Benign Prostatic Hyperplasia (BPH): Enlarged Prostate Symptoms & Treatment

Benign prostatic hyperplasia — BPH for short — is the medical term for a non-cancerous enlargement of the prostate gland. If you have been told you have an “enlarged prostate”, “prostatomegaly” or “benign prostatic hypertrophy”, these all describe the same underlying condition.

The prostate is a small gland, roughly the size of a walnut or a satsuma, sitting just below the bladder. It wraps around the urethra, the tube carrying urine out of the body. As men age, the prostate commonly grows, and because of where it sits, that growth can squeeze the urethra — rather like a kink in a garden hose making it harder to pass urine comfortably.

BPH is not cancer, and it does not increase your risk of developing prostate cancer. The two conditions can, however, coexist, which is precisely why careful assessment matters.

Did you know:

Approximately 50 percent of men between the ages of 51 and 60 will experience symptoms of BPH, and this figure rises significantly to nearly 90 percent for those over the age of 80.

Symptoms of an Enlarged Prostate

BPH develops slowly. The early signs of an enlarged prostate often feel like a minor nuisance before they begin to erode your quality of life. Collectively these are known as lower urinary tract symptoms, or LUTS.

• A weak or interrupted urinary flow.
• Difficulty starting to urinate or needing to strain.
• A frequent or urgent need to urinate, especially during the night (nocturia).
• A feeling that your bladder has not emptied completely after you have finished.
• Dribbling at the end of the stream.

While these symptoms are common, certain “red flag” situations require urgent medical attention. If you experience a complete inability to pass urine (acute urinary retention), notice blood in your urine (haematuria), or feel significant pain in the lower abdomen or bladder area, you should seek help from a GP or an emergency department immediately.

Causes & Risk Factors

The exact cause of prostate enlargement is not fully understood, but it is heavily linked to the natural ageing process.

Treatment pathways

Management of BPH follows a tiered approach, starting with the least invasive options and moving toward advanced surgical techniques if required.

Medical Pathways:

• Alpha-blockers: Medications like tamsulosin or alfuzosin work by relaxing the muscles in the prostate and bladder neck, making it easier to urinate.
• 5-alpha reductase inhibitors: Drugs such as finasteride or dutasteride can actually shrink the prostate gland by blocking the hormonal changes that cause growth.
• Combined Therapy: In many cases, using both types of medication provides the most effective relief for moderate symptoms.

Surgical & Minimally Invasive Pathways:

For those who do not find relief with medication, Mr Collins offers advanced interventions:

• Rezum (Steam Ablation): A minimally invasive procedure that uses water vapour (steam) to destroy excess prostate tissue, which is then naturally absorbed by the
• HoLEP (Holmium Laser Enucleation): A highly effective laser treatment often used for larger prostates, essentially cutting out the obstructing lump via telescope and breaking it into little pieces for extraction.
• TURP (Transurethral Resection of the Prostate): The traditional “gold standard” where excess tissue is removed by cutting away chips using an electrical current, though this is now often superseded by newer technologies using different energy forms.

The Prevention: Lifestyle tips to do at home

While you cannot stop the natural growth of the prostate, you can manage the symptoms and support bladder health through proactive habits:

• Fluid Management: Reduce fluid intake in the late evening, particularly caffeine and alcohol, to minimise trips to the bathroom at night.
• Bladder Retraining: Try to gradually increase the time between bathroom visits to strengthen the bladder’s capacity.
• Double Voiding: After you finish urinating, wait a few moments and try again to ensure the bladder is as empty as possible.
• Pelvic Floor Exercises: Strengthening the muscles around the bladder can improve control and reduce urgency or leaking.
• Maintain a Healthy Weight: A diet rich in vegetables and healthy fats can help regulate the hormones associated with prostate growth.
  

BPH vs prostate cancer: what’s the difference?

This is the question that brings most men to the clinic, and it deserves a direct answer.

BPH is a benign overgrowth of prostate tissue in the central zone of the gland, around the urethra, which is why it causes urinary symptoms early. Prostate cancer typically begins in the outer (peripheral) zone, away from the urethra, which is why it often causes no symptoms at all until it is advanced.

The practical implication is uncomfortable but important: urinary symptoms point towards BPH, but the absence of urinary symptoms tells you nothing reassuring about cancer. The two are assessed separately. An enlarged prostate also produces more PSA, so a raised reading in a man with BPH frequently has a benign explanation rather than a cancerous one

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