Benign prostate englargement: what is it and who does it affect?

Written by: Mr Marc Laniado
Published: | Updated: 25/03/2019
Edited by: Emily Lawrenson

Benign prostate enlargement affects an estimated 80% of men over 70 in the UK. It is a condition which can seriously affect quality of life, and cause people to worry about their prostate health. Here, leading urologist Mr Marc Laniado explains what prostate enlargement actually is, and how it can affect overall health. 

 

What is benign prostate enlargement?

In this condition, the prostate becomes bigger disturbing the urinary flow. BPE is important because disturbance in urinary symptoms interferes with living a normal life, can be painful and sometimes cause serious ill-health. By age 50 years about 3 in 10 men will have it and by 70 years almost 8 in 10 men will be suffering with BPE.

What are the symptoms of an enlarged prostate and how is it diagnosed?

Initially, men may notice they pass urine more frequently than their peers and at night. They may also notice that it takes a while to get started when reaching the toilet and the flow is less strong. At a public toilet, the flow may not hit the wall, but dribble in front of their feet. These symptoms may deteriorate over time such that the urinary flow stops and starts, and that it takes a long time to finish passing urine. If a urine infection occurs, then these symptoms become exacerbated, it hurts to pass urine, the urine smells foul and blood may be seen in the urine. Stones can also cause urine infections and pain in the lower belly. Some men suddenly become unable to pass urine at all. This is very painful and will make a man go to the Accident/Emergency department even if he did not want to visit a doctor before!

What causes BPE?

As with all things in medicine, the causes of BPE are incompletely understood. Age is the most important factor such that 40% of men aged 50 may have evidence of BPH, and this increases further with age. Studies on twins and families of men with BPE have shown a family history is important for more than half if BPE occurs under 60 years of age. For men with relatives who require surgery for BPE, the risk for BPE-related surgery is increased four-fold.

Black men are more likely than white men to have BPE, whereas Asian men are less likely to have BPE. BPE is associated with heart disease, use of drugs known as beta-blockers and lack of physical exercise. Fat appears to be important as it induces inflammation, which in turns causes BPE. BPE is more common in obese men, and certain dietary fats may induce inflammation. Prostatitis, which is inflammation of the prostate, is associated with an enlarged prostate and BPE. Relatively uniquely in the body, prostate tissue reverts to an embryonic state in which it is more sensitive to chemicals signals, known as growth factors, in the fluid that bathes the cells. Consequently, the cells grow.

Can a benign enlarged prostate lead to cancer?

There is no causal relationship between an enlarged prostate and prostate cancer, although it has been speculated that there might be. In men with BPE, the prostate becomes enlarged and a marker called PSA in the blood becomes elevated. This is because the level of PSA is proportional to the size of the prostate. PSA is also produced excessively by prostate cancer and so a high PSA can be used to identify men who might have prostate cancer. However, men with BPE have large prostates and so higher levels of PSA anyway. Consequently, they get tested for prostate cancer more intensely than men with small prostate who do not have their PSA elevated.

When men with an enlarged prostate visit doctors, the PSA test is often done and prostate cancer is consequently found almost by chance. The cancer would possibly not have been diagnosed had the men not visited their doctors because of urinary symptoms. 

Find out how BPE can be managed and treated here

By Mr Marc Laniado
Urology

*Please note that Mr Laniado is still consulting (both face-to-face and remotely) during COVID-19*

 

Mr Marc Laniado offers men with prostate enlargement or early prostate cancer treatments that benefit with less chance of side-effects. He uses the most advanced techniques that have a consistently better success rate. These are personalised to the individual needs and values of each man he sees.

 

Prostate cancer:

  • highly accurate diagnostic tests with the least side-effects (enhanced MRI, transperineal prostate biopsies, and genomic testing)
  • treatments for early prostate cancer that can preserve bladder control and erections more consistently than conventional treatments (focal therapy by HIFU, Retzius-sparing prostatectomy with nerve-sparing (NeuroSAFE), and seeds, a.ka. brachytherapy)
  • active surveillance: close monitoring for men who do not need immediate treatment

Prostate Enlargement (BPH):

  • minimally invasive treatments for small to medium-sized prostate that can improve urinary symptoms and maintain erections & ejaculation (Rezum and UroLift)
  • treatments for large prostates that improve urinary symptoms with a faster and more comfortable recovery (Aquablation, laser prostatectomy, HoLEP)
  • assessment for Prostate Artery Embolisation (PAE) 

 

He is a highly experienced urologist and works full time in the direct clinical care of men with prostate problems. Annually, he performs about 100 Retzius-sparing prostatectomies, as well as HIFU,  and 100 or more treatments for BPH.

 

He is the joint chairman of the prostate cancer multidisciplinary team for private patients at the Wellington Hospital and the Princess Grace Hospital where he operates and sees patients. He also sees patients at The London Clinic.

 

Mr Laniado was appointed as a consultant in 2002 and started performing conventional robotic prostatectomies in 2008. In 2016, He switched to the Retzius-sparing approach because of the much better bladder control and recovery of erections with similar cancer outcomes. He trains surgeons learning how to perform Retzius-sparing prostatectomies at the Royal Berkshire Hospital. NHS patients consult with him at the Royal Berkshire Hospital and Wexham Park Hospital (Frimley Health), where he is the lead for urological cancer.

 

Mr Laniado graduated from Guy's Hospital Medical School in 1989, having previously gained a BSc in physiology. Following specialist urology training in London, he became a Fellow of the Royal College of Surgeons (Urology) in 2000, going on to complete his MD in prostate cancer research, Fellow of the European Board of Urology in 2002, and become an international member of the American Urological Association. Before taking up his career as a consultant, Mr Laniado extended his knowledge and skills on a Visiting Fellowship at the Cleveland Clinic Foundation in the USA, where he trained in minimally invasive surgical techniques. 

 

Mr Laniado chooses treatments wherever possible for prostate problems that maximise the benefit-to-risk ratio, which are often less readily available. However, it is not possible to completely eliminate the chance or impact of after-effects after treatment, although the risk and impact are minimalised as much as possible.

 

 

View Profile

Overall assessment of their patients


This website uses its own and third-party cookies to collect information in order to improve our services, to show you advertising related to your preferences, as well as to analyse your browsing habits..