Introduction
Benign Prostatic Enlargement (BPE) affects most men as they age. This non-cancerous growth of the prostate can make daily life harder through urinary problems. If left untreated, BPE can lead to serious health issues.
“BPE is a normal aging process in men, but when it causes bothersome symptoms, it needs medical attention,” says Dr. Michael Harrington from Northwestern University. “Today we have better and less invasive treatment options than ever before.”
This article explains BPE in simple terms. You’ll learn about its causes, symptoms, diagnosis, and treatments to help you make better health decisions.
What Is BPE?
BPE is the non-cancerous growth of the prostate gland. The prostate sits just below the bladder in men. It surrounds the urethra—the tube that carries urine out of the body. As men age, the prostate naturally grows larger.
Dr. Sarah Chen explains: “BPE differs from prostate cancer. BPE comes from normal aging, while prostate cancer involves malignant cell growth. The two conditions can exist together, but they’re very different.”
When the enlarged prostate squeezes the urethra, it causes various urinary symptoms. These range from mild annoyances to serious problems that affect sleep, daily activities, and quality of life.
How Common Is It?
BPE is extremely common in older men. About 50% of men have BPE by age 60. Up to 90% have it by age 85. The condition becomes more common as men age.
Several factors affect who gets BPE:
Age is the main risk factor. Symptoms rarely appear before 40 but become common after 50. The prostate grows about 2.4% larger each year in most men over 50.
Family history plays a big role. Men whose fathers or brothers have BPE are more likely to get it too.
Dr. James Wilson notes, “Hormones, especially testosterone and DHT, drive prostate growth. As men age, these hormone levels change, causing more prostate cells to grow.”
Other possible risk factors include obesity, diabetes, and heart disease. A recent study found that men with metabolic syndrome were 1.5 times more likely to develop serious BPE symptoms.
What Causes BPE?
Scientists don’t fully understand what causes BPE, but they’ve identified several key factors:
Hormone changes play a crucial role. As men age, levels of DHT (made from testosterone) stay high in the prostate. “DHT stimulates cell growth in the prostate,” explains Dr. Elizabeth Ramirez. “Some BPE medications work by blocking the conversion of testosterone to DHT.”
BPE affects a specific part of the prostate. It mainly involves the transition zone—the area around the urethra. This explains why it directly affects urination.
Inflammation appears to worsen BPE. Chronic inflammation may speed up prostate growth. Research shows inflammatory markers are often high in tissue samples from men with BPE symptoms.
Recent studies suggest links between metabolic problems and BPE. Insulin resistance and body-wide inflammation may contribute to prostate growth in some men.
What Are the Symptoms?
BPE symptoms usually develop slowly over months or years. They fall into two main groups: storage symptoms (related to holding urine) and voiding symptoms (related to emptying the bladder).
Common symptoms include:
- Urinating more often, sometimes every 1-2 hours
- Sudden, strong urges to urinate
- Waking up multiple times at night to urinate
- Trouble starting the urine stream
- Weak urine flow
- Starting and stopping multiple times while urinating
- Feeling that the bladder isn’t empty after urinating
- Needing to push or strain to urinate
- Leaking urine after finishing urination
“We use the International Prostate Symptom Score to measure symptom severity,” says Dr. Robert Thompson. “It helps us track changes over time and after treatment.”
Symptoms typically worsen slowly. However, some men may suddenly lose the ability to urinate—a condition called acute urinary retention. This requires immediate medical care. About 10% of men with untreated BPE will experience this within five years.
Complications if Left Untreated
Without treatment, BPE can cause several serious problems:
Urinary tract infections may occur when urine stays in the bladder. Bacteria can grow in this leftover urine. “Repeated UTIs in older men should always prompt a check for BPE,” advises Dr. Jennifer Martinez.
Bladder stones can form when minerals in urine crystallize. These stones can cause pain, blood in urine, and more blockage.
Bladder damage happens when the bladder muscle thickens from working harder. Eventually, this can lead to a weak bladder that doesn’t empty properly.
Kidney damage is the most serious risk. High pressure in the bladder can back up to the kidneys. This can cause kidney swelling and even kidney failure in severe cases.
“While less common today thanks to earlier diagnosis, kidney damage from BPE still happens and can be permanent,” warns Dr. Paul Chen. “This shows why you shouldn’t ignore urinary symptoms.”
How Is BPE Diagnosed?
