Men often dread even the idea of having a prostate check. But because enlarged prostate, or benign prostatic hyperplasia (BPH), is a common condition that affects men as they age, it's important to know the facts.

About 50% of men between the ages of 51 and 60 have BPH, and that number jumps to 70% among men aged 60 to 69 and around 80% of men over 70 years of age. While some men who have BPH do not experience any bothersome symptoms, for many it causes problems with urination including increased urinary frequency, urgency, and an inability to completely empty the bladder.

Fortunately, a range of treatments are available for BPH, from lifestyle changes to medications to surgical interventions.

“BPH and the associated urinary symptoms are one of the most common reasons for a man to visit a urologist,” says urologist Daniel Kellner, MD. “Many men tend to accept urinary problems from BPH as a normal part of aging; they may not realize there is help available to improve their urination and quality of life.”

The prostate is a walnut-sized gland that rests below the bladder and in front of the rectum. It surrounds the urethra, the tube through which urine flows from the bladder, through the penis, and out of the body. The prostate produces a fluid that is a component of semen.

As men age, the cells of the prostate proliferate in response to the presence of a hormone called dihydrotestosterone. This causes the prostate to grow in size, resulting in an enlarged prostate, also known as benign prostatic hyperplasia, or BPH.

The size to which the prostate grows is variable; in some cases, the prostate grows only slightly larger than normal, while in others, the prostate is greatly enlarged.

While this is a benign growth, meaning it is not cancerous, it can nevertheless cause problems. In particular, the enlarged prostate can physically press against the urethra and obstruct the flow of urine. In turn, the obstruction of the urethra can prompt changes to the muscles of the bladder, which can result in incomplete emptying of the bladder during urination.

The precise cause of BPH is not fully understood, though it is associated with the exposure of cells within the prostate to a hormone known as dihydrotestosterone in aging men. This hormone stimulates the proliferation of certain cells in the prostate, which results in an enlarged prostate gland.

It’s worth noting that dihydrotestosterone levels are the same in men with and without BPH; doctors do not yet know why some men develop enlarged prostates while others do not.

Several risk factors increase the chances that a man will develop BPH:

• Age. BPH is often considered a normal part of aging. The risk for BPH increases as men get older.
• Family history. Several studies have shown that men who have a family history of BPH are more likely to develop it than men without a family history of the condition.
• Metabolic Syndrome and obesity. Some evidence suggests that men who are obese or who have the metabolic syndrome (a group of risk factors for cardiovascular disease and diabetes including, among others, abdominal obesity, high blood pressure, insulin resistance, and low HDL cholesterol levels) are at increased risk for developing BPH.

Benign prostatic hyperplasia can cause a number of lower urinary tract symptoms, including the following:

• Urinary hesitancy, or difficulty starting urination
• Weak urinary stream
• Need to strain muscles to begin the flow of urine
• Urinary stream that starts and stops one or more times
• Inability to completely empty bladder of urine
• Increased frequency of urination
• Increased urge to urinate
• Increased frequency of urination at night, which often disrupts sleep (called nocturia)
• Urge incontinence, or the involuntary loss of urine
• Flow of urine slows to a dribble toward end of urination

In some cases, BPH can lead to damage to the kidney, bladder stones, hematuria (blood in the urine), urinary tract infections (UTIs), and acute urinary retention, a condition characterized by the inability to urinate and accompanied by pain and swelling in the lower abdomen.

To diagnose BPH, doctors evaluate a patient’s medical history, perform a physical exam, and run diagnostic tests.

As a first step, the doctor will collect information about the patient’s medical history. Typically questions center on urinary symptoms associated with BPH including urination frequency, nighttime urination habits, the feeling of incomplete bladder emptying and urgency to urinate, and whether the patient needs to strain to urinate. The doctor may also ask about daily fluid intake, consumption of caffeine and alcohol, and whether the patient takes medications that can affect urination.

During the physical exam, the doctor will examine the abdomen and pelvic area, and perform a digital rectal exam. During a digital rectal exam, the doctor will insert a finger into the patient’s rectum to feel the prostate to check for enlargement or other abnormalities.

In most cases, the doctor will order some additional tests to help confirm a diagnosis of BPH, including bloodwork to measure the levels of prostate-specific antigen (PSA), a protein produced by the prostate gland. Elevated levels of PSA may be a sign of an enlarged prostate. A urinalysis, a test in which a patient urinates into a container, is sometimes recommended. This test checks for signs of a urinary tract infection, blood in the urine (hematuria), and kidney function. 

The doctor may also recommend other tests that measure the rate of urine flow and the amount of urine that remains in the bladder after urination. In some cases, doctors may order an ultrasound of the prostate and/or a cystoscopy, a procedure in which a cystoscope—a tube equipped with a small lens—is inserted into the urethra to allow the doctor to examine the urethra and bladder.