KEY TAKEAWAYS

  • BPH is extremely common in men over 50.
  • BPH is non-cancerous but shares symptoms with prostate cancer.
  • Common signs include frequent urination, a weak urine stream, and trouble emptying the bladder.
  • Early treatment with benign prostatic hyperplasia medications or procedures can improve quality of life.
Benign Prostatic Hyperplasia

If you're a man over 40 and you've started noticing changes in your bathroom habits, maybe you're waking up more often at night to urinate or having trouble starting your stream, you're not alone. These could be signs of benign prostatic hyperplasia (BPH), a condition commonly known as an enlarged prostate.

While BPH isn’t cancer, it can cause uncomfortable symptoms that affect your quality of life. Fortunately, there are a variety of enlarged prostate treatment, from medications to minimally invasive procedures, that can help you manage it effectively.

What Is BPH?

Benign prostatic hyperplasia happens when the prostate gland grows larger over time. The prostate sits below the bladder and surrounds part of the urethra, the tube that carries urine and semen out of the body.

As the prostate enlarges, it can squeeze or block the urethra, making it harder to urinate. This can lead to a range of uncomfortable urinary symptoms. As the prostate grows, it can squeeze the urethra and block or slow down urine flow. This is why BPH can lead to urinary symptoms like a weak stream, dribbling after urination, or feeling like your bladder isn't fully empty.

Though BPH is not cancerous, it’s important to distinguish it from other conditions, especially prostate cancer, which can cause similar symptoms.

Who Gets BPH?

BPH is extremely common in older men. Nearly half of all men over 60 have some signs of an enlarged prostate. By age 85, that number jumps to around 90%.

In Malaysia, for example, the National Health and Morbidity Survey (2019) found that 16% of men over 40 show signs of BPH. Among men over 75, that number doubles.

Risk factors for developing BPH include:

  • Age (especially after 50)
  • Family history of prostate problems
  • Obesity or chronic illness, like diabetes or heart disease
  • Hormonal changes, including those triggered by testosterone supplements

Symptoms of an Enlarged Prostate

Before we are going to enlarged prostate treatment, we need to understand that not everyone with BPH will notice symptoms right away, but for many, they gradually appear and worsen over time.

Common symptoms:
- Frequent or urgent need to urinate
- Waking often at night to pee (nocturia)
- Difficulty starting urination
- Weak or interrupted urine stream
- Dribbling after urination
- Feeling like the bladder isn’t fully empty

Less common symptoms: 
- Urinary tract infections (UTIs)
- Blood in the urine
- Complete inability to urinate

Interestingly, the size of the prostate doesn’t always match symptom severity. Some men with only slightly enlarged prostates have serious symptoms, while others with large prostates feel fine.

What Causes BPH?

While the exact cause isn’t fully understood, most experts agree that hormonal changes with age play a major role.

As testosterone levels drop and estrogen levels remain steady, this imbalance may trigger prostate cell growth. In addition:

  • Dihydrotestosterone (DHT), a potent form of testosterone, builds up and encourages prostate enlargement.
  • Men taking testosterone therapy may develop or worsen BPH symptoms.

BPH is not contagious, and you can’t catch it from someone else. 

SUMMARY

As men get older, testosterone levels gradually drop. At the same time, estrogen levels stay relatively the same, which may affect how prostate cells grow. Another hormone, dihydrotestosterone (DHT) which is a powerful form of testosterone is also known to play a role. Men with higher levels of DHT tend to have larger prostates.

Diagnosis and When to See a Doctor

If you're experiencing any urinary symptoms, it’s time to talk to your doctor. You may be referred to a urologist, a specialist in urinary and prostate conditions.

Diagnostic tests may include:

  • Digital rectal exam (DRE) to feel the size of the prostate
  • PSA blood test to check for signs of cancer
  • Urinalysis to rule out infection
  • Ultrasound or bladder scan
  • Cystoscopy in complex cases

Annual prostate screenings are recommended starting at age 55–69. If you're at higher risk (e.g., Black or with a family history), screenings should start at age 40.

Enlarged Prostate Treatment Options

There’s no one-size-fits-all approach. Treatment depends on your symptoms, prostate size, age, and health status.

1. Medications

Benign prostatic hyperplasia medications are often the first line of defense. They include: - Alpha blockers (like tamsulosin): Relax muscles around the bladder neck and prostate to ease urination. - 5-alpha reductase inhibitors (like finasteride): Reduce prostate size by lowering DHT levels. - Combination therapy: Using both for better results. - Tadalafil (Cialis): Also used for erectile dysfunction, it may improve urinary symptoms.

2. Surgery

In more severe cases, surgical options include:
- Simple prostatectomy
- HoLEP (Holmium laser removal of prostate tissue)

Your urologist will recommend the best enlarged prostate treatment based on your symptoms and prostate size.

3. Vitamin D and BPH: A Possible Protective Role

One of the enlarged prostate treatment is considering vitamin D. Vitamin D may help reduce the risk or progression of BPH due to its anti-inflammatory and hormone-regulating effects.

What research suggests:
- Vitamin D receptors are found in prostate tissue, suggesting a biological role in prostate health.
- Vit D may inhibit cell proliferation in the prostate, slowing its growth.

Could It Be Something Else?

Not all urinary problems are caused by BPH. Other possible causes include:

  • Prostatitis (prostate inflammation)
  • Urinary tract infections
  • Bladder or kidney stones
  • Urethral strictures (narrowing of the urinary tract)
  • Prostate or bladder cancer
  • Neurological conditions affecting bladder control

Some medications, including opioids, tricyclic antidepressants, and cold/allergy drugs, can also lead to symptoms that mimic BPH. That’s why a proper diagnosis is so important before starting treatment.

What Happens if BPH Goes Untreated?

If you're dealing with frequent urination, difficulty starting, or waking up multiple times a night to pee, don’t brush it off as just “getting older.” These are signs your prostate may be enlarged, and early treatment can make a big difference.

Ignoring the signs of an enlarged prostate can lead to serious complications:

  • Bladder stones
  • Kidney damage from urine backing up
  • Frequent UTIs
  • Complete urinary retention

The good news is that most people find relief through benign prostatic hyperplasia medications, procedures, or lifestyle changes.

Final Thoughts

Benign prostatic hyperplasia is a common but manageable part of aging for many men. While it’s not cancer, the symptoms can significantly affect daily life and they often overlap with more serious conditions like prostate cancer.

Fortunately, many effective enlarged prostate treatment available, including benign prostatic hyperplasia medications, in-office procedures, and surgery. If you’re noticing changes in how you urinate, don’t ignore them. Early evaluation and treatment can save you.