Prostate enlargement

What is it?

In young men, the prostate has a volume comparable to a walnut. At an older age, the prostate increased in volume. This age-related increase in benign prostate tissue is called ‘benign prostatic hypertrophy’ (B.P.H.). The disadvantage of this increase in volume is that it can block the urethra, making it difficult to urinate.

A prostate enlargement has nothing to do with prostate cancer. A prostate enlargement is also not the pre-stage of prostate cancer.

What are the symptoms of a prostate enlargement?

• Frequent urination
• Getting up at night to urinate
• Urge to urinate
• The feeling of not being able to empty the bladder completely
• Slow start of urination
• Weak urine flow
• Intermittent urination flow: stopping... starting
• Urine loss (sometimes)
• Painful urination (sometimes)
• Blood in the urine (only in exceptional cases)
• Inability to urinate (also called acute urinary retention)

How is the diagnosis determined?

• Rectal examination
• Blood tests (Prostate Specific Antigens)
• Transrectal ultrasound imaging
• Prostate symptom score (IPSS)
• Uroflowmetry
• Cystoscopy
• Prostate puncture biopsy (sometimes)

How is prostate enlargement treated?

Medication

• Alpha blockers

Medication of the alpha-blockers class stimulates the urethra. Improvements can usually be noticed within a few days or weeks. This improvement will only continue as long as the medication is taken.

Typical side effects are fatigue, dizziness and a dry orgasm. These side effects are infrequent and reversible, which means that they will disappear when the medication is stopped.

• 5-alpha reductase inhibitors

5-alpha-reductase inhibitors block the action of the hormones that stimulate prostate growth. This medication is especially indicated in case of very pronounced swelling of the prostate. Because it takes some time for the prostate to shrink effectively, it can take several months before you notice any improvement.

Side effects occur in less than 10% of patients. These are a decrease in sperm volume, a lower libido and problematic erections. This medication is often prescribed together with an alpha-blocker.

• Homeopathy

There is some discussion about how effective all kinds of plant extracts really are in the treatment of benign prostatic hypertrophy, but a (limited) beneficial effect of plant extracts on prostate-related urinary problems is presumed.

It can also help to drink less (especially in the evening), avoid caffeine or spicy food, avoid certain medications and treat constipation.

Surgery

• Transurethral Resection Prostate (TURP)
• Laser vaporisation of the prostate
• Open prostate surgery (adenomectomy)
• Watchful-waiting approach

Latest publication date: 12/12/2023
Supervising author: Dr Ameye Filip