What Is Benign Prostatic Hyperplasia (BPH)?

The prostate is a gland located in the male pelvis just below the bladder, which surrounds the urethra. It is responsible for creating a fluid that supports sperm and is a major part of semen. During puberty the prostate doubles in size; it continues to grow (albeit more slowly) for the rest of a man’s life.

If the prostate becomes too large, it puts pressure on the urethra, leading to obstruction. The blockage can lead to a variety of urinary and pelvic issues. An enlarged prostate that is not caused by cancer is called benign prostatic hyperplasia, or BPH – “benign” meaning noncancerous, “prostatic” referring to the prostate, and “hyperplasia” referring to the overgrowth of glandular tissue. It may also be referred to as benign prostatic hypertrophy, though hyperplasia is the preferred medical term.

What Causes BPH?

BPH is one of the most common conditions diagnosed in men over the age of 50. In fact, 30-40% of men are estimated to have an enlarged prostate in their 40s, and that number rises to 70-80% by the time men reach 80 years of age.¹ So why does it happen?

Right now, we don’t have a conclusive answer. Most studies point to hormonal changes as a key factor in prostate growth, especially changes to DHT, androgen, and testosterone levels. Because the prostate never stops growing, age also plays a role in BPH. But most researchers agree that the condition is complex with multiple avenues for development.

Risk Factors for Prostate Enlargement

Age over 40
Family history of prostatic hyperplasia
Type II Diabetes
Obesity
Heart disease and circulation issues
Erectile dysfunction (ED)
Sedentary lifestyle

Benign Prostate Hyperplasia Symptoms

When the prostate becomes enlarged, it squeezes the urethra, cutting off the proper flow of urine and semen. This can cause pain during urination or ejaculation, a feeling of incomplete urinating, and urinary frequency and urgency because the bladder is not being fully emptied during urination. Other lower urinary tract symptoms (LUTS)² of BPH include:

Incontinence, such as urinary “dribbling” or leakage
Urine that has a dark color or foul odor
Weak urine stream
Waking up in the night to urinate (called nocturia)
Straining to urinate

Unfortunately, the symptoms of BPH overlap with signs of other serious conditions, including prostate and bladder cancer, bladder stones, urethral strictures, pelvic floor spasms, and neurogenic bladder. Left unaddressed, both BPH and these other conditions can worsen and make treatment more difficult.

If you are experiencing any BPH symptoms, it’s time to schedule an appointment with your primary care physician or a urologist. They will then perform tests to rule out cancer and other diagnoses before recommending BPH treatment.

Get BPH Treatment Today

If you’re experiencing symptoms, schedule an appointment with your primary care provider as soon as possible.

Contact Us Today

Prostate Artery Embolization

How BPH Is Diagnosed

There are several ways to diagnose men with BPH. Most doctors will begin by taking a full patient history and asking questions about urinary and pelvic symptoms. The next step is usually a digital rectal exam (DRE), in which the physician places a finger inside the anus to feel for prostate enlargement or other anatomical changes. If their findings warrant further investigation, the physician may then order a number of different tests:

PSA blood tests check for abnormal levels of prostate-specific-antigen in the body.
Urodynamic testing of urine pressure flow and post-void residual urine volumes are used to assess bladder and urethral function.
Cystoscopy uses a small, lighted catheter with a camera, inserted into the urethra, to look at the interior of the bladder.
MRI, CT scans, and ultrasounds can be used to see anatomical changes in the prostate, bladder, and pelvis.
Prostate biopsy involves removing a small amount of prostate tissue to test for cancer.

Treatment Options for Benign Prostate Hyperplasia

Among men with enlarged prostates, more than 50% will have symptoms bothersome enough to require treatment.³ For those whose quality of life is not impacted by symptoms, physicians commonly recommend “watchful waiting” and re-evaluation over time.

Mild to moderate prostate enlargement can be managed with medication and/or lifestyle changes. Patients may be advised to avoid alcohol and caffeine, increase mobility, lose weight, or use pelvic floor exercises to relieve symptoms.

There are a number of medications used to treat BPH, most of which are designed to help increase, decrease, or maintain hormone levels that can affect prostate size. More severe BPH cases, or those in which medication is not helpful, may require procedural intervention.

Minimally Invasive BPH Treatments

Because the prevalence of BPH increases with age, many patients may have contraindications for medications or surgery. For example, most surgical options require the patient to undergo general anesthesia, which can be risky for elderly patients, as well as those with certain heart and lung issues. Additionally, surgical resection or removal of the prostate can result in complications such as urinary incontinence and erectile dysfunction.

When a patient can’t have surgery or wants to avoid its potential side effects, minimally invasive treatment options are an effective alternative. These include:

Prostatic Artery Embolization (PAE): Uses a catheter to deposit microscopic particles to block specific prostate blood vessels, cutting off oxygen and shrinking the prostate without requiring general anesthesia.
Aquablation: Uses ultrasound guidance to direct a high-pressure stream of saline, removing a portion of prostate tissue.
Paclitaxel-coated prostatic balloon dilation: Inserts a balloon covered in a chemotherapy drug to deliver targeted medicine that inhibits prostate growth, while a second dilation balloon opens up the urethra.
Water vapor thermal infusion: Uses a needle to deliver steam directly into the prostate, causing excess cells to die and be reabsorbed into the body.
Transurethral microwave thermotherapy: Transmits microwave heat into the prostate to destroy overgrown tissue.

Surgery Options for Enlarged Prostate

Surgical treatments for BPH fall into three main categories. Prostate saving surgeries focus on relieving BPH symptoms while preserving prostate tissue. Resection procedures seek to “debulk” or remove parts of the prostate to ease symptoms while maintaining some glandular functionality. Prostate removal is the most extreme option, reserved for those with severe symptoms, for whom other treatments have been unsuccessful.

Prostate Saving Surgeries	Prostate Resection Surgeries	Prostate Removal Surgeries
Prostate Saving Surgeries Transurethral incision of the prostate Prostatic urethral lift	Prostate Resection Surgeries Transurethral resection of the prostate (TURP) Transurethral electrovaporization Transurethral laser vaporization Holmium laser enucleation of the prostate (HoLEP) Thulium laser enucleation of the prostate (ThuLEP)	Prostate Removal Surgeries Open, laparoscopic, or robot-assisted prostatectomy

Learn About Your Benign Prostatic Hyperplasia (BPH) Treatment Options

For more information on prostate artery embolization for BPH, reach out to our New Jersey radiology clinic.