Enlarged Prostate

What is the prostate gland?

The prostate is a small walnut-shaped gland in the male reproductive system. Its primary function is to produce prostate fluid, which is crucial to fertility as it nourishes and transports sperm.

The prostate gland is located below the bladder. The water pipe (urethra) passes through the prostate and carries urine from the bladder or, during orgasm, carries semen.

The prostate gland has a role in hormone production. It changes testosterone into a biologically active form called dihydrotestosterone (DHT) which is ten times more potent.

What causes Benign Prostatic Hyperplasia BPH?

It's a common finding in men over 50 and tends to progress with age.

In some men, the prostate grows only mildly; in others, larger than expected, the prostate becomes huge.  

The exact cause why a prostate grows is not known. However a combination of genetics, hormonal changes and environmental influence may be implicated

Is an enlarged prostate common?

The prostate starts growing from the age of around 30 years. Interestingly at that age, testosterone levels start declining at a rate of 0.7% per year.

Benign prostatic hyperplasia is more common as men age, as shown below;

• 50% of men between the ages of 51 and 60-year group
• 70% of men between the ages of 60 to 69-year group
• 80% of men over the age of 70 to 79-year group
• 90% of men over the age of 80 years

Does prostate size matter?

Changes in urinary voiding habits can be found in small or enlarged prostates.

Knowledge of the size of the prostate helps in decision-making regarding treatment.

A normal prostate is walnut-sized and would be around 25 ml.

An enlarged prostate means:

• small prostate, 30 ml to 40 ml
• medium prostate, 40 ml to 80 ml  
• large prostate, 40 mL to 100 mL
• extra-large prostate greater than 150ml  

BPH Statistics at a Glance

Latest treatment options for enlarged prostate

The following will be a detailed snapshot about what you need to know and the options you can explore. As a urologist specialised in this field I provide all my patients with information of what is available. Today bespoke treatment for an enlarged  prostate is possible.

The Best Natural Methods to Reduce Prostate Enlargement

There is no solid research that proves particular food effectiveness or food role in prevention; however, the most common natural food allegedly quoted that may counteract prostate enlargement are;

• Beta-sitosterol food sources (avocados, pecans, soybeans)
• Zinc Food sources (sesame seeds, pumpkin seeds)
• Vitamin C food sources (Bell peppers, kale, cauliflower)
• Lycopene food sources (tomatoes, watermelon, grapefruit, papaya)
• Tofu

What key Lifestyle Changes Can Help with Enlarged Prostate Symptoms?

1. Switch  to Decaffeinated Beverages:     Choose decaffeinated tea and coffee.
2. Avoid  fizzy drinks, spices, sweeteners, and juices as they can irritate the bladder lining.
3. Quit Smoking: Smoking chemicals can aggravate lower urinary tract issues.
4. Reduce  Alcohol Consumption:  Either stop drinking alcohol or cut down your intake.
5. Manage Evening Fluid Intake: Avoid  drinking fluids three hours before bedtime and do not drink during the night. Waking up once at night to urinate is normal after fifty, and twice      is common after sixty.
6. Lose Excess Weight: Shedding extra pounds can help reduce      symptoms.
7. Engage in Regular Exercise:  Maintaining regular physical activity can improve your overall health and  help manage symptoms.
8. Prevent Constipation: Keep your bowel movements regular to  avoid additional pressure on your bladder.

Choosing the Right Medical Treatment for Prostate Enlargement

1. Alpha-blockers (tamsulosin/alfuzosin/ doxazosin).

These medications relax the muscles in the bladder, bladder, neck and urethra and help to improve urine flow. Healthcare providers can prescribe them to treat high blood pressure and treat chronic prostatitis. They are once-daily medications. The common side effects are dizziness (postural hypotension) which happens in around 10% of men. 5% to 10 % of men may experience erectile dysfunction, including dry orgasms.

·        5-Alpha reductase inhibitors (finasteride/dutasteride)

These medications reduce to some extent the size of the very large prostate glands and a certain degree, in some cases, stop it from growing larger. They take a long time to start being effective, typically 9 to 12 months. If you check your blood test PSA and are on one of these medications, you need to double it to get the actual result. 1% of men may complain of breast tenderness and enlargement, which needs to be stopped. In around 5% of men, it can cause erectile dysfunction.

·        Phosphodiesterase inhibitors (Cialis)

These drugs are mainly prescribed for erectile issues. However, they were found to improve urinary problems by relaxing muscles in the lower urinary tract. There are various medications, commonly Cialis, on a daily dose is prescribed. Common side effects include headaches, flushing, indigestion, nasal congestion, flu-like symptoms, vision issues, back pain and muscle pain.

·        Anticholinergics (solifenacin/ oxybutynin/ trospium)

They relax the bladder muscles reducing bladder spasms. They address mainly overactive bladder symptoms. The most common side effects are dry mouth, constipation, frontal facial fullness, tiredness and impaired memory.

·        combination of medications.

The above medications are initially prescribed as a stand-alone; however, if BPH symptoms do not improve or bothersome symptoms worsen, a combination of drugs can be tried before considering surgical management.  

Top Surgical Methods to Treat an Enlarged Prostate

Transurethral Resection of the Prostate (TURP)

A procedure where a particular tool removes excess prostate tissue through the urethra, improving urine flow.

Bladder Neck Incision (BNI)

Small incisions are made at the bladder neck to relieve tightness and improve urine flow.

Laser Prostate Surgery

It involves using lasers to remove (HoLeP) or vaporise (Greenlight) excess prostate tissue, suitable for larger prostates.

Prostatic Urethral Lift (UroLift)

Minimally invasive method that uses implants to hold prostate tissue out of the way, improving urine flow.

REZUM

A treatment that uses steam to reduce prostate size, ideal for moderately enlarged prostates.

Aquablation

Robotic technology uses a water jet guided by real-time ultrasound to remove prostate tissue.

Simple Open Prostatectomy

Traditional open surgery to remove large amounts of prostate tissue, used less frequently due to more advanced options available.

Prostatic Arterial Embolisation (PAE)

A minimally invasive procedure that blocks blood flow to the prostate to reduce its size.