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Enlarged prostate: symptoms, tests and treatment options
Enlarged prostate is a common condition in men, particularly with advancing age. The gradual enlargement of the prostate gland is known as benign prostatic hyperplasia (BPH). Another term sometimes used for this condition is prostate adenoma.
It is important to understand that this is a benign process, meaning that BPH itself is not cancer. Nevertheless, its consequences can range from persistent discomfort during urination to complications affecting the bladder and kidneys.
The prostate is located below the bladder and surrounds the initial part of the urethra. As it increases in size, it may compress the urethra and restrict the normal flow of urine. Over time, this can lead to a feeling of incomplete bladder emptying and other urinary problems.
An enlarged prostate is a common age-related change, but the symptoms should not simply be tolerated. Timely medical assessment can help prevent unnecessary worsening of the condition.
Symptoms of an enlarged prostate
In the early stages, symptoms may be mild and develop gradually. Many men consider them a normal part of ageing and postpone seeing a urologist.
Some of the most common symptoms include:
- Frequent urination during the day and at night. If you previously woke up once during the night but now need to get up three or four times, this change deserves attention.
- Weak or interrupted urine stream. You may need to strain in order to start or maintain urination.
- Difficulty starting urination. You may feel the urge to urinate, but the flow does not begin immediately.
- A sensation of incomplete bladder emptying. After urinating, you may still feel that some urine remains in the bladder.
- Sudden and strong urinary urgency. The need to urinate may appear unexpectedly and be difficult to postpone.
- Dribbling after urination.
- Urinary retention. You may have a strong urge to urinate but be unable to pass urine.
If these symptoms are accompanied by pain, burning, fever, or blood in the urine, medical evaluation is necessary. A sudden inability to urinate is also a condition in which medical attention should not be delayed.
Causes and factors associated with prostate enlargement
The exact mechanism behind benign prostatic hyperplasia is not fully understood, but the process is closely associated with ageing and hormonal changes.
As men age, sex hormone levels change. Dihydrotestosterone (DHT) plays a role in the growth of prostate tissue and is one of the factors associated with the development of BPH.
Other factors that may be associated with a higher risk or more pronounced symptoms include:
- Family history. If a close relative, such as your father or brother, has had prostate adenoma, your risk may be higher.
- Overweight and obesity. These conditions are associated with metabolic and hormonal changes.
- Diabetes and metabolic disorders. They may be associated with more pronounced lower urinary tract symptoms.
- Sedentary lifestyle. Insufficient physical activity may be linked to a less favorable overall health profile.
- Dietary habits. Alcohol, caffeine, and certain irritating foods may worsen urinary symptoms in some men.
Prostate enlargement is not caused by sexual activity, as some people mistakenly believe. It is mainly associated with ageing and individual factors.
Tests for an enlarged prostate
The examination usually begins with a discussion about your symptoms, lifestyle, medications, and chronic health conditions. The urologist will ask when the symptoms started and whether they have become worse over time.
A digital rectal examination (DRE) may also be performed. This allows the doctor to make an approximate assessment of the size, shape, and consistency of the prostate.
Additional tests may include:
- Ultrasound examination. This can be used to assess the prostate, bladder, and the amount of urine remaining in the bladder after urination.
- Uroflowmetry. This test measures the speed and characteristics of urine flow by having the patient urinate into a special device.
- PSA test. Prostate-specific antigen may be included as part of prostate assessment. The result is interpreted by a doctor together with the patient’s age, symptoms, physical examination, and other test results.
- Urinalysis. This helps detect signs of infection, blood in the urine, or other abnormalities.
- Post-void residual urine measurement. The amount of urine remaining in the bladder after urination is important when assessing the severity of urinary obstruction.
What do the main tests evaluate?
| Test | What it evaluates |
|---|---|
| Digital rectal examination | The size, shape, and consistency of the prostate |
| Ultrasound | The prostate, bladder, and post-void residual urine |
| Uroflowmetry | The speed and strength of urine flow |
| PSA | A marker assessed together with other information about the prostate |
| Urinalysis | Signs of infection, blood, and other abnormalities |
Treatment of benign prostatic hyperplasia
Treatment is determined individually according to the severity of symptoms, prostate size, post-void residual urine, general health, and the impact of the condition on quality of life.
Monitoring for mild symptoms
When symptoms are mild, the doctor may recommend active monitoring with regular check-ups and follow-up tests.
It may also be helpful to pay attention to everyday habits, such as the amount of fluid consumed in the evening, caffeine and alcohol intake, physical activity, and body weight.
Medical treatment
For moderate to more severe symptoms, medication may be prescribed. Commonly used groups of medicines include:
- Alpha-blockers. These medications relax the smooth muscles around the prostate and bladder neck and may improve urine flow.
- 5-alpha-reductase inhibitors. These medications affect the conversion of testosterone into DHT and, in suitable patients, may gradually reduce prostate size and the risk of disease progression.
In certain patients, a combination of medications may be used depending on symptoms, prostate size, and the risk of progression.
If you are considering dietary supplements or other products related to prostate health, including Urosterol, discuss their use with a doctor or pharmacist, especially if you are already taking medication.
Surgical treatment
Not every patient requires surgery. Interventional treatment may be considered when symptoms are severe, medication does not provide sufficient relief, or complications develop.
Reasons for considering an intervention may include recurrent or severe urinary retention, bladder stones, recurrent infections, a significant amount of residual urine, or impaired kidney function. The specific procedure is selected by the urologist according to the patient’s condition and individual characteristics.
When should you not delay seeing a urologist?
A medical consultation is recommended when symptoms become more pronounced, you wake up repeatedly during the night to urinate, the urine stream becomes weaker, or the feeling of incomplete bladder emptying becomes persistent.
If you suddenly become unable to urinate, notice visible blood in the urine, develop a fever, or experience severe pain, you should seek medical attention promptly.
Timely assessment helps determine the right treatment
An enlarged prostate does not automatically mean that surgery is necessary. For some men, regular monitoring may be sufficient; others may need medication, while interventional treatment may be considered when certain complications are present.
The most important thing is not to regard urinary symptoms as an unavoidable part of ageing. A timely consultation with a urologist and the appropriate diagnostic tests can help identify the cause of urinary problems and determine the most suitable treatment approach for the individual patient.