Proper diagnosis of BPE involves several steps:
Your doctor will ask about your symptoms. They’ll likely use a questionnaire called the IPSS to assess how severe your symptoms are and how they affect your life.
A physical exam includes a digital rectal exam (DRE). Your doctor feels the prostate through the rectum to check its size and shape. “A DRE provides valuable initial information about prostate enlargement,” explains Dr. David Coleman.
Lab tests typically include:
- Urine tests to check for infection or blood
- Blood tests to check kidney function
- PSA test, which may be high in BPE, prostate cancer, or prostate inflammation
Urodynamic tests may measure bladder function:
- Uroflowmetry measures urine flow rate
- Post-void residual volume checks how completely the bladder empties
- Pressure flow studies for complex cases
Imaging studies may include:
- Ultrasound to measure prostate size and shape
- Sometimes MRI for more detailed images
- Cystoscopy, where a thin scope looks directly at the prostate and bladder
“Not every test is needed for every patient,” says Dr. Susan Williams. “We consider age, symptom severity, other health issues, and treatment preferences when planning the evaluation.”
Treatment Options
Treatment for BPE follows a step-by-step approach based on symptom severity, prostate size, complications, and patient preferences:
Watchful Waiting
For men with mild symptoms that don’t affect quality of life much, watchful waiting is often best. This means regular check-ups without active treatment.
“Many men with mild BPE symptoms can manage well with simple lifestyle changes,” notes Dr. Richard Johnson. “Drinking less in the evening, cutting back on caffeine and alcohol, and double-voiding—urinating, waiting a moment, then trying again—can help a lot.”
Regular follow-up is important even with watchful waiting to make sure symptoms don’t get worse.
Medications
Several types of medications can help with BPE:
Alpha-blockers (like tamsulosin, alfuzosin, and silodosin) relax muscles in the prostate and bladder neck. This makes urination easier. “Alpha-blockers work quickly, often within days,” explains Dr. Maria Rodriguez. “They’re generally well-tolerated but can cause dizziness and changes in ejaculation.”
5-alpha-reductase inhibitors (finasteride and dutasteride) shrink the prostate by blocking DHT production. These drugs typically reduce prostate size by 20-30% over 6-12 months. They work best for men with larger prostates but take longer to show benefit.
PDE5 inhibitors, particularly tadalafil, can treat BPE symptoms and erectile dysfunction together. “They improve blood flow and reduce muscle tension in the lower urinary tract,” says Dr. Thomas Lee.
Combination therapy using both an alpha-blocker and a 5-alpha-reductase inhibitor works better than either drug alone for men with larger prostates and moderate to severe symptoms.
Plant extracts like saw palmetto are popular but show mixed results in studies. “Some men report benefits from these natural remedies, but research hasn’t consistently shown they work,” cautions Dr. Nancy Baker.
Minimally Invasive Procedures
For men who don’t respond to medications or prefer to avoid daily pills, several less invasive options exist:
TUMT uses microwave energy to destroy excess prostate tissue.
TUNA employs radiofrequency energy delivered through needles to remove prostate tissue.
Rezūm uses water vapor to destroy prostate cells while preserving sexual function in most men.
UroLift places small implants that hold enlarged prostate tissue away from the urethra.
“These options can often be done as outpatient procedures with faster recovery than traditional surgery,” says Dr. Andrew Miller. “They bridge the gap between medication and more extensive surgery.”
Surgical Options
For severe symptoms, very large prostates, or complications, surgical options may be best:
TURP has long been the gold standard surgical treatment. It removes the inner portion of the prostate using an instrument inserted through the urethra. Studies show TURP provides lasting symptom relief for 15+ years in most men.
Laser procedures including HoLEP and greenlight laser vaporization cause less bleeding and require shorter hospital stays. “Laser techniques have improved greatly over the past decade,” notes Dr. Lisa Chang. “They now provide results similar to TURP with potentially fewer complications, especially for men on blood thinners.”
Open or robotic simple prostatectomy may be recommended for extremely large prostates (typically over 80-100 grams). This removes the inner portion of the prostate through an abdominal incision or with robotic assistance.
“When considering surgery, we look at prostate size, the patient’s age, overall health, concerns about sexual function, and personal preferences,” says Dr. William Peterson.
Living with BPE: Self-Care Tips
Beyond medical treatments, several lifestyle approaches can help manage BPE symptoms:
Timed voiding means urinating on a schedule rather than waiting for the urge. This can help manage frequency and urgency.
Pelvic floor exercises may improve control and reduce some symptoms, particularly after surgery.
