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 and to get a prostate exam at your next checkup.
Enlarged prostate mainly affects men over 50—in fact, by the time men reach the ages of 51 to 60, nearly 50 percent of them have the condition. It is, however, extremely rare for men under the age of 40 to have an enlarged prostate. While an enlarged prostate can be uncomfortable, it's not life threatening.
"If you have urinary symptoms, it usually is not a sign of prostate cancer," says Stanton Honig, MD, a Yale Medicine urologist and clinical professor of urology at Yale School of Medicine. "However, it is important to get checked to be sure. We have excellent medical and minimally invasive treatment options to help these urinary symptoms," says Dr. Honig.
A diagnosis of enlarged prostate often leaves men confused about treatment options. However, our Yale Medicine specialists are trained in the latest procedures that restore quality of life as quickly and comfortably as possible.
What is the prostate?
The prostate is a walnut-sized gland that rests just below the bladder. It surrounds the urethra, the tube that carries urine from the bladder out of the body. The prostate plays a critical role in the male reproductive system by helping to nourish sperm and direct it from the testicles when a man ejaculates.
What is enlarged prostate?
Enlarged prostate refers to the state in which the prostate is enlarged but not cancerous.
Hormonal changes and cell growth resulting from the aging process may cause the prostate to swell, often impinging upon and compressing the urethra. This causes the bladder walls to become thicker and can prevent the bladder from emptying completely.
What are the risk factors for enlarged prostate?
Researchers are still largely unclear on what causes the prostate to become enlarged but risk factors include:
- Age: As many as 90 percent of men over the age of 80 have an enlarged prostate.
- Family history: Men who have a family history of the condition are more likely to suffer from it.
- Other health issues: Men who suffer from obesity, heart disease, or type 2 diabetes have higher rates of an enlarged prostate diagnoses.
What are the symptoms of enlarged prostate?
When the prostate becomes enlarged, it can block the urethra and impair bladder function. Symptoms that may indicate this is happening include:
- Urinating many times a day and being unable to hold off urination
- Problems starting a urine stream or a weak or interrupted stream, followed by dribbling at the end
- Waking at night to urinate and accidental loss of urine
- Decrease in the volume of ejaculate
What are the potential complications of enlarged prostate?
There are several potential complications of enlarged prostate, some more serious than others. These include the inability to completely empty the bladder, blood in the urine, urinary tract infections, bladder and kidney damage and bladder stones.
How is enlarged prostate diagnosed?
The first step is a standard physical exam which often involves a urine analysis and a digital rectal exam, which involves a doctor inserting a finger into the rectum. The physician will assess the size and contour of the prostate and determine if any nodules are present, which may suggest the presence of prostate cancer.
The physician may also assess for tenderness, which can be found when the prostate is inflamed. Tests may be done in the office to assess strength of urine flow or to check for residual urine in the bladder.
Next, doctors may run one or several tests to make an accurate diagnosis. These can include a PSA (prostate specific antigen) blood test, urodynamic tests (which assess bladder performance), cystoscopy (inserting a scope into the bladder) and transrectal ultrasound (sending sound waves through the wall of the rectum to get an image of the prostate).
How is enlarged prostate treated?
Treatments for enlarged prostate include:
Lifestyle changes: These can include reducing liquid intake, bladder training (a program of urinating on schedule), abstaining from alcohol and caffeinated beverages and regularly exercising the pelvic muscles.
Medication: A class of medication called Alpha Blockers works to relax muscle fibers in the prostate and bladder. This relaxation allows for increased urine flow and less frequent urination. A second class of medication, called Alpha Reductase Inhibitors, works to block the hormones that cause the prostate to swell. Many patients will take a combination of these two types of medication.
Minimally invasive procedures: Our specialists are trained in two minimally invasive procedures that can help remove or reduce the obstructing prostate tissue:
- UroLift: For symptoms from an enlarged prostate, a new treatment is called UroLift, according to Daniel Kellner, MD, a Yale Medicine urologist who performs this procedure. The minimally invasive treatment is done in the doctor’s office on an outpatient basis. It solves the problem of a blocked urethra by inserting a tiny implant that pushes the enlarged prostate out of the way. No prostate tissue is removed, and the procedure takes about an hour.
- GreenLight laser treatment: One procedure that is commonly done by Yale Medicine urologists is GreenLight laser vaporization of the prostate. In this procedure, laser energy is used to vaporize prostate tissue quickly and efficiently with minimal side effects. Patients can go home the same day and resume normal activities within 1-2 days.
- Prostatic arterial embolization: This new, outpatient procedure is performed by an interventional radiologist. Using only mild sedation, the doctor releases tiny beads into the arteries that supply the prostate gland, accessed through a small hole made in the wrist or groin. The beads (which can't be felt by the patient) travel through the body to the patient's prostatic arteries. Once there, the beads block off the blood flow to the swollen prostate, and over time the prostate gland then shrinks. The procedure takes about two hours, and patients go home the same day. Within a few weeks, symptoms of BPH (such as weak stream, urinating frequently, and incomplete emptying) improve dramatically. Most patients are then able to stop taking medications and have their catheter removed if one is present, says Raj Ayyagari, MD, a Yale Medicine interventional radiologist, who performs this procedure at Yale New Haven Hospital. There has been no demonstrated impact on male sexual function, and in fact some patients actually experience improvement in erectile function.
Surgery: For severe cases of a very enlarged prostate, surgical removal of the prostate—called transurethral resection of the prostate (TURP)—may be the recommended course of action. Patients will decide with their doctor if aggressive treatment is warranted, depending on the size of the prostate and severity of symptoms.
How is Yale Medicine’s approach to treating enlarged prostate unique?
"Urologists at Yale Medicine can give you a personalized approach to prostate care for both benign and malignant conditions," says Dr. Honig.
Doctors at Yale Medicine work closely with specialists across all disciplines at Yale New Haven Hospital. Our doctors are dedicated to providing the latest treatments—all personalized to meet the needs of each patient. This collaboration between different departments and teams sets Yale Medicine apart in its standard of care.