Benign prostatic hyperplasia

File:Benign Prostatic Hyperplasia (BPH).png

BPH is the most common cause of lower urinary tract symptoms (LUTS), which are divided into storage, voiding, and symptoms which occur after urination.{{citation |title = Lower urinary tract symptoms in men: management |publisher = NICE (National Institute for Health and Care Excellence) }} Storage symptoms include the need to urinate frequently, waking at night to urinate, urgency (compelling need to void that cannot be deferred), involuntary urination, including involuntary urination at night, or urge incontinence (urine leak following a strong sudden need to urinate).{{cite web |title = Urge incontinence |url = https://www.nlm.nih.gov/medlineplus/ency/article/001270.htm |website = MedlinePlus |publisher = US National Library of Medicine |access-date = 26 October 2015 |url-status = live |archive-url = https://web.archive.org/web/20151006031743/https://www.nlm.nih.gov/medlineplus/ency/article/001270.htm |archive-date = 6 October 2015}} Voiding symptoms include urinary hesitancy (a delay between trying to urinate and the flow actually beginning), intermittency (not continuous),{{cite book | chapter = Incontinence and Stream Abnormalities | chapter-url = https://www.ncbi.nlm.nih.gov/books/NBK295/ | title = Clinical Methods: The History, Physical, and Laboratory Examinations | edition = 3rd | location = Boston | publisher = Butterworths | date = 1990 | pmid = 21250138 | vauthors = White JR, O'Brien III DP, Walker HK, Hall WD, Hurst JW | isbn = 9780409900774 }} involuntary interruption of voiding, weak urinary stream, straining to void, a sensation of incomplete emptying, and uncontrollable leaking after the end of urination.{{cite journal | vauthors = Robinson J | title = Post-micturition dribble in men: causes and treatment | journal = Nursing Standard | volume = 22 | issue = 30 | pages = 43–46 | date = 11 February 2008 | pmid = 18459613 | doi = 10.7748/ns2008.04.22.30.43.c6440 }}{{cite journal | vauthors = Sarma AV, Wei JT | title = Clinical practice. Benign prostatic hyperplasia and lower urinary tract symptoms | journal = The New England Journal of Medicine | volume = 367 | issue = 3 | pages = 248–257 | date = July 2012 | pmid = 22808960 | doi = 10.1056/nejmcp1106637 }}{{cite web |title = Urination – difficulty with flow |url = https://www.nlm.nih.gov/medlineplus/ency/article/003143.htm |website = MedlinePlus |publisher = US National Library of Medicine |access-date = 26 October 2015 |url-status = live |archive-url = https://web.archive.org/web/20151006115737/https://www.nlm.nih.gov/medlineplus/ency/article/003143.htm |archive-date = 6 October 2015}} These symptoms may be accompanied by bladder pain or pain while urinating, called dysuria.{{cite web |title = Urination – painful |url = https://www.nlm.nih.gov/medlineplus/ency/article/003145.htm |website = MedlinePlus |publisher = US National Library of Medicine |access-date = 26 October 2015 |url-status = live |archive-url = https://web.archive.org/web/20151006110537/https://www.nlm.nih.gov/medlineplus/ency/article/003145.htm |archive-date = 6 October 2015}}

Bladder outlet obstruction (BOO) can be caused by BPH.{{cite web |title = Bladder outlet obstruction |url = https://www.nlm.nih.gov/medlineplus/ency/article/002238.htm |website = MedlinePlus |publisher = US National Library of Medicine |access-date = 26 October 2015 |url-status = live |archive-url = https://web.archive.org/web/20151006110511/https://www.nlm.nih.gov/medlineplus/ency/article/002238.htm |archive-date = 6 October 2015}} Symptoms are abdominal pain, a continuous feeling of a full bladder, frequent urination, acute urinary retention (inability to urinate), pain during urination (dysuria), problems starting urination (urinary hesitancy), slow urine flow, starting and stopping (urinary intermittency), and nocturia.{{cite web |url= https://www.lecturio.com/concepts/benign-prostatic-hyperplasia/ | title= Benign Prostatic Hyperplasia

