Prostate enlargement

Most prostatic enlargement is due to benign prostatic hyperplasia (BPH), a problem that bothers men increasingly with advancing age. The process of BPH generally begins in a man’s 30s, evolves very slowly and usually causes symptoms only after he has passed the half-century mark.

In BPH the normal elements of the prostate gland grow in size and number. Their sheer bulk may compress the urethra which courses through the center of the prostate and impedes the flow of urine through the urethra from the bladder to the outside. The urethral compression leads to urine retention and the need for frequent urination. If severe enough, complete blockage can occur.

BPH is very common. Half of all men over 50 develop symptoms of PBH, but only 10% need medical or surgical intervention.

BPH is completely benign. It is not a precursor (a forerunner) to prostate cancer.

Treatment of BPH is usually reserved for men with significant symptoms. Watchful waiting with medical monitoring once a year is appropriate for most men with BPH.

The medical therapy of BPH includes medication. The prostate enlargement in BPH is directly dependent on dihydrotestosterone (DHT), the principal androgen hormone in the prostate, certain medication blocks the enzyme needed to make DHT and so lowers blood and tissue DHT levels and helps reduce the size of the prostate. Other medication belongs to a class of drugs called alpha-1 blockers which relax the smooth muscle of the prostate and the bladder neck. Relaxing these muscles helps relieve the urinary obstruction caused by the enlarged prostate.