Benign Prostatic Hyperplasia (Enlarged Prostate)

Overview

Benign prostatic hyperplasia (BPH) is a non-cancerous enlargement of the prostate gland. It is one of the most common conditions affecting men, with prevalence rising steadily with age — affecting roughly half of men in their fifties and the great majority of men in their seventies and eighties. Because the prostate gland surrounds the urethra just below the bladder, enlargement can progressively narrow the urinary channel and interfere with normal bladder emptying.

BPH is not prostate cancer, and having BPH does not increase the risk of developing cancer. Nevertheless, PSA (prostate-specific antigen) is measured before starting treatment to ensure that prostate cancer is not also present.

Symptoms

BPH produces a group of symptoms collectively known as lower urinary tract symptoms (LUTS). These fall into two categories:

Voiding (obstructive) symptoms

• Weak or slow urinary stream
• Straining to start urination
• Prolonged voiding time
• Sensation of incomplete bladder emptying
• Post-void dribbling
• In severe cases, acute urinary retention (sudden inability to pass urine — a medical emergency)

Storage (irritative) symptoms

• Urinary frequency (passing urine more than eight times per day)
• Nocturia (waking at night to urinate, often two or more times)
• Urgency (a sudden, compelling need to urinate)
• Urge urinary incontinence

Symptoms are often quantified using the International Prostate Symptom Score (IPSS), a validated questionnaire that helps guide treatment decisions.

Diagnosis

Evaluation typically includes:

• IPSS questionnaire to grade symptom severity
• Urine dipstick and culture to exclude infection or blood in the urine
• PSA blood test to screen for prostate cancer before treatment
• Urine flow test (uroflowmetry) to measure the speed and pattern of the urinary stream
• Post-void residual ultrasound to estimate how much urine remains in the bladder after voiding Additional tests such as renal ultrasound or flexible cystoscopy may be arranged when indicated.

Treatment

Treatment is tailored to symptom severity, prostate size, and individual circumstances.

Watchful waiting Men with mild, stable symptoms and no complications may choose active monitoring with periodic reassessment, supported by lifestyle advice (fluid management, reducing evening caffeine and alcohol, double voiding).

Medication

• Alpha-blockers (tamsulosin, alfuzosin, silodosin) relax the smooth muscle of the prostate and bladder neck, improving flow within days to weeks.
• 5-alpha reductase inhibitors (finasteride, dutasteride) reduce prostate volume over several months and are most effective in larger glands.
• Combination therapy is used when a single agent provides insufficient relief.
• PDE5 inhibitors (tadalafil) can also be used in men who have concurrent erectile dysfunction.

Surgical and minimally invasive treatment Several procedures are available depending on prostate size, anatomy, and patient preference:

• HoLEP (Holmium Laser Enucleation of the Prostate) — a size-independent laser procedure that removes the obstructing prostate tissue from within
• TURP (Transurethral Resection of the Prostate) — the long-established surgical standard using electrical resection
• GreenLight laser vaporisation — laser energy vaporises prostate tissue, suitable for men on anticoagulants
• UroLift — implants that hold the prostate lobes apart without removing tissue; preserves ejaculatory function
• Rezūm — water vapour (steam) therapy injected into the prostate to reduce its volume

The appropriate surgical option is discussed at consultation based on prostate size, anatomy, and individual health factors.