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The prostate is a male reproductive gland that produces the fluid that carries sperm during ejaculation. It surrounds the urethra, the tube through which urine passes out of the body.

An enlarged prostate means the gland has grown bigger. Prostate enlargement happens to almost all men as they get older. As the gland grows, it can press on the urethra and cause urination and bladder problems.

An enlarged prostate is often called benign prostatic hyperplasia (BPH) or benign prostatic hypertrophy. It is not cancer, and it does not raise your risk for prostate cancer.

Watch this video about: Enlarged prostate gland

BPH; Benign prostatic hypertrophy (hyperplasia); Prostate - enlarged

The actual cause of prostate enlargement is unknown. Factors linked to aging and the testicles themselves may play a role in the growth of the gland. Men who have had their testicles removed at a young age (for example, as a result of testicular cancer) do not develop BPH.

Similarly, if the testicles are removed after a man develops BPH, the prostate begins to shrink in size.

Some facts about prostate enlargement:

• The likelihood of developing an enlarged prostate increases with age.
• BPH is so common that it has been said all men will have an enlarged prostate if they live long enough.
• A small amount of prostate enlargement is present in many men over age 40 and more than 90% of men over age 80.
• No risk factors have been identified other than having normally functioning testicles.

Less than half of all men with BPH have symptoms of the disease, which include:

• Dribbling at the end of urinating
• Inability to urinate (urinary retention)
• Incomplete emptying of your bladder
• Incontinence
• Needing to urinate two or more times per night
• Pain with urination or bloody urine (these may indicate infection)
• Slowed or delayed start of the urinary stream
• Straining to urinate
• Strong and sudden urge to urinate
• Weak urine stream

After taking a complete medical history, your doctor will perform a digital rectal exam to feel the prostate gland. The following tests may also be performed:

• Urine flow rate
• Post-void residual urine test to see how much urine is left in your bladder after urination
• Pressure flow studies to measure the pressure in the bladder as you urinate
• Urinalysis to check for blood or infection
• Urine culture to check for infection
• Prostate-specific antigen (PSA) blood test to screen for prostate cancer
• Cystoscopy

In addition, you may be asked to complete a form to evaluate the severity of your symptoms and their impact on your daily life. Your score may be compared to past records to determine if the condition is getting worse.

See: BPH support groups

Men who have had long-standing BPH with a gradual increase in symptoms may develop:

• Sudden inability to urinate
• Urinary tract infections
• Urinary stones
• Damage to the kidneys
• Blood in the urine

Even after surgical treatment, a recurrence of BPH may develop over time.

Call your doctor right away if you have:

• Less urine than usual
• Fever or chills
• Back, side, or abdominal pain
• Blood or pus in your urine

Also call your doctor if:

• Your bladder does not feel completely empty after you urinate
• You take medications that may cause urinary problems, like diuretics, antihistamines, antidepressants, or sedatives. Do NOT stop or adjust your medications on your own without talking to your doctor
• You have taken self-care measures for 2 months without relief

Bent S, Kane C, Shinohara K, et. al. Saw palmetto for benign prostatic hyperplasia. NEJM. 2006; 354:557-566.

Abrams P, Chapple C, Khoury S, Roehrborn C, de la Rosette J; International Scientific Committee. Evaluation and treatment of lower urinary tract symptoms in older men. J Urol. 2009;181:1779-1787.

Kirby R, Lepor H. Evaluation and Nonsurgical Management of Benign Prostatic Hyperplasia. In: Wein AJ, Kavoussi LR, Novick AC, Partin AW, Peters CA, eds. Campbell-Walsh Urology. 9th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 87.

Lourenco T, Pickard R, Vale L, Grant A, Fraser C, MacLennan G, et al. Minimally invasive treatments for benign prostatic enlargement: systematic review of randomised clinical trials. BMJ. 2008 Oct 9;337:a1662.doi:10.1136/bmj.a1662.

Roehrborn CG, McConnell JD. Benign Prostatic Hyperplasia: Etiology, Pathophysiology, Epidemiology, and Natural History. Wein AJ, Kavoussi LR, Novick AC, Partin AW, Peters CA, eds. Campbell-Walsh Urology. 9th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 86.

Rich KT, Safranek S. PPIN's clinical inquiries. Medical treatment of benign prostatic hyperplasia. Am Fam Physician. 2008;77:665-666.