Benign Prostatic Hyperplasia Frequently Asked Questions

Q: What is benign prostatic hyperplasia (BPH)?

Benign prostatic hyperplasia (BPH) refers to enlargement of the prostate gland, a walnut-shaped gland that surrounds the urethra. When the prostate increases in size, it can press on and narrow the urethra (the tube that transports urine out of the body), resulting in urinary difficulties.

There is no known cause of BPH, but it is thought to be related to changes in hormone levels as men age.

Q: How common is BPH?

BPH typically begins in men over 50 years of age, with as many as 50 percent of men experiencing symptoms by age 60. Ninety percent of men will usually report symptoms by age 85. It is uncommon for BPH to cause symptoms before the age of 40.

Q: What are the symptoms of BPH?

The enlargement of the prostate results in the narrowing of the urethra which causes the symptoms of BPH. Difficulty beginning urination, a weak urination stream, and the sense of incomplete bladder emptying are common symptoms of BPH. Others include the urge to urinate often at night and discomfort in the lower abdomen. The symptoms of BPH usually worsen over time, sometimes resulting in urge incontinence.

Q: How is BPH diagnosed?

Your primary care physician will likely refer you to a urologist who will perform a number of tests to rule out causes of urinary problems other than BPH. Your doctor may prescribe a digital rectal exam to provide a sense of the size of your prostate and discover any structural abnormalities. The physician may use a cystoscope during your examination; this instrument is inserted in the penile opening (done with a local numbing agent) and allows the physician to see inside the urethra and the bladder. A PSA blood test may be performed if prostate cancer is suspected. Learn more about getting a BPH diagnosis

Q: How is BPH treated?

There are a range of treatment options for BPH. Your urologist will work with you to devise an optimal treatment plan, taking into account the severity of your condition, your age, medical history. The Mount Sinai Hospital offers multiple treatments, including active surveillance, medications, minimally invasive procedures, and open surgery, if necessary.

  • Active surveillance: Some BPH cases are so mild that immediate treatment is not necessary. With active surveillance, also known as “watchful waiting,” your doctor will check with you periodically to assess your symptoms, discuss your quality of life, and determine any health risks.

  • Medications: Your doctor may prescribe oral agents to better manage BPH. Alpha 1-blockers relax certain muscles; so, for some men, they are helpful with urine flow. Finasteride (Proscar®) and dutasteride (Avodart®) are 5 –alpha- reductase-inhibitors, which can lower levels of hormones produced by the prostate, reduce the size of the prostate gland, increase urine flow rate, and decrease symptoms of BPH. Antibiotics may be prescribed to treat chronic prostatitis (inflammation of the prostate), which may accompany BPH.

  • Tradition surgery (retropubic or suprapubic): Open surgery is most often performed on men with large prostates and in cases when the prostate cannot be removed through the penis.

  • Minimally invasive surgery: Transurethral Resection of the Prostate, or TURP, is a minimally invasive procedure, whereby an instrument is inserted into the penis that allows the physician to shave excess tissue from the prostate.

  • Laser treatment: Photo-selective vaporization of the prostate (or PVP) uses laser energy to vaporize prostate tissue.  It generally causes less bleeding than TURP because the laser energy is absorbed by red blood cells; thus, many patients considered “high risk” and patients on blood-thinning medications might be candidates for this procedure.  In addition, there are fewer side effects in comparison to conventional TURP and generally does not require an overnight stay. 

    Bipolar cautery vaporization (also referred to as Button TURP) is an exciting new treatment option for BPH. Like the Greenlight procedure, the Button TURP is performed with saline and thus eliminates the risk of the TUR Syndrome, allowing surgeons to operate for longer than 90 minutes resulting in faster and safe ablation of large prostates. Button TURP has also demonstrated reduced bleeding and a lower readmissions rate than TURP. At The Mount Sinai Hospital, Button TURP patients are often discharged the same day as their procedure.

    Learn more about BPH treatments

Q: Can BPH be prevented?

There are no specific prevention tips because the enlargement of the prostate occurs naturally as men age.

Q: Does BPH lead to prostate cancer?

There is no evidence linking BPH to cancer, though men with prostate cancer can have BPH.

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