Benign Prostatic Hyperplasia (BPH): Symptoms, Causes & Treatment Options

What Is BPH?

Benign prostatic hyperplasia is a non-cancerous enlargement of the prostate gland that commonly affects men over 50. The prostate surrounds the urethra; enlargement compresses the urethra, causing lower urinary tract symptoms (LUTS).

Typical Symptoms (LUTS)

• Urinary frequency (day and night/nocturia).
• Urgency, sometimes with urge incontinence.
• Weak, intermittent stream.
• Hesitancy, straining to void.
• Incomplete bladder emptying, post-void dribbling.
• Less commonly: hematuria, dysuria (if complicated by infection/stone).

Pathophysiology

Stromal and epithelial hyperplasia driven by androgen (DHT) and estrogen signaling, growth factors, and chronic inflammation. Not all enlarged prostates cause symptoms; symptom severity correlates with outlet obstruction and bladder adaptation.

Evaluation

• History (IPSS/AUA symptom score), voiding diary.
• DRE (size, consistency, nodules).
• Urinalysis, PSA (age-adjusted), renal function if obstruction suspected.
• Uroflowmetry, post-void residual (PVR) ultrasound.
• Urodynamics if diagnosis unclear or prior surgery failed.

Management

• Watchful waiting: Mild symptoms, low bother.
• Lifestyle: Fluid management, timed voiding, avoid caffeine/alcohol, treat constipation.
• Medical: Alpha-blockers (tamsulosin) for rapid symptom relief; 5α-reductase inhibitors (finasteride, dutasteride) shrink prostate over 6–12 months; combination therapy for larger glands; PDE5 inhibitors (tadalafil) for LUTS/ED overlap.
• Minimally invasive: UroLift, Rezūm, TUMT, PAE.
• Surgical: TURP (gold standard), HoLEP, ThuLEP, simple prostatectomy for >80–100 g glands.

Key Point

BPH is not prostate cancer, though both can coexist. Regular screening per guidelines remains appropriate.