| website= The Lecturio Medical Concept Library |access-date= 5 July 2021}}

BPH can be a progressive disease, especially if left untreated. Incomplete voiding results in residual urine or urinary stasis, which can lead to an increased risk of urinary tract infection.{{cite journal | vauthors = Truzzi JC, Almeida FM, Nunes EC, Sadi MV | title = Residual urinary volume and urinary tract infection--when are they linked? | journal = The Journal of Urology | volume = 180 | issue = 1 | pages = 182–185 | date = July 2008 | pmid = 18499191 | doi = 10.1016/j.juro.2008.03.044 }}

Most experts consider androgens (testosterone and related hormones) to play a permissive role in the development of BPH. This means that androgens must be present for BPH to occur, but do not necessarily directly cause the condition. This is supported by evidence suggesting that castrated boys do not develop BPH when they age. In a study of 26 eunuchs from the palace of the Qing dynasty still living in Beijing in 1960, the prostate could not be felt in 81% of the studied eunuchs.{{cite journal | vauthors = Wu CP, Gu FL | title = The prostate in eunuchs | journal = Progress in Clinical and Biological Research | volume = 370 | pages = 249–255 | date = 1991 | pmid = 1924456 }} The average time since castration was 54 years (range, 41–65 years). On the other hand, some studies suggest that administering exogenous testosterone is not associated with a significant increase in the risk of BPH symptoms, so the role of testosterone in prostate cancer and BPH is still unclear. Further randomized controlled trials with more participants are needed to quantify any risk of giving exogenous testosterone.{{cite web |title = Testosterone and Aging: Clinical Research Directions. |url = https://www.ncbi.nlm.nih.gov/books/NBK216175/ |publisher = NCBI Bookshelf |access-date = 2 February 2015 |url-status = live |archive-url = https://web.archive.org/web/20171105194336/https://www.ncbi.nlm.nih.gov/books/NBK216175/ |archive-date = 5 November 2017}}

Dihydrotestosterone (DHT), a metabolite of testosterone, is a critical mediator of prostatic growth. DHT is synthesized in the prostate from circulating testosterone by the action of the enzyme 5α-reductase, type 2. DHT can act in an autocrine fashion on the stromal cells or in paracrine fashion by diffusing into nearby epithelial cells. In both of these cell types, DHT binds to nuclear androgen receptors and signals the transcription of growth factors that are mitogenic to the epithelial and stromal cells. DHT is ten times more potent than testosterone because it dissociates from the androgen receptor more slowly. The importance of DHT in causing nodular hyperplasia is supported by clinical observations in which an inhibitor of 5α-reductase such as finasteride is given to men with this condition. Therapy with a 5α-reductase inhibitor markedly reduces the DHT content of the prostate and, in turn, reduces prostate volume and BPH symptoms.{{cite web |title = Proscar (finasteride) Prescribing Information |url = http://www.accessdata.fda.gov/drugsatfda_docs/label/2010/020180s037lbl.pdf |website = FDA – Drug Documents |publisher = Merck and Company |access-date = 2 March 2015 |url-status = dead |archive-url = https://web.archive.org/web/20160303231752/http://www.accessdata.fda.gov/drugsatfda_docs/label/2010/020180s037lbl.pdf |archive-date = 3 March 2016}}{{cite journal | vauthors = Bartsch G, Rittmaster RS, Klocker H | title = Dihydrotestosterone and the concept of 5alpha-reductase inhibition in human benign prostatic hyperplasia | journal = World Journal of Urology | volume = 19 | issue = 6 | pages = 413–425 | date = April 2002 | pmid = 12022710 | doi = 10.1007/s00345-002-0248-5 | s2cid = 3257666 }}

