Understanding prostate enlargement

Enlargement is common, and it is not cancer

Benign prostatic hyperplasia means the prostate has grown more cells and is not cancerous. MedlinePlus states that BPH does not increase the risk of prostate cancer. The gland often continues to grow through adult life, which is why enlargement is the most common prostate condition after age 50. The chance is higher with age, with a family history, with obesity, heart and circulation disease, type 2 diabetes, erectile dysfunction, and with too little physical activity. Researchers are not sure of the cause. Hormone changes with aging are one explanation they consider.

The National Cancer Institute describes the same anatomy: a larger prostate can press on the bladder and narrow the urethra. A large gland does not always need treatment. Symptoms, not size alone, usually drive that decision.

What the symptoms feel like

MedlinePlus lists a frequent or urgent need to urinate, waking often at night, trouble starting, a weak or interrupted stream, dribbling, leakage, a feeling of incomplete emptying, pain after ejaculation or during urination, and urine with an unusual color or smell. Any of those symptoms can also come from a more serious problem, so they belong in a medical history rather than in a self-diagnosis.

Get help immediately if you cannot urinate, if fever and chills come with painful and frequent urination, if there is blood in the urine, or if you have pain in the lower abdomen and urinary tract. Acute urinary retention, the sudden inability to urinate, is a medical emergency. Cold and allergy medicines, alcohol, cold temperatures, and long periods of inactivity can set it off.

For most men, BPH does not cause further damage. It does raise the chance of retention, infection, bladder stones, bladder damage, and kidney damage. That is a reason for follow-up when symptoms are more than a nuisance.

How a clinician evaluates it

The first visit usually covers your history, your family’s history, the medicines you take, and an exam. The exam may include a gloved finger in the rectum to feel whether the prostate is large, tender, or irregular. Tests are added when they would help: a urine test, a PSA blood test, flow studies, a look inside the urethra and bladder, ultrasound, or a biopsy if cancer has to be ruled in or out. PSA can rise with enlargement itself, so an elevated number is not a cancer diagnosis.

Treatment is a range, not a ladder everyone climbs

MedlinePlus groups the options by how much the symptoms bother you, your general health, your age, and the size of the prostate.

• Not everyone needs treatment.
• Lifestyle changes may ease mild symptoms. They include drinking less before bed or before going out, cutting back on caffeine and alcohol, bladder training, exercises for the muscles that control urine, and preventing or treating constipation.
• Medicines may help mild to moderate symptoms by slowing growth, shrinking the prostate, or relaxing muscle so urine flows more easily. Two medicines are sometimes used together. The class names and the limits of that evidence are in the medicines article. This page does not list doses.
• Procedures may be considered when symptoms are moderate or severe and medicines are not enough. They are done through the urethra to widen the channel, destroy some tissue with heat, or, in surgery, remove tissue or cut it so it presses less on the urethra. Most BPH surgery uses instruments passed through the urethra. Benefits and side effects differ. A clinician who can describe the specific procedure should explain both.

Researchers have not found a way to prevent BPH. Saw palmetto, a supplement often sold for this condition, probably does not improve the urinary symptoms, according to the National Center for Complementary and Integrative Health.

What you can do before you decide

Track symptoms for a week or two, bring the medicine list, and ask what is likely to happen if you wait. Ask which side effects you would find unacceptable, especially sexual and ejaculatory changes. If cancer is still a question, the enlargement plan and the cancer evaluation should not be mixed together by an advertisement.