By Daniel Sackman

Talking about prostate health is a day in the life of a urologist. But as a specialist who treats conditions involving the male reproductive system and urinary tract, I know this conversation is far from routine for most men. That’s why I welcome opportunities to focus on issues around men’s health.

Today I’ll discuss a common clinical diagnosis — especially for men over 50 — known as benign prostatic hyperplasia, or BPH. Simply put, BPH means an enlarged prostate, a condition generally considered to be a regular part of male aging.

But what does “normal aging” really mean in terms of how men experience BPH signs or symptoms? My answer may seem vague. But every patient is different, and an enlarged prostate can cause a range of symptoms, from mildly bothersome to severely uncomfortable. Plus, you have to factor in the hereditary aspect of prostate health; if your parent or sibling has BPH, you are four times more likely to develop it yourself.

What to expect when you’re experiencing BPH.

The prostate is a small gland that sits between the bladder and the penis. Urine leaves the bladder and flows through the center of the prostate by way of the urethra. As the prostate tissue gets larger, it presses up against the urethra. As the urethra tube narrows, men may experience one or more of the following:

• A weak or slow urine stream.
• Difficulty in starting to urinate, or a stream that stops and starts.
• Nocturia, or frequent voiding at night.
• A feeling of urgency or increase in frequency.

Of course, these symptoms can also be caused by other medical conditions. To rule out other diseases, a urologist will need to do a physical exam and further testing to confirm a BPH diagnosis.

What are the treatment options for BPH?

Fortunately, men have plenty of options, especially as the prostate often continues to grow as men age. For some men who only experience mild or occasional symptoms, the best course of action may be only observation and monitoring. More bothersome or advanced symptoms can be treated with medication or surgery, as well as newer, non-invasive procedures.

BPH medications: Drugs known as alpha-blockers, such as Flomax, typically work by relaxing the muscles around the urethra. This leaves the urethra channel wider for a more normal urine flow. Another class of drugs is 5-alpha-reductase inhibitors like Proscar, which decreases the prostate’s size by as much as 25 percent. I always counsel my patients that, just like taking any medication, there can be potential side-effects to these drugs, such as changes in blood pressure and possible sexual side-effects.

Surgery for BPH: The most common BPH surgery is called a transurethral resection of the prostate, or TURP. To reduce the pressure on the urethra from the prostate enlargement, I surgically remove part of the prostate. Some men who opt for the TURP procedure can experience reoccurring urinary tract infections or even (although rare) erectile dysfunction.

Effective, non-invasive techniques: Two popular options are performed right in the office and don’t require general anesthesia. As the name suggests, the Urolift procedure lifts the prostate away from the urethra to open the channel for a better urine flow. The Rezum technique uses high-pressure steam to decrease prostate tissue enough to open the urethra. Patients usually see an improvement in symptoms within just a few weeks. Another positive outcome of these non-invasive procedures is that the effects can be beneficial for at least five years and safely be repeated if necessary.

Dr. Daniel Sackman is a MultiCare Health System urologist. This article was originally published by MultiCare in 2020 and updated in 2022.