What is prostate ?

The prostate gland  is only found in men. It lies just beneath the bladder. It is normally about the size of a chestnut. The urethra (the tube which passes urine from the bladder) runs through the middle of the prostate. The prostate’s main function is to produce fluid which protects and enriches sperm.

Cross-section diagram of the prostate and nearby organs

What are the symptoms of prostate enlargement?

If the prostate becomes enlarged, it can place pressure on the bladder and urethra, the tube through which urine passes. This can affect :
difficulty starting urination
a frequent need to urinate
difficulty fully emptying the bladder
These symptoms can range from mild to severe.

How common is prostate enlargement?

Prostate enlargement is a common condition associated with ageing. Around 60% of men who are aged 60 or over have some degree of prostate enlargement.
The cause of prostate enlargement is unknown, but most experts agree that it is linked to changes in hormone levels in a man’s body due to ageing

What is the outlook?

Prostate enlargement is not usually a serious threat to a man’s health.
In some men, the symptoms are mild and do not require treatment. In others, symptoms can be very troublesome and have a major impact on their quality of life.
Complications of prostate enlargement can include urinary tract infections (UTIs) or acute urinary retention (AUR) but serious complications are rare.

What are the treatment?

If you have an enlarged prostate, your treatment plan will be determined by how severe your symptoms are.
If your symptoms are mild to moderate, you will receive no immediate medical treatment but will be given regular check-ups to carefully monitor your prostate. This is often referred to as “watchful waiting”.
You will probably also be advised to make changes to your lifestyle to see if they improve your symptoms

You may be advised to:
Stop drinking any liquids for one to two hours before going to bed. This will help to prevent nocturia (waking up during the night to pass urine).
If you’ve been prescribed medication (see below), experiment with the time you take this. For example, taking it at 7pm may help prevent nocturia.
Stop drinking alcohol and caffeine, or limit your consumption of them. They can irritate your bladder and make your symptoms worse.
Exercise regularly. Research has shown that moderate exercise, such as walking for 30 to 60 minutes a day, can improve symptoms (although it is unclear exactly why this is).

Bladder training

Bladder training is an exercise programme to increase the time between urination and to increase the amount of urine your bladder can hold.
You will be given a target, such as waiting for at least two hours between each time you urinate. It’s a good idea to use a bladder training chart, which allows you to record each time you pass urine and record the volume of urine passed (you’ll need a plastic jug to measure this).
You will also be taught a number of exercises, such as breathing, relaxation and muscle exercises, to help take your mind off the need to urinate.
Over time, your target time will be increased and at the end of the programme you should find that you are able to go for longer without urinating.
Bladder training should only be tried under medical supervision.

Medication

Medication, in combination with the lifestyle changes above, is usually recommended to treat moderate to severe symptoms of prostate enlargement.

Finasteride and dutasteride are widely used to treat prostate enlargement. They block the effects of a hormone called DHT (see causes of prostate enlargement) on the prostate gland, which can reduce the size of the prostate and improve your associated symptoms.
If you are prescribed one of these medications, you may experience an immediate improvement in symptoms. However, you’ll need to take it for at least six months to get the maximum benefit, and your doctor will need to monitor you every year.

Alpha blockers

Alpha blockers help relax the muscles of your bladder, making it easier to pass urine.
You may be given alpha blockers as your primary treatment or in combination with finasteride.

Surgery

Surgery is usually only recommended for moderate to severe symptoms of prostate enlargement that have failed to respond to medication.
Trans-urethral resection of the prostate (TURP)

Trans-urethral resection of the prostate (TURP) is a surgical procedure where excess prostate tissue is removed to reduce the pressure on your bladder.

Open prostatectomy

This procedure may be more effective than a TURP if you have severe prostate enlargement.