Benign Prostatic Hyperplasia (BPH) or Enlarged Prostate

Benign prostatic hyperplasia (BPH) is the medical term for a noncancerous enlargement of the prostate. The condition becomes increasingly common as men age and can cause urinary symptoms that are similar to those associated with prostate cancer. However, BPH is not cancer, and having an enlarged prostate does not increase the risk of developing prostate cancer.

Still, symptoms such as difficulty urinating, a weak urine stream or frequent trips to the bathroom can understandably raise concerns about prostate cancer. Because BPH and prostate cancer can cause some of the same urinary problems—and because it is possible to have both conditions at the same time—a medical evaluation can help determine what is causing the symptoms and whether further testing is necessary.

At Moffitt Cancer Center, prostate care extends beyond cancer treatment. The specialists in our Urologic Oncology Program have extensive expertise in evaluating prostate conditions and distinguishing benign prostate enlargement from prostate cancer. Our patients have access to advanced diagnostic testing and a multispecialty team that can determine the right path forward based on the findings.

Common lower urinary tract symptoms (LUTS) in men

As the prostate enlarges, it can press against the urethra, the tube that carries urine out of the bladder. BPH can also affect how the bladder stores and empties urine. The resulting problems are collectively known as lower urinary tract symptoms (LUTS).

Enlarged prostate symptoms can vary considerably from one patient to another and may include:

• Frequent urination – The patient may need to urinate more often than usual, sometimes at relatively short intervals.
• Urinary urgency – The need to urinate may come on suddenly and be difficult to postpone.
• Nocturia – The patient may wake up multiple times during the night to urinate.
• Difficulty starting urination – There may be a delay or a need to strain before urine begins to flow.
• A weak or interrupted urine stream – Urine may flow slowly or stop and start during urination.
• Dribbling after urination – A small amount of urine may continue to leak after the patient believes urination is complete.
• A feeling that the bladder has not emptied completely – The patient may still feel the need to urinate after using the bathroom.

The severity of urinary symptoms does not necessarily correspond to the size of the prostate. A moderately enlarged prostate can cause significant symptoms in one patient, while a substantially enlarged prostate may cause relatively few problems in another.

Lower urinary tract symptoms are not specific to BPH. Urinary tract infections, bladder conditions, certain medications and other health issues can produce similar symptoms. Prostate cancer is another possible cause, although early prostate cancer often has no noticeable warning signs. For these reasons, persistent or bothersome urinary changes should be evaluated rather than attributed to BPH based on symptoms alone.

BPH vs. prostate cancer: What is the difference?

Although both BPH and prostate cancer involve the prostate gland, they are fundamentally different conditions. BPH develops when noncancerous prostate cells increase in number, causing the prostate to enlarge. Prostate cancer occurs when abnormal prostate cells grow uncontrollably and form a malignant tumor.

The conditions also tend to develop in different areas of the prostate. BPH typically affects tissue surrounding the urethra, which helps explain why urinary symptoms are common. Prostate cancer frequently begins in the peripheral zone, which is located toward the outer portion of the prostate, and may not interfere with urination during its early stages.

Most importantly, BPH does not turn into prostate cancer, nor does it increase the risk of developing prostate cancer. The two conditions can occur independently in the same patient, however. Therefore, testing may be appropriate when urinary symptoms develop or when other findings raise concern about prostate cancer.

How is BPH diagnosed?

Diagnosing benign prostatic hyperplasia begins with determining whether an enlarged prostate is the likely source of the patient’s urinary symptoms and assessing how much those symptoms are affecting daily life. The evaluation can also help identify other possible causes and determine whether additional testing for prostate cancer is appropriate.

At Moffitt, patients have access to specialized prostate expertise and advanced diagnostic resources. The diagnostic process for BPH may include:

Medical history and symptom assessment

During the initial consultation, the healthcare provider will ask about the type, severity and duration of the patient's urinary symptoms. Questions may address how often the patient urinates, whether symptoms interfere with sleep or daily activities, medications the patient takes and any personal or family history relevant to prostate health.

A standardized questionnaire, such as the International Prostate Symptom Score (IPSS), also may be used to measure symptom severity and monitor changes over time.

Digital rectal examination (DRE)

To perform a digital rectal examination, the healthcare provider will gently insert a gloved, lubricated finger into the rectum to feel the back surface of the prostate. This exam can provide information about the prostate’s approximate size, shape and consistency and may identify firmness, nodules or other findings that warrant additional evaluation.

Prostate-specific antigen (PSA) blood test

Prostate-specific antigen is a protein produced by cells in the prostate. A blood test can measure the amount of PSA in the bloodstream and provide useful information about prostate health.

An elevated PSA level does not automatically mean the patient has prostate cancer. BPH itself can raise PSA levels, as can prostate inflammation, infection and other factors. If a PSA result is elevated or otherwise concerning, the healthcare team will interpret it in the context of the patient’s age, prostate size, previous PSA results and other clinical findings to determine whether additional testing is appropriate.

Urine and urinary function tests

Urine testing can help identify an infection, blood in the urine or other abnormalities that could be contributing to the patient’s symptoms. Additional tests may be used when more information about bladder emptying or urinary flow is needed.

