What is prostate enlargement?
The prostate, also known as the prostate gland, is one of the internal sex organs in men. It lies below the urinary bladder. The urethra passes through it. During ejaculation, the prostate secretes a secretion that ensures greater sperm motility. With increasing age, the tissue cells of the prostate can multiply too much and a so-called benign prostate enlargement or benign prostatic hyperplasia (BHP) can develop. It is usually harmless. However, if the prostate enlarges more and more, it can impair the function of the urinary tract. Experts refer to the problems that occur as benign prostate syndrome.
Frequency and age
The risk of developing benign prostate enlargement increases with age. In western industrialized countries, around 65 percent of men aged 65 and 80 to 90 percent of 80-year-olds suffer from an enlarged prostate.
Prostate enlargement: causes and risk factors
It is quite normal for the prostate to slowly increase in size as you get older. In some men, however, it grows excessively. It is typical of benign prostate enlargement that the cells of three types of tissue proliferate strongly:
- Muscle tissue
- Glandular tissue
- Connective tissue
Researchers have not yet been able to fully identify the trigger for the tissue growths. However, they suspect that hormonal fluctuations in old age could be responsible for this. For example, a man’s testosterone level decreases the older he gets. However, the estrogen level remains the same. This excess oestrogen can lead to fewer prostate cells dying a natural cell death. Dihydrotestosterone (DHT) could also play a role. This is the biologically more active form of testosterone. Elevated DHT levels can cause glandular tissue to proliferate abnormally.
Symptoms: Problems with urination are typical
As the prostate lies below the bladder and surrounds the urethra, increasing prostate enlargement increases the pressure on the urethra and bladder. This can lead to various problems. Experts refer to this as benign prostate syndrome (BPS):
- You feel the need to go to the toilet more often – especially at night.
- When you go to the toilet, it takes a while for the urine to come out.
- The urine stream is rather thin and is frequently interrupted.
- You have difficulty emptying your bladder completely and need the help of your abdominal muscles.
- At the end of the toilet visit there is still some urine dripping.
- You sometimes have pain when urinating.
Some men do not feel any of this despite severe prostate enlargement. For others, however, even a small increase in tissue in the prostate leads to the above-mentioned symptoms.
Prostate enlargement: Diagnosis with us
In order to diagnose an enlarged prostate, you should describe your symptoms to us as precisely as possible at the beginning of the examination. The typical problems with urination often indicate an enlarged prostate. Various examinations (blood and urine analysis, ultrasound, uroflowmetry, MRI) can then help to make an accurate diagnosis and rule out other diseases.
Ultrasound examination
In order to determine the extent of the tissue growth in more detail, we usually carry out an ultrasound examination. At the same time, we can also determine whether and how much residual urine remains in the bladder after you have been to the toilet. The kidneys are also examined for possible damage.
Urine test for prostate enlargement
A urine sample can provide information on whether a urinary tract or prostate infection is present. These cause similar symptoms to prostate enlargement.
Uroflowmetry
For uroflowmetry, you need to urinate into a special device with as full a bladder as possible, which measures the flow rate of the urine. This method allows us to measure whether urine can flow out of the bladder unhindered.
Determination of the PSA value
Prostate cancer can also cause similar symptoms to benign prostate enlargement. To rule out a prostate tumor, we sometimes take a blood sample and determine the concentration of prostate-specific antigen (PSA) in it. If the PSA value is elevated or increases by more than 20 percent within a year, this may indicate malignant tissue growth. However, there are also many other reasons for an elevated PSA value, such as an inflamed prostate or benign prostate enlargement. Therefore, the PSA value alone is not very meaningful.
Prostate biopsy
Prostate cancer can only be ruled out beyond doubt by taking a tissue sample from the prostate (prostate biopsy). We take these using a so-called punch biopsy. This can be done via the skin in the perineal area or via the rectum. And can be performed under local or general anesthesia. A subsequent examination of the removed tissue provides information on whether the prostate enlargement is benign or malignant.
Prostate enlargement: prevention, early detection, prognosis
Problems with urination can be a first indication that you are suffering from an enlarged prostate. Let us clarify the symptoms as quickly as possible, because other diseases such as inflammations or tumors can also cause the symptoms. From the age of 50, it also makes sense to have regular urological check-ups – even if there are no symptoms. The earlier prostate cancer and benign prostate enlargement are diagnosed, the better the chances of recovery.
As the cause of prostate enlargement is still unknown, it is difficult to prevent it directly. In general, however, it is advisable to maintain a healthy lifestyle. This includes,
- get enough exercise,
- to eat a wholesome and varied diet,
- avoid being overweight,
- drink alcohol only moderately and
- to give up cigarettes as completely as possible.
Prostate enlargement: course and prognosis
An enlarged prostate often leads to residual urine remaining in the bladder. This increases the risk of developing urinary tract infections or bladder stones. If prostate enlargement remains untreated, urine can build up in both kidneys. In the worst case, this can lead to irreparable damage and even kidney failure. Sometimes the greatly enlarged prostate can lead to a complete urinary retention. In this case, the affected men can no longer urinate at all. This may cause the bladder to expand considerably, which can cause pain. Urinary retention is a medical emergency, although it is very rare.
A large proportion of men with benign prostate enlargement have only mild to moderate symptoms and can live well with it in everyday life. Sometimes the symptoms also improve temporarily. Nevertheless, the problems usually increase slowly over the years. If other therapies are unable to alleviate the symptoms sufficiently or if complications such as urinary tract infections occur repeatedly, surgery may be helpful. This can usually alleviate the symptoms effectively.
Prostate enlargement: treatment depends on the symptoms present
In the case of benign prostate enlargement, treatment depends on whether symptoms are present and how severe they are. If symptoms are mild and there are no complications, regular annual check-ups are usually sufficient. Various medications can also help to alleviate the symptoms.