Enlarged Prostate (benign prostate hyperplasia)

What is the Prostate?

The prostate is a male gland. It surrounds the urethra (urinary channel) that connects to the bladder. During a male’s fertile years, the prostate gland makes fluid that comes out during ejaculation. As men get older, their prostate may become enlarged. Most men will experience some prostate growth starting in their 30s. However, symptoms may not be noticeable until age 50 or later.

At University of Utah Health, our urologists provide the full spectrum of treatment for men with an enlarged prostate — also known as benign prostatic hyperplasia (BPH). Our highly trained specialists help diagnose enlarged prostate issues and offer a range of treatments, including conservative treatments, minimally invasive surgery options, and more advanced surgeries.

What is the Normal Size of the Prostate Gland?

A normal-sized prostate is around 25 grams — approximately the size of a walnut. However, an enlarged prostate may grow well over three times the normal size (over 80 grams). The size of a man’s prostate varies from person to person. Size is just one of the many factors we consider when determining whether a man needs treatment for BPH.

Our doctors use a variety of tools to determine if you have an enlarged prostate and need treatment, including:

• physical examination,
• symptom discussion,
• severity of symptoms,
• diagnostic tests, and
• laboratory tests.

Prostate Enlargement Symptoms

The most common symptoms of BPH (enlarged prostate) relate to urinary function. You may experience:

• bladder obstruction, such as a slow stream of urine;
• starting and stopping while urinating;
• inability to empty your bladder completely;
• bladder irritation or discomfort;
• feeling an urgency to urinate;
• waking up multiple times at night to urinate; or
• urinary incontinence (an inability to control your bladder).

When you work harder to push urine out, these urinary symptoms could eventually put pressure on your bladder. This may lead to bladder abnormalities or other issues. It’s important to discuss any potential symptoms of BPH with your doctor.

Enlarged Prostate Causes

The exact cause of BPH (enlarged prostate) is not known. Most men will experience prostate enlargement as they get older. Some risk factors that could contribute to prostate enlargement include:

• family history of enlarged prostate,
• being overweight or obese,
• living a sedentary lifestyle,
• diabetes,
• heart disease, and
• aging. 

The following items don’t cause BPH, but could make your symptoms worse, including: 

• certain prescription medications, such as beta blockers and diuretics;
• a class of antidepressants called tricyclic antidepressants;
• over-the-counter medications such as antihistamines, decongestants, or NSAIDs (non-steroidal anti-inflammatory drugs);
• some types of beverages, such as alcohol, coffee, tea, or soda; and
• certain foods, such as red meat, spicy foods, or dairy.

How is an Enlarged Prostate Diagnosed?

A primary care provider (PCP) or urologist will diagnose BPH (enlarged prostate) after a discussion of your symptoms and a physical exam. Your doctor may recommend additional tests or imaging if the cause is not clear or if they need to rule out other conditions. The specific tests you need, if any, will depend on your health, family history, and other factors.

These tests may include:

• Urine test
• Digital rectal exam — The doctor will use their finger to determine the prostate size and texture.  
• Blood tests — These will help identify or rule out any kidney problems.
• PSA blood test — This test will identify any levels of prostate-specific antigen (PSA) in your blood, a chemical made by the prostate.
• Urinary flow test — This test will measure your urine volume and strength of the flow.
• Voiding diary — This journal will help you keep track of how often and how much you urinate in 24 hours.
• Transrectal ultrasound — We will insert a probe into your rectum that sends out high-energy sound waves to visualize and measure the size of your prostate.
• Urodynamic (pressure flow) study — During this study, a catheter (long, thin tube) will be inserted in your urethra.
• Cystoscopy — We will use a camera to view your urethra and bladder.

Enlarged Prostate Treatment

There are several treatment options for BPH (enlarged prostate).

Watchful Waiting

If you have minimal symptoms, your urologist may recommend a period of “watchful waiting.” You may be instructed to make some changes to your diet and lifestyle habits to relieve symptoms of BPH, such as losing weight (if necessary) or controlling your blood sugar levels. Your doctor may also encourage you to keep a diary about your symptoms to see if they worsen over time.

Our doctors will schedule your appointments at regular intervals (at least once a year or more often, if necessary) to: 

• Discuss your symptoms.
• Conduct a physical exam.
• Order lab tests.

If your BPH gets worse, your doctor will recommend one or more of the following treatment options. 

Medications

Some patients can successfully address BPH with medication and avoid the need for surgery or other interventions. There are four common medications we prescribe for an enlarged prostate, either on their own or in combination with one another:

• Alpha blockers — This medication will relax your prostate and bladder opening to allow better urine flow. Many people see an improvement in their symptoms without serious side effects.
• 5-alpha reductase inhibitors — This medication will block hormones that can lead to prostrate growth. As a result, your prostate will shrink slowly over a period of four to six months. This medication works best for patients with significant prostate enlargement.
• Anticholinergic medications — This medication will block receptors in your nerve cells that cause muscle movement in the gastrointestinal tract. It treats overactive bladder, frequent urination, and consistent urges to urinate.
• PDE5 inhibitors — This medication will relax the muscles in your bladder and prostate to reduce some of the symptoms of BPH.

Enlarged Prostate Surgery

If medications do not work to reduce or eliminate symptoms of BPH, your urologist may recommend prostate surgery. Our urologists perform a wide range of surgeries to open the urethra where it runs through the prostate.