Testosterone promotes prostate cell proliferation,{{cite journal | vauthors = Feldman BJ, Feldman D | title = The development of androgen-independent prostate cancer | journal = Nature Reviews. Cancer | volume = 1 | issue = 1 | pages = 34–45 | date = October 2001 | pmid = 11900250 | doi = 10.1038/35094009 | s2cid = 205020623 }} but relatively low levels of serum testosterone are found in patients with BPH.{{cite journal | vauthors = Lagiou P, Mantzoros CS, Tzonou A, Signorello LB, Lipworth L, Trichopoulos D | title = Serum steroids in relation to benign prostatic hyperplasia | journal = Oncology | volume = 54 | issue = 6 | pages = 497–501 | year = 1997 | pmid = 9394847 | doi = 10.1159/000227609 }}{{cite journal | vauthors = Roberts RO, Jacobson DJ, Rhodes T, Klee GG, Leiber MM, Jacobsen SJ | title = Serum sex hormones and measures of benign prostatic hyperplasia | journal = The Prostate | volume = 61 | issue = 2 | pages = 124–131 | date = October 2004 | pmid = 15305335 | doi = 10.1002/pros.20080 | s2cid = 24288565 }} One small study has shown that medical castration lowers the serum and prostate hormone levels unevenly, having less effect on testosterone and DHT levels in the prostate.{{cite journal | vauthors = Page ST, Lin DW, Mostaghel EA, Hess DL, True LD, Amory JK, Nelson PS, Matsumoto AM, Bremner WJ | title = Persistent intraprostatic androgen concentrations after medical castration in healthy men | journal = The Journal of Clinical Endocrinology and Metabolism | volume = 91 | issue = 10 | pages = 3850–3856 | date = October 2006 | pmid = 16882745 | doi = 10.1210/jc.2006-0968 | doi-access = free }}

Besides testosterone and DHT, other androgens are also known to play a crucial role in BPH development. {{chem|C|21}} 11-oxygenated steroids (pregnanes) have been identified are precursors to 11-oxygenated androgens which are also potent agonists for the androgen receptor.{{cite journal | vauthors = Dimitrakov J, Joffe HV, Soldin SJ, Bolus R, Buffington CA, Nickel JC | title = Adrenocortical hormone abnormalities in men with chronic prostatitis/chronic pelvic pain syndrome | journal = Urology | volume = 71 | issue = 2 | pages = 261–266 | date = February 2008 | pmid = 18308097 | pmc = 2390769 | doi = 10.1016/j.urology.2007.09.025 }} Specifically, steroids like 11β-hydroxyprogesterone and 11-ketoprogesterone can be converted to 11-ketodihydrotestosterone, an 11-oxo form of DHT with the same potency. These precursors have also been detected in tissue biopsy samples from patients with BPH, as well as in their serum levels.{{cite journal | vauthors = du Toit T, Swart AC | title = The 11β-hydroxyandrostenedione pathway and C11-oxy C₂₁ backdoor pathway are active in benign prostatic hyperplasia yielding 11keto-testosterone and 11keto-progesterone | journal = The Journal of Steroid Biochemistry and Molecular Biology | volume = 196 | pages = 105497 | date = February 2020 | pmid = 31626910 | doi = 10.1016/j.jsbmb.2019.105497 | s2cid = 204734045 }}{{cite journal | vauthors = Masiutin MG, Yadav MK | title = "Re: Adrenocortical Hormone Abnormalities in Men With Chronic Prostatitis/Chronic Pelvic Pain Syndrome" | language = English | journal = Urology | volume = 169 | pages = 273 | date = November 2022 | pmid = 35987379 | doi = 10.1016/j.urology.2022.07.051 | s2cid = 251657694 }}{{cite journal | vauthors = Dimitrakoff J, Nickel JC | title = Author Reply | language = English | journal = Urology | volume = 169 | pages = 273–274 | date = November 2022 | pmid = 35985522 | doi = 10.1016/j.urology.2022.07.049 | s2cid = 251658492 }} Besides that, androgens biosynthesized via a backdoor pathway can contribute to the development of BPH.

