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The prostate gland is found just beneath the bladder and is normally about the size of a chestnut. The the tube which passes urine from the bladder (the urethra) runs through the middle of the prostate. The main function of the prostate is to produce the fluid that protects and enriches sperm. After the age of 50, the prostate gradually gets bigger. 90% of men over the age of 90 have an enlarged prostate.
The symptoms of prostate enlargement are called lower urinary tract symptoms (LUTS), but these can also be caused by other conditions. As the prostate enlarges it may cause the first part of the urethra to narrow, which in turn may partially obstruct the flow of urine. Because of this symptoms can include:
An enlarged prostate may also make the bladder irritable that can cause:
Usually symptoms are mild to begin with but over months or years they may become more troublesome and severe. Complications may develop in some cases.
However, an enlarged prostate does not always cause symptoms. Only 25-50% of men with an enlarged prostate will have symptoms. Also, the severity of the symptoms is not always related to the size of the prostate. Rather, it depends on how much the prostate obstructs the urethra.
What possible complications of protate enlargement are there?
Symptoms do not worsen in everyone and serious complications are unlikely to occur in most men with an enlarged prostate.
In 1% of cases, urinary retention can occur, which is when a total blockage of urine occurs and the person will no longer be able to pass urine. In this case, a catheter will need to be inserted to drain the bladder.
Another possible complication is chronic retention, where only some of the urine in the bladder is emptied when passing urine. This may cause recurring urine infections, or incontinence.
Have an enlarged prostate does not increase the risk of prostate cancer. Men with a benign prostate enlargement are no more or less likely to develop prostate cancer than those without the condition.
Tests are not always needed to confirm the diagnosis, rather benign prostatic enlargement is usually diagnosed based on the typical symptoms described above. However, the Consultant may wish to run tests in order to rule out other causes of symptoms. Tests may include:
In most cases, an enlarged prostate does not do any damage or cause complications. Whether treatment is needed usually depends on how much bother the symptoms cause to the patient.
Symptoms can be greatly improved with treatment, although no treatment is likely to remove all symptoms. Which treatments your Consultant considers depends on how severe and troublesome your symptoms are.
The following may help if you opt not to have treatment:
This may be recommended if your symptoms are quite mild and are not affecting your life too much. Your Consultant will review the situation every year, or sooner if there is change in symptoms. Symptoms do not always become worse and may even improve.
There are two groups of medicines that may help: alpha-blockers and 5-alpha reductase inhibitors. Medicines do not cure the problem, nor do they usually make symptoms go completely. However, symptoms often ease if you take a medicine.
The severity of symptoms is not always related to the size of the prostate. A small or large enlargement may cause mild or severe symptoms. An alpha-blocker may help, whatever the size of the prostate, as it works by relaxing muscle fibres. Finasteride or dutasteride tend to work best if you have a larger prostate which has more tissue to shrink. Your doctor will advise which medicine may be best in your circumstances. Also, if you develop a problem or side-effect with one type of medicine, then another may be an option.
Combinations of medicines
In some cases, a combination of an alpha-blocker plus a 5-alpha reductase inhibitor is used. This may give quicker and better relief of symptoms than either alone. Some studies suggest that in men who take a combination of two medicines, about four in five men can stop the alpha-blocker after 6-12 months without their symptoms getting any worse. This is likely to be because the prostate will have shrunk with the 5-alpha reductase inhibitor after this time and the alpha-blocker is no longer then needed.
If symptoms are severe, or if medicines do not help, partial removal of the prostate is an option. Approximately 25% of men with an enlarged prostate will require an operation at some stage.
The operation involves only the central part of the prostate to be removed (thus creating a wide channel for urine to flow through), leaving the outer part behind. This is different to surgery for prostate cancer where the entire prostate may be removed.
There are many options for removing prostate tissue. Your Consultant will discuss the most suitable operation for you in more detail.