Diet changes can help. “Some men find that cutting back on spicy foods, caffeine, and alcohol reduces irritative urinary symptoms,” advises Dr. Catherine Miller.
Regular exercise and maintaining a healthy weight are important. Obesity and metabolic syndrome are linked to worse BPE symptoms. A recent study found that overweight men who lost at least 8% of their body weight had much better urinary symptoms.
Managing fluids, especially drinking less in the evening, can reduce nighttime urination. However, staying hydrated during the day remains important.
“While these lifestyle approaches won’t cure BPE, they can greatly improve quality of life and may boost the effectiveness of medical treatments,” notes Dr. Jason Richards.
Research and Future Directions
Research into BPE continues to advance:
Scientists are investigating new drug targets, including specific growth factors and inflammatory substances involved in prostate enlargement. “We’re moving toward more targeted therapies that address the underlying causes of BPE rather than just treating symptoms,” explains Dr. Sandra Adams.
Surgical techniques keep improving, with focus on preserving sexual function, reducing complications, and enabling faster recovery. Over 20 clinical trials evaluating new surgical approaches for BPE are currently underway.
Personalized medicine approaches are gaining ground. “We’re getting better at predicting which patients will respond best to specific treatments based on factors like prostate anatomy, symptom patterns, and even genetic markers,” says Dr. Michael Chen.
Combination therapies that tackle multiple aspects of BPE at once show promise. A recent trial showed better outcomes with triple therapy (combining an alpha-blocker, 5-alpha-reductase inhibitor, and anti-inflammatory agent) compared to standard treatments for men with substantial prostatic inflammation.
Frequently Asked Questions
Is BPE the same as prostate cancer?
No. BPE is a benign (non-cancerous) condition. Prostate cancer involves abnormal, malignant cells. Both can cause similar urinary symptoms, which is why proper medical evaluation matters. “The two conditions can exist together, but BPE does not increase your risk of getting prostate cancer,” says Dr. Robert Chen.
At what age should men start watching for BPE?
BPE can begin in men in their 40s, but symptoms typically become noticeable in the 50s and 60s. By age 60, about half of all men have some degree of BPE. Dr. Alan Morris recommends that “men should report new urinary symptoms to their doctor regardless of age, but should be especially watchful after age 50.”
Can BPE cause erectile dysfunction?
BPE itself doesn’t directly cause erectile dysfunction (ED), but the conditions often occur together due to aging. Some BPE treatments may affect sexual function. “It’s important to discuss sexual function concerns with your doctor when considering BPE treatment options,” advises Dr. Laura Johnson.
Does having a vasectomy increase BPE risk?
No. Multiple large studies show vasectomy does not increase the risk of developing BPE. These are unrelated conditions affecting different parts of the male reproductive system.
Can diet affect BPE progression?
Some evidence suggests diet may influence BPE. “Men who eat Mediterranean-style diets rich in fruits, vegetables, whole grains, and healthy fats appear to have lower rates of BPE progression,” notes Dr. David Williams. Diets high in red meat and processed foods have been linked to increased risk in some studies. More research is needed for specific dietary recommendations.
Will I need surgery if I have BPE?
Not necessarily. Many men with BPE can be effectively managed with watchful waiting or medications. Surgery is typically saved for men with severe symptoms that don’t respond to other treatments, those with very large prostates, or those who develop complications. Less than 10% of men diagnosed with BPE will ultimately need surgery.
Is BPE preventable?
Currently, there’s no proven way to prevent BPE entirely. Age-related prostate growth appears to be a normal part of male aging. However, some evidence suggests that regular exercise, maintaining healthy weight, and managing conditions like diabetes and high blood pressure may help reduce the risk of severe BPE symptoms. “While we can’t prevent the prostate from growing, a healthy lifestyle may help moderate symptom progression,” explains Dr. Samuel Patterson.
Conclusion
BPE affects most men as they age, but its impact varies widely. From watchful waiting to advanced surgery, the range of treatments allows for personalized approaches based on symptom severity, prostate characteristics, and individual preferences.
“BPE is not something you simply have to live with,” concludes Dr. James Wilson. “With proper evaluation and the right treatment approach, most men can achieve significant improvement in symptoms and quality of life.”
As our understanding of BPE improves, so will treatment options—offering hope for even more effective, less invasive, and more personalized approaches. The key for men with urinary symptoms is to seek help early rather than dismissing changes as an inevitable part of aging.