While there is some evidence that estrogen may play a role in the cause of BPH, this effect appears to be mediated mainly through local conversion of androgens to estrogen in the prostate tissue rather than a direct effect of estrogen itself.{{cite journal | vauthors = Ho CK, Nanda J, Chapman KE, Habib FK | title = Oestrogen and benign prostatic hyperplasia: effects on stromal cell proliferation and local formation from androgen | journal = The Journal of Endocrinology | volume = 197 | issue = 3 | pages = 483–491 | date = June 2008 | pmid = 18492814 | doi = 10.1677/JOE-07-0470 | doi-access = free }} In canine in vivo studies castration, which significantly reduced androgen levels but left estrogen levels unchanged, caused significant atrophy of the prostate.{{cite journal | vauthors = Niu YJ, Ma TX, Zhang J, Xu Y, Han RF, Sun G | title = Androgen and prostatic stroma | journal = Asian Journal of Andrology | volume = 5 | issue = 1 | pages = 19–26 | date = March 2003 | pmid = 12646998 }} Studies looking for a correlation between prostatic hyperplasia and serum estrogen levels in humans have generally shown none.{{cite journal | vauthors = Ansari MA, Begum D, Islam F | title = Serum sex steroids, gonadotrophins and sex hormone-binding globulin in prostatic hyperplasia | journal = Annals of Saudi Medicine | volume = 28 | issue = 3 | pages = 174–178 | year = 2008 | pmid = 18500180 | pmc = 6074428 | doi = 10.4103/0256-4947.51727 | doi-access = free }}

In 2008, Gat et al. published evidence that BPH is caused by failure in the spermatic venous drainage system resulting in increased hydrostatic pressure and local testosterone levels elevated more than 100-fold above serum levels.{{cite journal | vauthors = Gat Y, Gornish M, Heiblum M, Joshua S | title = Reversal of benign prostate hyperplasia by selective occlusion of impaired venous drainage in the male reproductive system: novel mechanism, new treatment | journal = Andrologia | volume = 40 | issue = 5 | pages = 273–281 | date = October 2008 | pmid = 18811916 | doi = 10.1111/j.1439-0272.2008.00883.x | s2cid = 205442245 | doi-access = free }} If confirmed, this mechanism explains why serum androgen levels do not seem to correlate with BPH and why giving exogenous testosterone would not make much difference.

Studies indicate that dietary patterns may affect the development of BPH, but further research is needed to clarify any important relationship.{{cite journal | vauthors = Heber D | title = Prostate enlargement: the canary in the coal mine? | journal = The American Journal of Clinical Nutrition | volume = 75 | issue = 4 | pages = 605–606 | date = April 2002 | pmid = 11916745 | doi = 10.1093/ajcn/75.4.605 | doi-access = free }} Studies from China suggest that greater protein intake may be a factor in the development of BPH. Men older than 60 in rural areas had very low rates of clinical BPH, while men living in cities and consuming more animal protein had a higher incidence.{{cite journal | vauthors = Zhang SX, Yu B, Guo SL, Wang YW, Yin CK | title = [Comparison of incidence of BPH and related factors between urban and rural inhabitants in district of Wannan] | journal = Zhonghua Nan Ke Xue = National Journal of Andrology | volume = 9 | issue = 1 | pages = 45–47 | date = February 2003 | pmid = 12680332 }}{{cite journal | vauthors = Gu F | title = Changes in the prevalence of benign prostatic hyperplasia in China | journal = Chinese Medical Journal | volume = 110 | issue = 3 | pages = 163–166 | date = March 1997 | pmid = 9594331 }} On the other hand, a study in Japanese-American men in Hawaii found a strong negative association with alcohol intake, but a weak positive association with beef intake.{{cite journal | vauthors = Chyou PH, Nomura AM, Stemmermann GN, Hankin JH | title = A prospective study of alcohol, diet, and other lifestyle factors in relation to obstructive uropathy | journal = The Prostate | volume = 22 | issue = 3 | pages = 253–264 | date = 1993 | pmid = 7683816 | doi = 10.1002/pros.2990220308 | s2cid = 32639108 }} In a large prospective cohort study in the US (the Health Professionals Follow-up Study), investigators reported modest associations between BPH (men with strong symptoms of BPH or surgically confirmed BPH) and total energy and protein, but not fat intake.{{cite journal | vauthors = Suzuki S, Platz EA, Kawachi I, Willett WC, Giovannucci E | title = Intakes of energy and macronutrients and the risk of benign prostatic hyperplasia | journal = The American Journal of Clinical Nutrition | volume = 75 | issue = 4 | pages = 689–697 | date = April 2002 | pmid = 11916755 | doi = 10.1093/ajcn/75.4.689 | doi-access = free }} There is also epidemiological evidence linking BPH with metabolic syndrome (concurrent obesity, impaired glucose metabolism and diabetes, high triglyceride levels, high levels of low-density cholesterol, and hypertension).{{cite journal | vauthors = Gacci M, Corona G, Vignozzi L, Salvi M, Serni S, De Nunzio C, Tubaro A, Oelke M, Carini M, Maggi M | title = Metabolic syndrome and benign prostatic enlargement: a systematic review and meta-analysis | journal = BJU International | volume = 115 | issue = 1 | pages = 24–31 | date = January 2015 | pmid = 24602293 | doi = 10.1111/bju.12728 | hdl-access = free | s2cid = 22937831 | doi-access = free | hdl = 2158/953282 }}

