Enlarged prostate

The prostate gland is the size of a walnut and lies underneath the bladder. It gradually grows bigger as men get older, with 40 per cent of over 50s and 75 per cent in their 70s affected by symptoms of an enlarged prostate, and most commonly by a condition called benign prostatic hyperplasia, or benign prostatic hyperplasia.

Causes

The main job of the prostate is to produce fluid to protect sperm, and when mixed together this forms semen. The tube (urethra) which takes urine from the bladder and through the penis runs through the prostate gland. As the prostate gland enlarges it puts pressure on the urethra, which can cause bladder problems.

It’s believed hormone changes are linked with prostate enlargement: as men age, levels of the hormone dihydrotestosterone increase which is thought to stimulate growth of the prostate gland. Levels of the hormone testosterone also decrease, while levels of the female hormone oestrogen increase, and this may stimulate growth.

Symptoms

An enlarged prostate doesn't always cause problems and only 25 to 50 per cent of men affected will have any symptoms.

Needing to pass urine more often, especially at night, is a classic sign. Other symptoms include difficulties starting to pass urine, dribbling and weaker flow which may be interrupted. You may need to push when urinating and there might be a feeling of not having emptied your bladder.

Symptoms are usually mild to start with and get progressively worse. In the later stages an enlarged prostate can cause bladder stones, infections and kidney damage. Not all urinary symptoms are caused by an enlarged prostate. See your doctor if you pass blood, become incontinent or have pain.

Diagnosis

An enlarged prostate can usually be diagnosed by symptoms, but tests are normally carried out to confirm the diagnosis and check for other causes. Your doctor will ask you to complete a questionnaire called the International Prostate Symptom Score.

Symptoms can overlap with other conditions, including prostate cancer, so further tests are done to exclude these. Urine and blood tests will check for infection and kidney function.

A rectal examination may be done to check for signs of prostate cancer, which causes the gland to become hard and bumpy. It’s the most common cancer in men, with 40,000 new cases a year in the UK. Don't worry though, you’re not any more likely to develop cancer if you have an enlarged prostate.

You might be offered a PSA test (prostate-specific antigen), a blood test measuring the amount of PSA protein produced. A raised level indicates an enlarged prostate while a high level may point to cancer. But plenty of men with high PSA levels don't have cancer and some men with prostate cancer don't have raised PSA levels.

Who gets it?

Benign prostatic hyperplasia mainly affects men over 50. Between the ages of 31 and 50 the prostate doubles in size every 4.5 years. Black men tend to be more affected than white men, possibly due to higher testosterone levels and research shows that rates of enlarged prostate are also higher in men with raised blood pressure or diabetes.

Treatments

Some men have mild symptoms and can manage with lifestyle changes. These include cutting down on caffeine, alcohol and fizzy drinks; drinking less in the evening; keeping to a healthy weight; eating more fibre to avoid constipation; bladder retraining and wearing incontinence pads or sheaths to soak up leaks.

Drugs are prescribed if lifestyle changes are not enough, these include: alpha-blockers (tamsulosin, alfuzosin, prazosin), which work by relaxing bladder muscles to make passing urine easier. Others called 5-alpha-reductase inhibitors (finasteride and dutasteride) block effects of the hormone dihydrotestosterone, reducing the size of the prostate.

One in four men will eventually need surgery to ease BPH symptoms. An operation to remove the central part of the gland creates a wider channel for urine to pass through. A new treatment uses implants in the urethra to improve urine flow.

Botulinum toxin injections are being investigated as an alternative to surgery. Vitamin D deficiency has been associated with enlarged prostate and increasing intake through diet and supplements seems to slow its growth, although more research is needed.

Nothing beats a healthy, balanced diet to provide all the nutrients we need. But when this isn’t possible supplements can help. This article isn’t intended to replace medical advice. Please consult your healthcare professional before trying supplements or herbal medicines.

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