Benign Prostatic Hyperplasia (BPH)
Non-cancerous enlargement of the prostate causing lower urinary tract symptoms in older men.
Overview
Benign prostatic hyperplasia is the histological diagnosis underlying most lower urinary tract symptoms (LUTS) in older men. It causes voiding difficulty, frequency and nocturia, with risk of urinary retention. It is not prostate cancer, but the two can coexist.
Symptoms
- • Hesitancy, weak stream, intermittent flow
- • Straining, incomplete emptying, post-void dribbling
- • Frequency, urgency, nocturia
- • Acute retention — painful, sudden inability to pass urine
Risk factors
- • Age >50 (rises steeply)
- • Family history
- • Obesity, metabolic syndrome
- • Lack of physical activity
Causes
- • Age-related hyperplasia of prostatic glandular and stromal tissue
- • Androgen-driven; not caused by sexual activity
🚨 Red flags — seek urgent care
- • Acute painful urinary retention — emergency
- • Visible haematuria
- • Recurrent UTIs
- • Weight loss, bone pain — consider prostate cancer
- • Renal impairment from chronic obstruction
When to seek care
- • Bothersome LUTS
- • Any blood in urine — urgent assessment
- • Suspected acute retention — emergency
Diagnosis
- • Symptom score (IPSS) and quality-of-life score
- • Urinalysis, U&E, PSA (after counselling)
- • Digital rectal examination
- • Post-void residual ultrasound, uroflowmetry
- • Refer urology for haematuria, retention, abnormal DRE or raised PSA
Treatment
- • Conservative: fluid timing, bladder training, treat constipation, review diuretics
- • Alpha-blocker (tamsulosin) for symptom relief
- • 5-alpha-reductase inhibitor (finasteride) for larger prostates — reduces progression
- • Combination therapy for moderate-severe LUTS with large prostate
- • Surgery: TURP, HoLEP, prostatic urethral lift, Rezum for refractory or complicated disease
Prevention
- • Maintain healthy weight and regular physical activity
- • Manage cardiometabolic risk
Complications
- • Acute and chronic urinary retention
- • Recurrent UTIs
- • Bladder stones
- • Bladder dysfunction
- • Renal impairment in severe obstruction
Prognosis
BPH is progressive but rarely dangerous. Most men achieve good symptom control with medication; surgery is highly effective for refractory disease and complications.
Education & self-care
BPH is common, treatable and not cancer. Bothersome urinary symptoms warrant assessment — most respond well to medication.
Frequently asked questions
Does BPH cause prostate cancer?
No — BPH and prostate cancer are separate conditions, although they can occur together and both increase with age.
Will I need surgery?
Most men do well with lifestyle changes and medication. Surgery is reserved for severe, refractory or complicated cases.
Is benign prostatic enlargement a sign of cancer?
No. BPH and prostate cancer are different conditions, although they can coexist. Investigation usually includes a digital exam, urinary symptom score, urine flow, and a PSA test if appropriate.
How long do tamsulosin and finasteride take to work?
Tamsulosin improves flow within days. 5-alpha reductase inhibitors like finasteride shrink the prostate and need 3–6 months for full effect.
When is surgery needed?
Surgical options (TURP, laser, Urolift, Rezum) are considered when symptoms remain bothersome despite medication, or when there is recurrent retention, stones, infections or kidney impact.