: 120-360mg daily.
Note: While some men find relief with these supplements, scientific evidence varies in quality and consistency. Always consult with your healthcare provider before starting any supplement, especially if you're taking other medications.
Living with BPH
Managing BPH is often a long-term process. Here are strategies for living well with this condition:
- Regular monitoring - Keep scheduled follow-up appointments with your healthcare provider
- Medication adherence - Take prescribed medications consistently as directed
- Symptom tracking - Monitor changes in your symptoms and report significant changes to your doctor
- Dietary considerations - Some men find symptom relief by avoiding bladder irritants like alcohol, caffeine, artificial sweeteners, and spicy foods
- Timed voiding - Urinating on a schedule rather than waiting until the urge is strong
- Stress management - Stress can worsen urinary symptoms; relaxation techniques may help
- Exercise - Regular physical activity may help reduce BPH symptoms
When to See a Doctor
Seek Immediate Medical Attention If:
- You are completely unable to urinate (urinary retention)
- You have severe discomfort or pain in your lower abdomen and urinary tract
- You have blood in your urine (hematuria)
- You have fever and chills along with urinary symptoms, which may indicate infection
Make an appointment with your doctor if:
- You're experiencing urinary problems that bother you
- Your symptoms have worsened
- You're experiencing new symptoms
- You're over 50 and haven't had a prostate examination
- Your current treatment isn't providing adequate relief
Conclusion
Benign Prostatic Hyperplasia is an extremely common condition that, while not life-threatening, can significantly impact quality of life. The good news is that with today's wide range of treatment options, from medications to minimally invasive procedures to surgery, most men can find effective symptom relief.
The key is to seek medical attention when symptoms begin interfering with your daily life. Early intervention can prevent complications and help maintain your quality of life. Work closely with your healthcare provider to find the treatment approach that best suits your specific situation, symptom severity, and personal preferences.
Remember that BPH is not cancer and does not increase your risk of developing prostate cancer. However, because the symptoms can be similar, proper diagnosis is essential.
Frequently Asked Questions About BPH
No, BPH (Benign Prostatic Hyperplasia) and prostate cancer are entirely different conditions. BPH is a non-cancerous enlargement of the prostate gland that commonly occurs as men age. The word 'benign' specifically means it is not cancer and cannot spread to other parts of the body. While both conditions can cause similar urinary symptoms and may coexist in the same person, having BPH does not increase your risk of developing prostate cancer. However, because the symptoms can overlap, proper diagnosis by a healthcare professional is essential. This typically involves a physical examination, PSA blood test, and sometimes imaging or other tests to distinguish between the two conditions.
The most effective medications for BPH depend on symptom severity, prostate size, and individual factors. Alpha-blockers (such as tamsulosin, alfuzosin, and silodosin) work quickly to relax prostate and bladder neck muscles, improving urine flow within days to weeks. They're often first-line therapy for moderate symptoms. 5-alpha reductase inhibitors (finasteride, dutasteride) shrink the prostate by blocking DHT production, but take 3-6 months to show full effect and work best for larger prostates. For men with both BPH and erectile dysfunction, daily tadalafil (Cialis) can address both conditions. Combination therapy using an alpha-blocker with a 5-alpha reductase inhibitor provides superior symptom relief for moderate-to-severe BPH than either medication alone, though with increased side effect risk. Your doctor will recommend the most appropriate option based on your specific situation.
Currently, there is no proven strategy to prevent BPH entirely, as age-related hormonal changes that drive prostate growth cannot be completely avoided. However, several lifestyle factors may help reduce your risk or minimize symptom progression: 1) Maintaining a healthy weight and staying physically active - obesity and sedentary lifestyle are associated with increased BPH risk; 2) Following a heart-healthy diet rich in fruits, vegetables, and whole grains while limiting red meat and high-fat foods; 3) Managing conditions like diabetes, heart disease, and high blood pressure, which are linked to increased BPH risk; 4) Avoiding excessive alcohol and caffeine consumption, which can irritate the bladder and worsen symptoms; 5) Practicing regular ejaculation, which some studies suggest may help reduce prostate congestion. While these measures cannot guarantee prevention, they support overall prostate health and may reduce symptom severity if BPH does develop.
