Enlarged prostate (BPH)

What is it?

The prostate surrounds the urethra, the tube that carries urine out of the bladder. As the prostate grows, it can narrow the urethra and make it harder to empty the bladder. BPH is not cancer and does not turn into cancer.

Common symptoms

• A weak or slow urine stream, or difficulty starting
• Needing to urinate often or urgently
• Getting up at night to urinate
• Feeling that your bladder has not fully emptied
• Dribbling at the end of urination

How we assess it

• A review of your symptoms, often with a short questionnaire
• A physical examination, including a prostate examination
• A urine test and, when appropriate, a PSA blood test
• A urine flow test and a bladder scan to measure how well your bladder empties
• Sometimes an ultrasound or a cystoscopy (a look inside the bladder with a thin camera)

Treatment options

Lifestyle changes

Mild symptoms can often be improved by drinking less in the evening, limiting caffeine and alcohol, and emptying the bladder on a regular schedule.

Medications

Alpha blockers relax the muscle of the prostate and bladder neck and usually work within days. 5-alpha reductase inhibitors shrink the prostate gradually over several months. The two are sometimes used together.

Surgery

Surgery may be recommended if medications do not help enough, cause side effects, or if the prostate causes complications such as being unable to urinate. Options include GreenLight laser vapourization, usually done without an overnight stay, and transurethral resection of the prostate (TURP). Neither requires an incision.