What causes an enlarged prostate?

Written by: Professor Richard Hindley
Published: | Updated: 08/05/2019
Edited by: Laura Burgess

Troublesome urinary symptoms due to benign prostate enlargement (BPE or BPH) are a common problem. Over half of men over the age of 50 will have some symptoms due to this condition, and this rises to 70% by the age of 70.

What causes the prostate to enlarge?

The prostate enlarges because of the effects of a hormone called testosterone which is produced by the testicles. This is a normal part of the ageing process but this enlargement can press on and kink the water pipe (urethra). The most common symptoms of an enlarged prostate are: 

  • Getting up more often at night (nocturia) 
  • Daytime frequency of urination
  • Poor flow and hesitancy passing urine
  • Urgency with increasing difficulty holding on
  • A feeling of incomplete emptying of the bladder

How is BPH treated?

Having reassured that there are no signs of prostate cancer, the initial treatment options have traditionally been to make lifestyle changes or to try medication. Surgery typically is reserved for those men with severe symptoms or problems such as retention of urine (a painful inability to pass urine). However, things are now changing as the side-effects of medication have been rather underestimated, and there are some new minimally invasive surgical treatment alternatives. These include laser treatments such as the GreenLight vaporization procedure, as well as Holmium laser enucleation. Furthermore, new procedures which can be performed under local anaesthetic are now available. These include the UroLift procedure (using implants) and Rezum water vapour treatment (using steam).

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What are the early warning signs of prostate cancer?

The best way to detect prostate cancer early is to have a PSA blood test which can be performed at your local surgery, clinic or hospital. If you have a family history of prostate cancer or develop urinary symptoms, then for men over the age of 50 (40 if family history and in some cases younger). The blood test helps to detect prostate cancer early before it is too advanced. Also, the PSA blood test result can be useful for future reference and comparison as an upward trend in the reading can suggest prostate cancer developing.

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By Professor Richard Hindley

Mr Richard Graham Hindley is a renowned consultant urologist based in London and Hampshire. He specialises in diagnosing and treating prostate conditions, such as prostate cancer and benign prostatic enlargement, utilising techniques such as GreenLight laser surgery, Urolift, and Rezum water vapour therapy. He is among a select few surgeons in the UK that are experienced in high intensity focal ultrasound (HIFU) treatment for localised prostate cancer.

After graduating from the University of Dundee, he trained in Brighton and the South Thames region (including King's Hospital). In 2003, he undertook a fellowship in laparoscopic urology in Brisbane, before being appointed as a consultant surgeon in Basingstoke where he has spent over a decade honing his skills, and helping to improve the local service, turning the Basingstoke centre into one of the leading centres in the UK.

Mr Hindley is now clinical lead for urology in his department at the North Hampshire Hospital and is also experienced in treating kidney conditions. At the end of 2017, he was appointed as a Visiting Professor at the University of Winchester working in the Department of Health and Wellbeing. He is also now working as a consultant urologist at UCLH one day a week working with the prostate cancer diagnostics and focal therapy team.

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