Introduction
Benign Prostatic Enlargement (BPE) affects most men as they age. This non-cancerous prostate growth can disrupt your life with annoying urinary problems. Many men don’t know about BPE until symptoms start. Let’s explore what BPE is, why it happens, and what you can do about it.
What is the Prostate?
The prostate is a walnut-sized gland below your bladder. It wraps around the urethra—the tube that carries urine out of your body. The prostate makes fluid that helps sperm survive.
When you’re young, your prostate is small. As you age, it naturally grows larger. This growth can eventually squeeze the urethra and block urine flow.
What is BPE?
Facts About BPE
BPE means your prostate has grown larger, but not because of cancer. It’s extremely common:
- Half of all men over 50 have some BPE
- 60% of men have it by age 60
- Nearly 90% of men have it by age 85
This makes BPE one of the most common health issues men face.
Why Does BPE Happen?
Doctors don’t fully understand what causes BPE, but several factors play a role:
Hormone Changes
- DHT (a type of testosterone) makes the prostate grow
- The balance between testosterone and estrogen shifts as you age
Age
- Your risk increases greatly after 40
- Your prostate grows faster as you get older
Family History
- BPE often runs in families
- You’re more likely to get it if your father or brothers have it
Lifestyle
- Being overweight raises your risk
- Not exercising enough can make BPE worse
- A diet high in certain fats may contribute
Health Conditions
- Diabetes and metabolic syndrome increase your risk
- Heart disease often occurs alongside BPE
Signs and Symptoms
Urinary Problems
BPE typically causes urinary symptoms that fall into three groups:
Storage Problems
- Needing to pee often
- Sudden, urgent need to pee
- Waking up at night to pee
- Can’t hold it when you need to go
Voiding Problems
- Weak urine stream
- Straining to start peeing
- Start-and-stop stream
- Taking too long to pee
- Feeling like you didn’t empty your bladder
After-Peeing Problems
- Dribbling after you finish
- Feeling like you still need to go
How BPE Affects Daily Life
These symptoms can seriously impact your quality of life:
- Night trips to the bathroom disrupt sleep
- You may avoid social events due to bathroom needs
- You might feel anxious about finding bathrooms in public
- Work productivity can suffer
- You might feel embarrassed about your symptoms
Possible Complications
Without treatment, BPE can lead to serious problems:
- Complete inability to urinate (urinary retention)
- Bladder infections
- Bladder stones
- Bladder damage
- Kidney damage in severe cases
- Blood in your urine
How Doctors Diagnose BPE
Getting a proper diagnosis involves several steps:
Medical History
Your doctor will ask about:
- How long you’ve had symptoms
- How severe your symptoms are
- Previous urinary problems
- Other health conditions
- Medications you take
You might fill out a questionnaire to rate your symptoms.
Physical Exam
Your doctor will perform a digital rectal exam (DRE) to:
- Feel your prostate size
- Check for unusual lumps
- See if your prostate feels smooth or irregular
Lab Tests
Several tests help with diagnosis:
- Urine tests to check for infection or blood
- Blood tests to check kidney function
- PSA blood test to help rule out prostate cancer
- Urine flow tests to measure your stream strength
Imaging
Some cases require additional testing:
- Ultrasound to measure prostate size
- Tests to see how much urine stays in your bladder
- Sometimes a camera exam (cystoscopy) to see inside the bladder
Other Possible Causes
Doctors must rule out other conditions with similar symptoms:
- Prostate cancer
- Narrowed urethra
- Bladder control problems due to nerve issues
- Bladder cancer
- Prostate inflammation
Treatment Options
Treatment ranges from simple changes to surgery, depending on how bad your symptoms are.