The most effective surgical treatments for BPH depend on prostate size, symptom severity, and individual factors. Transurethral Resection of the Prostate (TURP) remains the gold standard with excellent long-term outcomes, though newer options offer advantages for specific situations. Laser procedures like Holmium Laser Enucleation (HoLEP) and Greenlight Photovaporization (PVP) provide comparable results to TURP with less bleeding and shorter catheterization time. For very large prostates (>80-100g), simple prostatectomy (open, laparoscopic, or robotic) may be optimal. Minimally invasive options like UroLift and Rezūm water vapor therapy offer quicker recovery and sexual function preservation, though with potentially less durable symptom relief than TURP. Aquablation, using high-velocity water jets, shows promise for precisely treating various prostate sizes while minimizing sexual side effects. The 'best' procedure varies by individual, and factors like recovery time, complication risks, and preservation of sexual function should be discussed with your urologist to determine the most appropriate option for your specific situation.
Natural supplements show mixed effectiveness for BPH symptoms, with varying quality of scientific evidence. Saw palmetto, the most studied supplement, demonstrates modest benefit in some trials but not others; a standardized extract of 320mg daily may help some men with mild symptoms. Beta-sitosterol (60-130mg daily) has shown improvement in urinary flow and residual volume in limited studies. Pygeum africanum extract (100-200mg daily) may reduce inflammation and improve urinary symptoms according to some research. Rye grass pollen extract (Cernilton) shows promise for reducing prostate size and improving symptoms in several small studies. Other supplements like stinging nettle, pumpkin seed, and zinc have less robust evidence. Overall, these supplements may provide modest symptom relief for some men with mild BPH, but effects are typically less pronounced than prescription medications. Quality and potency vary between products, and supplements should not replace medical evaluation. Always consult with a healthcare provider before starting supplements, especially if you have existing prostate conditions or take medications.
You should see a doctor about urinary symptoms in the following situations: 1) If you experience sudden inability to urinate (urinary retention), which requires emergency care; 2) When you notice blood in your urine (hematuria); 3) If you have pain during urination, especially with fever, which may indicate infection; 4) When urinary symptoms interfere with your sleep, daily activities, or quality of life; 5) If you have a weak urine stream, difficulty starting urination, frequent urination (especially at night), or a sense of incomplete emptying; 6) When you're over 50 with new or worsening urinary symptoms; 7) If you have a family history of prostate cancer and develop urinary symptoms. Early evaluation is important because these symptoms can indicate various conditions ranging from easily treatable infections to BPH, prostatitis, or prostate cancer. Prompt diagnosis allows for appropriate treatment, preventing complications like bladder damage or kidney problems that can occur with prolonged obstruction.
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Medically Reviewed By:
Dr. Robert Wilson, MD, Urology
Minimally Invasive Urologic Surgery
All medical content on this site has been reviewed by qualified healthcare professionals.
About the Author
Dr. Michael Chen
MD, Urology
Dr. Chen is a board-certified urologist with over 15 years of experience specializing in prostate health and men's urological conditions.
No, BPH (Benign Prostatic Hyperplasia) and prostate cancer are entirely different conditions. BPH is a non-cancerous enlargement of the prostate gland that commonly occurs as men age. The word 'benign' specifically means it is not cancer and cannot spread to other parts of the body. While both conditions can cause similar urinary symptoms and may coexist in the same person, having BPH does not increase your risk of developing prostate cancer. However, because the symptoms can overlap, proper diagnosis by a healthcare professional is essential. This typically involves a physical examination, PSA blood test, and sometimes imaging or other tests to distinguish between the two conditions.