Benign prostatic hyperplasia is an age-related disease. Misrepair-accumulation aging theory{{cite journal | vauthors = Wang J, Michelitsch T, Wunderlin A, Mahadeva R | title = Aging as a consequence of misrepair--A novel theory of aging. | journal = Nature Precedings | date = March 2009 | doi = 10.1038/npre.2009.2988.1 | doi-access = free | arxiv = 0904.0575 }} suggests that the development of benign prostatic hyperplasia is a consequence of fibrosis and weakening of the muscular tissue in the prostate.{{cite arXiv |title = Tissue fibrosis: a principal evidence for the central role of Misrepairs in aging | vauthors = Wang-Michelitsch J, Michelitsch T |year = 2015 |class = cs.DM |eprint = 1503.01376 }} The muscular tissue is important in the functionality of the prostate, and provides the force for excreting the fluid produced by prostatic glands. However, repeated contractions and dilations of myofibers will unavoidably cause injuries and broken myofibers. Myofibers have a low potential for regeneration; therefore, collagen fibers need to be used to replace the broken myofibers. Such misrepairs make the muscular tissue weak in functioning, and the fluid secreted by glands cannot be excreted completely. Then, the accumulation of fluid in glands increases the resistance of muscular tissue during the movements of contractions and dilations, and more and more myofibers will be broken and replaced by collagen fibers.{{cite journal | vauthors = Roehrborn CG | title = Benign prostatic hyperplasia: an overview | journal = Reviews in Urology | volume = 7 | issue = Suppl 9 | pages = S3–S14 | date = 2005 | pmid = 16985902 | pmc = 1477638 }}

File:Benign prostate hyperplasia.jpg

As men age, the enzymes aromatase and 5-alpha reductase increase in activity. These enzymes are responsible for converting androgen hormones into estrogen and DHT, respectively. This metabolism of androgen hormones leads to a decrease in testosterone but increased levels of DHT and estrogen.

