What is the prostate gland?
The prostate is a male reproductive gland located beneath the bladder, surrounding the upper urethra, in front of the rectum. It cannot be examined externally and must be assessed through a rectal examination. In adult men, it is roughly the size of a walnut and is responsible for producing approximately 30% of seminal fluid. As men age, the prostate naturally enlarges and its tissue may undergo benign (non-cancerous) changes driven by ageing and male sex hormones.
What is BPH and how does it develop?
Enlarged prostate or Benign Prostatic Hyperplasia (BPH) occurs when the prostate grows abnormally large. The enlarged inner tissue — which encircles the urethra — compresses it, restricting urine flow. At the same time, increased nerve stimulation around the bladder neck and prostate causes the urethral sphincter to contract more than normal, further contributing to symptoms. Notably, the neurological component tends to cause more symptoms than the size of the gland itself.
BPH is common in men over 40, with prevalence rising with age. By the age of 80, approximately 80% of men will have the condition. However, only 40–50% will develop noticeable symptoms.
Can an enlarged prostate develop into prostate cancer?
No, enlarged prostate is not cancer and does not become prostate cancer, though both conditions can coexist, as they arise in different parts of the prostate.
Symptoms
Obstructive symptoms (caused by urethral compression):
- Weak or slow urine stream
- Difficulty initiating urination, requiring straining or waiting
- Interrupted stream — starting and stopping
- Dribbling after urination ends
- Feeling of incomplete bladder emptying
- Complete inability to urinate despite a strong urge
Irritative symptoms (caused by the bladder’s response to the enlarged prostate):
- Frequent urination, unable to hold for more than two hours
- Waking more than twice at night to urinate
- Sudden, urgent need to urinate that is difficult to control
Other symptoms may include blood in the urine, or signs of urinary tract infection such as cloudy or strong-smelling urine, fever, or chills. Prolonged urinary obstruction can, in rare cases, lead to chronic kidney failure.
Complications
If left untreated, BPH can lead to kidney failure, urinary tract infections, and bladder stones.
Diagnosis
Diagnosis typically involves the following steps, with items 1–3 forming the essential baseline assessment before further investigations are considered:
- Medical history — the doctor will ask about symptoms and their duration, and may use a validated urinary symptom scoring questionnaire
- Digital rectal examination — the doctor assesses the size and surface texture of the prostate to help distinguish BPH from prostate cancer
- Uroflowmetry and post-void residual measurement — evaluates urine flow rate and the volume of urine remaining in the bladder after voiding
- PSA (Prostate-Specific Antigen) blood test — a blood enzyme marker used to screen for prostate abnormalities
- Ultrasound — measures prostate size; if PSA is significantly elevated, a fine-needle biopsy may be performed to investigate further
- Cystoscopy — internal examination of the bladder using a scope, performed when clinically indicated