The most effective medications for BPH depend on symptom severity, prostate size, and individual factors. Alpha-blockers (such as tamsulosin, alfuzosin, and silodosin) work quickly to relax prostate and bladder neck muscles, improving urine flow within days to weeks. They're often first-line therapy for moderate symptoms. 5-alpha reductase inhibitors (finasteride, dutasteride) shrink the prostate by blocking DHT production, but take 3-6 months to show full effect and work best for larger prostates. For men with both BPH and erectile dysfunction, daily tadalafil (Cialis) can address both conditions. Combination therapy using an alpha-blocker with a 5-alpha reductase inhibitor provides superior symptom relief for moderate-to-severe BPH than either medication alone, though with increased side effect risk. Your doctor will recommend the most appropriate option based on your specific situation.
Currently, there is no proven strategy to prevent BPH entirely, as age-related hormonal changes that drive prostate growth cannot be completely avoided. However, several lifestyle factors may help reduce your risk or minimize symptom progression: 1) Maintaining a healthy weight and staying physically active - obesity and sedentary lifestyle are associated with increased BPH risk; 2) Following a heart-healthy diet rich in fruits, vegetables, and whole grains while limiting red meat and high-fat foods; 3) Managing conditions like diabetes, heart disease, and high blood pressure, which are linked to increased BPH risk; 4) Avoiding excessive alcohol and caffeine consumption, which can irritate the bladder and worsen symptoms; 5) Practicing regular ejaculation, which some studies suggest may help reduce prostate congestion. While these measures cannot guarantee prevention, they support overall prostate health and may reduce symptom severity if BPH does develop.
The most effective surgical treatments for BPH depend on prostate size, symptom severity, and individual factors. Transurethral Resection of the Prostate (TURP) remains the gold standard with excellent long-term outcomes, though newer options offer advantages for specific situations. Laser procedures like Holmium Laser Enucleation (HoLEP) and Greenlight Photovaporization (PVP) provide comparable results to TURP with less bleeding and shorter catheterization time. For very large prostates (>80-100g), simple prostatectomy (open, laparoscopic, or robotic) may be optimal. Minimally invasive options like UroLift and Rezūm water vapor therapy offer quicker recovery and sexual function preservation, though with potentially less durable symptom relief than TURP. Aquablation, using high-velocity water jets, shows promise for precisely treating various prostate sizes while minimizing sexual side effects. The 'best' procedure varies by individual, and factors like recovery time, complication risks, and preservation of sexual function should be discussed with your urologist to determine the most appropriate option for your specific situation.
Natural supplements show mixed effectiveness for BPH symptoms, with varying quality of scientific evidence. Saw palmetto, the most studied supplement, demonstrates modest benefit in some trials but not others; a standardized extract of 320mg daily may help some men with mild symptoms. Beta-sitosterol (60-130mg daily) has shown improvement in urinary flow and residual volume in limited studies. Pygeum africanum extract (100-200mg daily) may reduce inflammation and improve urinary symptoms according to some research. Rye grass pollen extract (Cernilton) shows promise for reducing prostate size and improving symptoms in several small studies. Other supplements like stinging nettle, pumpkin seed, and zinc have less robust evidence. Overall, these supplements may provide modest symptom relief for some men with mild BPH, but effects are typically less pronounced than prescription medications. Quality and potency vary between products, and supplements should not replace medical evaluation. Always consult with a healthcare provider before starting supplements, especially if you have existing prostate conditions or take medications.
You should see a doctor about urinary symptoms in the following situations: 1) If you experience sudden inability to urinate (urinary retention), which requires emergency care; 2) When you notice blood in your urine (hematuria); 3) If you have pain during urination, especially with fever, which may indicate infection; 4) When urinary symptoms interfere with your sleep, daily activities, or quality of life; 5) If you have a weak urine stream, difficulty starting urination, frequent urination (especially at night), or a sense of incomplete emptying; 6) When you're over 50 with new or worsening urinary symptoms; 7) If you have a family history of prostate cancer and develop urinary symptoms. Early evaluation is important because these symptoms can indicate various conditions ranging from easily treatable infections to BPH, prostatitis, or prostate cancer. Prompt diagnosis allows for appropriate treatment, preventing complications like bladder damage or kidney problems that can occur with prolonged obstruction.