Both the glandular epithelial cells and the stromal cells (including muscular fibers) undergo hyperplasia in BPH. Most sources agree that of the two tissues, stromal hyperplasia predominates, but the exact ratio of the two is unclear.{{cite journal | vauthors = Wasserman NF | title = Benign prostatic hyperplasia: a review and ultrasound classification | journal = Radiologic Clinics of North America | volume = 44 | issue = 5 | pages = 689–710, viii | date = September 2006 | pmid = 17030221 | doi = 10.1016/j.rcl.2006.07.005 }}{{rp|694}}

Anatomically the median and lateral lobes are usually enlarged, due to their highly glandular composition. The anterior lobe has little in the way of glandular tissue and is seldom enlarged. (Carcinoma of the prostate typically occurs in the posterior lobe – hence the ability to discern an irregular outline per rectal examination). The earliest microscopic signs of BPH usually begin between the age of 30 and 50 years old in the PUG, which is posterior to the proximal urethra.{{rp|694}} In BPH, the majority of growth occurs in the transition zone (TZ) of the prostate.{{rp|694}} In addition to these two classic areas, the peripheral zone (PZ) is also involved to a lesser extent.{{rp|695}} Prostatic cancer typically occurs in the PZ. However, BPH nodules, usually from the TZ are often biopsied anyway to rule out cancer in the TZ.{{rp|695}} BPH can be a progressive growth that in rare instances leads to exceptional enlargement. In some males, the prostate enlargement exceeds 200 to 500 grams.{{cite journal | vauthors = Ojewola RW, Tijani KH, Fatuga AL, Onyeze CI, Okeke CJ | title = Management of a giant prostatic enlargement: Case report and review of the literature | journal = The Nigerian Postgraduate Medical Journal | volume = 27 | issue = 3 | pages = 242–247 | year = 2020 | pmid = 32687126 | doi = 10.4103/npmj.npmj_69_20 | publisher = Medknow | s2cid = 220652018 | doi-access = free }} This condition has been defined as giant prostatic hyperplasia (GPH).

The clinical diagnosis of BPH is based on a history of LUTS (lower urinary tract symptoms), a digital rectal exam, and the exclusion of other causes of similar signs and symptoms. The degree of LUTS does not necessarily correspond to the size of the prostate. An enlarged prostate gland on rectal examination that is symmetric and smooth supports a diagnosis of BPH. However, if the prostate gland feels asymmetrical, firm, or nodular, this raises concern for prostate cancer.

Validated questionnaires such as the American Urological Association Symptom Index (AUA-SI), the International Prostate Symptom Score (I-PSS), and more recently the UWIN score (urgency, weak stream, incomplete emptying, and nocturia) are useful aids to making the diagnosis of BPH and quantifying the severity of symptoms.{{cite journal | vauthors = Parsons JK | title = Benign Prostatic Hyperplasia and Male Lower Urinary Tract Symptoms: Epidemiology and Risk Factors | journal = Current Bladder Dysfunction Reports | volume = 5 | issue = 4 | pages = 212–218 | date = December 2010 | pmid = 21475707 | pmc = 3061630 | doi = 10.1007/s11884-010-0067-2 }}{{cite journal | vauthors = Eid K, Krughoff K, Stoimenova D, Smith D, Phillips J, O'Donnell C, Barqawi A | title = Validation of the Urgency, Weak stream, Incomplete emptying, and Nocturia (UWIN) score compared with the American Urological Association Symptoms Score in assessing lower urinary tract symptoms in the clinical setting | journal = Urology | volume = 83 | issue = 1 | pages = 181–185 | date = January 2014 | pmid = 24139351 | doi = 10.1016/j.urology.2013.08.039 }}

Urinalysis is typically performed when LUTS are present and BPH is suspected to evaluate for signs of a urinary tract infection, glucose in the urine (suggestive of diabetes), or protein in the urine (suggestive of kidney disease). Bloodwork including kidney function tests and prostate specific antigen (PSA) are often ordered to evaluate for kidney damage and prostate cancer, respectively. However, checking blood PSA levels for prostate cancer screening is controversial and not necessarily indicated in every evaluation for BPH. Benign prostatic hyperplasia and prostate cancer are both capable of increasing blood PSA levels and PSA elevation is unable to differentiate these two conditions well. If PSA levels are checked and are high, then further investigation is warranted. Measures including PSA density, free PSA, rectal examination, and transrectal ultrasonography may help determine whether a PSA increase is due to BPH or prostate cancer.

