Prostate growth or enlargement

Condition

This condition is sometimes called 'Benign Prostatic Enlargement' (BPE), and is also known as Benign Prostatic Hypertrophy (BPH). The key word here is 'benign' and indicates this is not cancer.

The prostate grows as men age, beginning in the 40s or 50s and onwards, and this growth can have an impact on bladder function. The problem often manifests as trouble with urination, such as weak urine flow, going to the toilet frequently during the day and/or overnight, a feeling of not emptying the bladder fully, difficulty starting the flow and dribbling towards the end. It can also cause symptoms of having to go in a hurry and sometimes leaking before arriving at the toilet (urgency and urge incontinence). The symptoms can take many years to appear and can get progressively worse.

If left untreated, these symptoms can culminate in complete urinary retention - where the patient has a full bladder but cannot urinate at all. This is usually extremely uncomfortable and will usually need a visit to an Emergency Department where a catheter will be inserted into the bladder to drain it. 

Treatment

Patients who present to a urologist with symptoms suggestive of BPE/BPH will undergo a thorough history and investigation, including a rectal exam of the prostate, and a urine flow test.

If the symptoms are not too bad and the patient can tolerate them, and other investigations do not point to any serious problems, then the symptoms can be simply monitored, with follow up visits every 6 to 12 months.

For more serious problems, the first step in treatment is usually medical therapy, using two major groups of drugs in tablet form:

• Alpha-blockers, which relax the bladder muscle fibres at the top of the prostate and allow the flow to start easier, the bladder to empty better, and generally decrease the overall amount and severity of symptoms the patient is experiencing. 

• 5-alpha reductase inhibitors, these tablets prevent the conversion of testosterone to the active form within the prostate cells, and result in gradual shrinkage of the prostate over 6 months by up 20-40% in volume. Generally these are used in patients with larger prostates, and do have some side effects in some men including effects on libido and erectile quality which can impact their ongoing use.

Generally patients can remain on medical therapy indefinitely if it controls their symptoms and if it is well tolerated.

Surgical treatment of the prostate enlargement is a common operation known as a TURP (transurethral resection of the prostate). 

A TURP involves the insertion of a resectoscope (a combined visual and surgical instrument) through the tip of your penis and into the tube that carries urine from your bladder (urethra). Using the resectoscope, your surgeon trims away excess prostate tissue that's blocking urine flow.