Question 1

Symptoms of an enlarged prostate

Accepted Answer

The prostate, part of the male reproductive system, is a walnut-size gland, which sits below the bladder and surrounds the urethra, the tube that empties urine from the bladder and carries sperm out of the body. An enlarged prostate is also known as benign prostatic hyperplasia. It affects at least half of all men starting in their 50s, and the chances of getting the condition increase with age. Many men in their 40s can also have an enlarged prostate. The main symptoms of an enlarged prostate are related to urination. Symptoms can be classified as “either storage symptoms or voiding symptoms,” said Amin Herati, director of male infertility and men’s health as well as an assistant professor of urology at Johns Hopkins Hospital. The hyperplasia, a cellular growth of the tissue inside the prostate, can compress the urethra. This can lead to an obstruction of the urethra, making it more difficult to urinate or ejaculate. Often, the bladder doesn’t empty completely, so men feel an urgent need to urinate repeatedly, especially at night. Voiding symptoms include a weak urine stream, interrupted flow, dribbling and difficulty starting, experts said. An enlarged prostate can make some men unable to urinate, which would be considered a medical emergency and may require hospitalization. “Being proactive rather than reactive with the symptoms may be beneficial in preserving bladder and kidney function,” Herati said. “Treat it sooner than later.”

Question 2

Causes of an enlarged prostate

Accepted Answer

The causes of an enlarged prostate are not well known but are driven in part by hormones and growth factors, Herati said. “It’s two different processes: cell death and cell proliferation,” he said. “When that balance is tipped — where there is less cell death or more cell proliferation — the net result is enlargement of the prostate.” An enlarged prostate can be from other benign conditions such as inflammation, but that is typically temporary, Herati said. “The prostate is a testosterone-sensitive gland, so a combination of exposure and time will lead to growth,” said Marc Dall’Era, interim chair of urology at the University of California at Davis Health. All men experience some growth of the gland as they age, but the size varies. “While average size for a 60-70-year-old man may be a small lemon, some prostates can grow to the size of baseball and beyond,” he said. Aging and a family history of benign prostatic hyperplasia are risk factors. Medical conditions such as obesity, Type 2 diabetes, heart disease and erectile dysfunction are also associated with benign prostatic hyperplasia, experts said. An enlarged prostate is diagnosed through a patient evaluation, which includes medical, family and medications history and a physical exam, including a digital rectal exam. Urologists use medical tests such as urinalysis, a prostate-specific antigen blood test and a transrectal ultrasound. Severity of symptoms, though subjective, is also used for a diagnosis. “It really is important that men don’t be shy about these issues,” said Ross Krasnow, a urologic oncologist at MedStar Washington Hospital Center. “They need to feel comfortable talking to their primary care doctors so they can be referred to urologists.”

Question 3

Treatment options for an enlarged prostate

Accepted Answer

Treatments can range from surveillance and lifestyle changes such as taking time to go more frequently, to medications and surgery, said Kevin Wymer, an endourologist at Mayo Clinic who specializes in the management of benign prostatic hyperplasia. “Just because you have prostate enlargement, it doesn't mean you need to do anything about it,” Krasnow said. “If it’s not causing symptoms or dysfunction, it’s fine just to monitor the issue.” Two types of medications are commonly prescribed for the condition and to provide relief to men from debilitating symptoms, experts said. Alpha blockers are muscle relaxers for the prostate — they relax “the smooth muscle at the junction of the prostate and bladder neck and the smooth muscle of the prostate,” Herati said. The other type, 5-alpha-reductase inhibitors, can help decrease the size of the prostate. When medications are insufficient or cause unwanted side effects, in advanced cases or for men who are looking for more definitive treatment, surgery may be recommended to open the channel through the prostate to increase the flow, Wymer said. Surgical procedures are variable, based on the size of the prostate, the age and health status of the patient, and the patient’s ultimate goals, Krasnow said. Patients can undergo minimally invasive procedures that make the prostatic urethra wider with implants, such as UroLift, a trademarked system. “UroLift is a procedure in which you insert tiny implants through the prostate to widen the prostatic urethra so urine can flow with less resistance,” Herati said. The implants are left in place so the prostate tissue is held away from the urethra. Water vapor therapy will vaporize the prostate tissue. Newer procedures use chemotherapy to cause the tissue to regress, Herati said. A transurethral resection of the prostate involves shaving of the prostate. A prostatectomy is done for extreme cases of benign prostatic hyperplasia. “That involves either using a robot or manually opening up the bladder and going inside the bladder to evacuate the tissue of the prostate,” Herati said.

Question 4

When is an enlarged prostate serious

Accepted Answer

Benign prostatic hyperplasia can lead to complications. When it is left untreated for long periods of time, it can lead to urine retention, which can cause urinary tract infections, bladder damage or kidney damage, Wymer said. “And it can have pretty significant impacts on quality of life from the day-to-day symptoms,” he said. It is important to note, however, that benign prostatic hyperplasia is not associated with prostate cancer and does not increase the risk, but it can make prostate cancer screening more difficult, Wymer said. Marlene Cimons contributed to this report.

King Charles has an enlarged prostate. What is it, and how is it treated?

The condition affects most older men and can be treated with lifestyle changes, medications or surgery

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