Uroflowmetry is done to measure the rate of urine flow and total volume of urine voided when the subject is urinating.{{cite journal | vauthors = Gammie A, Drake MJ | title = The fundamentals of uroflowmetry practice, based on International Continence Society good urodynamic practices recommendations | journal = Neurourology and Urodynamics | volume = 37 | issue = S6 | pages = S44–S49 | date = August 2018 | pmid = 30614059 | doi = 10.1002/nau.23777 | s2cid = 58586667 | doi-access = free }}

Abdominal ultrasound examination of the prostate and kidneys is often performed to rule out hydronephrosis and hydroureter. Incidentally, cysts, tumours, and stones may be found on ultrasound. Post-void residual volume of more than 100 ml may indicate significant obstruction.{{Cite journal | vauthors = Foo KT |date=June 2013 |title=The Role of Transabdominal Ultrasound in Office Urology |journal=Proceedings of Singapore Healthcare |language=en |volume=22 |issue=2 |pages=125–130 |doi=10.1177/201010581302200208 |s2cid=74205747 |issn=2010-1058|doi-access=free }} Prostate size of 30 cc or more indicates enlargement of the prostate.{{cite journal | vauthors = Aprikian S, Luz M, Brimo F, Scarlata E, Hamel L, Cury FL, Tanguay S, Aprikian AG, Kassouf W, Chevalier S | title = Improving ultrasound-based prostate volume estimation | journal = BMC Urology | volume = 19 | issue = 1 | pages = 68 | date = July 2019 | pmid = 31340802 | pmc = 6657110 | doi = 10.1186/s12894-019-0492-2 | doi-access = free }}

Prostatic calcification can be detected through transrectal ultrasound (TRUS). Calcification is due to solidification of prostatic secretions or calcified corpora amylacea (hyaline masses on the prostate gland). Calcification is also found in a variety of other conditions such as prostatitis, chronic pelvic pain syndrome, and prostate cancer.{{cite journal | vauthors = Kitzing YX, Prando A, Varol C, Karczmar GS, Maclean F, Oto A | title = Benign Conditions That Mimic Prostate Carcinoma: MR Imaging Features with Histopathologic Correlation | journal = Radiographics | volume = 36 | issue = 1 | pages = 162–175 | date = January 2016 | pmid = 26587887 | pmc = 5496681 | doi = 10.1148/rg.2016150030 }}{{cite journal | vauthors = Singh S, Martin E, Tregidgo HF, Treeby B, Bandula S | title = Prostatic calcifications: Quantifying occurrence, radiodensity, and spatial distribution in prostate cancer patients | journal = Urologic Oncology | volume = 39 | issue = 10 | pages = 728.e1–728.e6 | date = October 2021 | pmid = 33485763 | pmc = 8492071 | doi = 10.1016/j.urolonc.2020.12.028 }} For those with elevated levels of PSA, TRUS guided biopsy is performed to take a sample of the prostate for investigation.{{cite journal | vauthors = Mitterberger M, Horninger W, Aigner F, Pinggera GM, Steppan I, Rehder P, Frauscher F | title = Ultrasound of the prostate | journal = Cancer Imaging | volume = 10 | issue = 1 | pages = 40–48 | date = March 2010 | pmid = 20199941 | pmc = 2842183 | doi = 10.1102/1470-7330.2010.0004 }} Although MRI is more accurate than TRUS in determining prostate volume, TRUS is less expensive and almost as accurate as MRI. Therefore, TRUS is still preferred to measure prostate volume.{{cite journal | vauthors = Lee JS, Chung BH | title = Transrectal ultrasound versus magnetic resonance imaging in the estimation of prostate volume as compared with radical prostatectomy specimens | journal = Urologia Internationalis | volume = 78 | issue = 4 | pages = 323–327 | date = 2007 | pmid = 17495490 | doi = 10.1159/000100836 | s2cid = 10731245 }}