For example, the healthcare team may measure the amount of urine left in the bladder after urination, known as the post-void residual, or perform a uroflowmetry test to assess the strength and pattern of the urine stream.

Imaging and additional prostate testing

Imaging is not necessary for every patient with BPH. When indicated, ultrasound can help evaluate the prostate, bladder or urinary tract and provide information that may guide treatment planning.

If the evaluation raises concern about prostate cancer, additional testing may be recommended. Moffitt’s advanced prostate diagnostic capabilities can help the healthcare team determine whether suspicious findings require further evaluation and distinguish benign prostate conditions from cancer as accurately as possible.

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How is BPH treated?

BPH treatment is highly personalized. Not every enlarged prostate needs to be treated, and when treatment is needed, the most appropriate approach can vary depending on factors such as the patient’s symptoms, quality of life, prostate anatomy and size, bladder function, overall health and personal preferences.

BPH treatment options can range from monitoring and medication to minimally invasive procedures. Options may include:

Watchful waiting

If BPH is causing mild symptoms that are not significantly affecting the patient's quality of life, immediate treatment may not be necessary. Instead, the healthcare team may recommend periodic monitoring to determine whether symptoms remain stable or become more bothersome.

The patient may also be advised to make practical changes that can help reduce urinary symptoms, such as limiting fluids before bedtime. The healthcare team can review the patient’s medications to determine whether any could be contributing to urinary difficulties.

Medication

Several types of medication can be used to manage BPH symptoms. The appropriate medication depends on the patient's symptoms, prostate characteristics, other health conditions and potential side effects.

Medication options may include:

• Alpha-blockers – These medications relax smooth muscle in the prostate and bladder neck, which can make it easier to urinate and improve urine flow.
• 5-alpha reductase inhibitors – These medications can gradually shrink the prostate or slow further enlargement by reducing the hormonal activity that contributes to prostate growth. They are generally most useful for patients with larger prostates.
• Combination therapy – Some patients may benefit from taking an alpha-blocker and a 5-alpha reductase inhibitor together.
• Other medications – Depending on the patient's symptoms, certain medications used for erectile dysfunction or bladder symptoms also may be considered.

Prostatic artery embolization (PAE)

Prostatic artery embolization is a minimally invasive procedure that reduces blood flow to selected areas of the enlarged prostate. During PAE, an interventional radiologist guides a thin catheter through a blood vessel to the arteries that supply the prostate, then delivers tiny particles that block targeted vessels.

Reduced blood flow can cause prostate tissue to shrink over time, which can relieve pressure on the urethra and improve urinary symptoms. Because PAE does not require traditional prostate surgery, it may be an option for appropriately selected patients seeking a less invasive approach.

Aquablation is a precise, robotic minimally invasive option to treat urinary symptoms caused by an enlarged prostate. This technology can treat a wide range of prostate sizes, giving us another option to consider when developing a treatment plan.

Marilin Nicholson, MD

Aquablation therapy

Aquablation therapy is a minimally invasive treatment that uses robotic technology and a heat-free waterjet to precisely remove prostate tissue that is obstructing urine flow. The procedure combines real-time imaging with computer-guided treatment planning, allowing the surgeon to identify the tissue that needs to be removed while helping preserve surrounding structures.

Aquablation may be an option for certain patients with moderate to severe BPH symptoms, including some patients with a larger prostate. As with other procedures for an enlarged prostate, candidacy depends on the patient's anatomy, symptoms, overall health and treatment goals.

When should an enlarged prostate be evaluated?

Urinary changes are common as men age, but symptoms that persist, worsen or interfere with everyday activities deserve medical attention. An evaluation is especially important because symptoms alone cannot reliably distinguish BPH from other prostate, bladder or urinary tract conditions.

The patient should seek prompt medical attention for an inability to urinate, visible blood in the urine or urinary symptoms accompanied by fever or chills. These findings can indicate urinary retention, infection or another condition that requires timely evaluation.

If the patient is primarily concerned about prostate cancer, a prostate evaluation can provide clarity. Urinary symptoms do not necessarily indicate cancer, and testing can help determine whether BPH or another benign condition is responsible and whether any additional cancer-focused evaluation is warranted.

Benefit from world-class care at Moffitt Cancer Center

Turning to a cancer center for evaluation of urinary symptoms does not mean the patient has cancer. At Moffitt, our genitourinary specialists apply their expertise in prostate disease to the full diagnostic process, including evaluating noncancerous conditions such as BPH and determining when findings do—or do not—warrant further investigation for prostate cancer.

Patients benefit from sophisticated diagnostic capabilities, individualized treatment planning and access to specialists with extensive experience in prostate health. If additional testing identifies prostate cancer, Moffitt can provide seamless access to a multispecialty team with expertise in the full spectrum of prostate cancer treatment. If the diagnosis is BPH, the healthcare team can focus on finding an appropriate approach to relieve symptoms and protect urinary function.

If you would like to learn more about benign prostatic hyperplasia or BPH treatment options, you can request an appointment with a specialist in Moffitt’s Urologic Oncology Program by calling 1-888-663-3488 or submitting a new patient registration form online. We do not require referrals.