Watchful Waiting
For mild symptoms that don’t disrupt life much, doctors may suggest:
- Regular symptom monitoring
- Yearly prostate exams
- Using symptom questionnaires to track changes
- Learning when to seek more treatment
Lifestyle Changes
Simple changes often help mild to moderate symptoms:
- Drink less fluid in the evening to reduce night bathroom trips
- Avoid alcohol and caffeine
- Try to urinate twice in a row (wait a moment and try again)
- Train your bladder to hold more
- Avoid certain medications that make symptoms worse
- Exercise regularly
Medications
Several types of medicine effectively treat BPE:
Alpha Blockers
- Examples: Flomax, alfuzosin, doxazosin
- How they work: Relax muscles in the prostate and bladder
- Benefits: Quick relief (days or weeks)
- Side effects: Dizziness, ejaculation changes, tiredness
5-Alpha Reductase Inhibitors
- Examples: Proscar, Avodart
- How they work: Shrink the prostate by blocking hormones
- Benefits: Reduce prostate size by 20-30% over 6-12 months
- Side effects: Less interest in sex, erectile problems
PDE5 Inhibitors
- Example: Cialis
- How they work: Relax muscles and increase blood flow
- Benefits: Improve BPE while helping with erectile function
- Side effects: Headache, flushing, back pain
Combination Therapy
- Using two types of medicine together
- Works better for larger prostates
- More chance of side effects
Minimally Invasive Procedures
For moderate to severe symptoms that don’t respond to medicine:
TURP (Transurethral Resection of the Prostate)
- Gold standard surgical treatment
- Removes blocking tissue through the urethra
- Very effective with lasting results
- Requires hospital stay and catheter
- Possible side effects: bleeding, ejaculation changes, erection problems
TUIP (Transurethral Incision of the Prostate)
- Small cuts in the prostate to reduce pressure
- Good for smaller prostates
- Less risk to sexual function than TURP
- Quicker recovery
Laser Therapies
- Several types available (HoLEP, PVP)
- Less bleeding and shorter catheter time
- Often done as outpatient procedures
UroLift
- Places tiny implants to hold prostate tissue away from urethra
- Better preserves sexual function
- Can be done with local anesthesia
- Not as effective for very large prostates
Rezūm
- Uses steam to destroy excess prostate tissue
- Minimally invasive with quick recovery
- Preserves sexual function
- Results take several weeks to appear
Surgery Options
For very large prostates or when complications exist:
- Open prostate surgery (removes inner portion)
- Robotic-assisted surgery
- Longer recovery but very effective
- Usually for prostates larger than 80-100 grams
Living with BPE
Self-Help Strategies
Men with BPE can improve symptoms through self-care:
- Maintain a healthy weight
- Exercise regularly
- Urinate on a schedule
- Don’t hold urine for long periods
- Plan when you drink fluids
- Adjust your diet (less spicy food, fewer artificial sweeteners)
When to Call the Doctor
See a doctor if you have:
- Sudden inability to urinate (emergency!)
- Blood in your urine
- Pain when urinating
- Signs of infection (fever, chills)
- Worsening symptoms despite treatment
- Changes in kidney function
BPE and Your Sex Life
BPE itself doesn’t usually cause sexual problems, but:
- Some treatments can affect sexual function
- Worrying about urinary symptoms may affect intimacy
- Talking openly with partners helps reduce anxiety
- Discuss sexual concerns with your doctor
New Research and Future Treatments
Recent Advances
BPE treatment continues to improve:
- New medication combinations with fewer side effects
- Better minimally invasive options
- Deeper understanding of hormone effects
- More knowledge about inflammation’s role in BPE
Promising New Treatments
Exciting new approaches include:
- Prostate artery embolization (PAE) – blocks blood flow to shrink the prostate
- New types of implantable devices
- Aquablation therapy using water jets
- Advanced vapor energy technology
Personalized Treatment
Treatments are becoming more tailored to each patient:
- Genetic testing to predict treatment success
- Biomarkers to guide therapy choices
- Considering other health conditions when planning treatment
- Including patient preferences in decision-making
Common Questions
Is BPE the same as prostate cancer? No. BPE is non-cancerous prostate growth. However, you can have both conditions at once, so regular cancer screening is still important.
Can I prevent BPE? There’s no proven way to prevent it. Healthy habits like exercise, maintaining proper weight, and eating fruits and vegetables may help slow it down.
Will BPE hurt my sex life? BPE itself rarely causes sexual problems. Some treatments may affect ejaculation or erections. Talk with your doctor about sexual concerns when choosing treatments.
Will I eventually need surgery? Not necessarily. Many men manage with medications or lifestyle changes alone. Surgery is mainly for severe symptoms or complications.
Do BPE symptoms come and go? Yes. Symptoms often fluctuate. Cold weather, alcohol, and certain medications can make them worse temporarily.
Is BPE hereditary? There seems to be a genetic link. You’re more likely to develop BPE if your close male relatives have it.
Conclusion
BPE affects most men as they age. It can disrupt your life with annoying urinary symptoms. Fortunately, modern medicine offers many effective treatments from simple lifestyle changes to advanced surgical techniques.
The key to managing BPE is talking openly with your doctor, getting proper evaluation, and finding the right treatment for your situation. With good care, most men with BPE maintain a good quality of life.
Research continues to improve treatment options. Regular prostate check-ups after age 50 help catch problems early and prevent complications.