The differential diagnosis for LUTS is broad and includes various medical conditions, neurologic disorders, and other diseases of the bladder, urethra, and prostate such as bladder cancer, urinary tract infection, urethral stricture, urethral calculi (stones), chronic prostatitis, and prostate cancer. Neurogenic bladder can cause urinary retention and cause symptoms similar to those of BPH. This may occur as a result of uncoordinated contraction of the bladder muscle or impairment in the timing of bladder muscle contraction and urethral sphincter relaxation. Notable causes of neurogenic bladder include disorders of the central nervous system such as Parkinson's disease, multiple sclerosis, and spinal cord injuries as well as disorders of the peripheral nervous system such as diabetes mellitus, vitamin B12 deficiency, and alcohol-induced nerve damage. Individuals affected by heart failure often experience nighttime awakenings to urinate due to redistribution of fluid accumulated in swollen legs.

Certain medications can increase urination difficulties by increasing bladder outlet resistance due to increased smooth muscle tone at the prostate or bladder neck and contribute to LUTS. Alpha-adrenergic agonist medications, such as decongestants with pseudoephedrine can increase bladder outlet resistance. In contrast, calcium channel blockers and anticholinergic medications can worsen urinary retention by promoting bladder muscle relaxation. Diuretic medications such as loop diuretics (e.g., furosemide) or thiazides (e.g., chlorthalidone) can cause or worsen urinary frequency and nighttime awakenings to urinate.

File:Nodular hyperplasia of the prostate.jpg|Micrograph showing nodular hyperplasia (left off center) of the prostate from a transurethral resection of the prostate (TURP). H&E stain.

File:Prostate histology.jpg|Microscopic examination of different types of prostate tissues (stained with immuno{{shy}}histochemical techniques): A. Normal (non-neoplastic) prostatic tissue (NNT). B. Benign prostatic hyperplasia. C. High-grade prostatic intraepithelial neoplasia. D. Prostatic adenocarcinoma (PCA).

When treating and managing benign prostatic hyperplasia, the aim is to prevent complications related to the disease and improve or relieve symptoms.{{cite journal | vauthors = Hwang EC, Gandhi S, Jung JH, Imamura M, Kim MH, Pang R, Dahm P | title = Naftopidil for the treatment of lower urinary tract symptoms compatible with benign prostatic hyperplasia | journal = The Cochrane Database of Systematic Reviews | volume = 2018 | issue = 10 | pages = CD007360 | date = October 2018 | pmid = 30306544 | pmc = 6516835 | doi = 10.1002/14651858.CD007360.pub3 }} Approaches used include lifestyle modifications, medications, catheterization, and surgery.

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Lifestyle alterations to address the symptoms of BPH include physical activity,{{cite journal | vauthors = Silva V, Grande AJ, Peccin MS | title = Physical activity for lower urinary tract symptoms secondary to benign prostatic obstruction | journal = The Cochrane Database of Systematic Reviews | volume = 2019 | issue = 4 | pages = CD012044 | date = April 2019 | pmid = 30953341 | pmc = 6450803 | doi = 10.1002/14651858.CD012044.pub2 }} decreasing fluid intake before bedtime, moderating the consumption of alcohol and caffeine-containing products, and following a timed voiding schedule.

Patients can also attempt to avoid products and medications with anticholinergic properties that may exacerbate urinary retention symptoms of BPH, including antihistamines, decongestants, opioids, and tricyclic antidepressants; however, changes in medications should be done with input from a medical professional.{{cite web |title = Benign prostatic hyperplasia |url = http://umm.edu/health/medical/reports/articles/benign-prostatic-hyperplasia |publisher = University of Maryland Medical Center |archive-url = https://web.archive.org/web/20170425092640/http://umm.edu/health/medical/reports/articles/benign-prostatic-hyperplasia |archive-date = 25 April 2017 }}

Physical activity has been recommended as a treatment for urinary tract symptoms. A 2019 Cochrane review of six studies involving 652 men assessing the effects of physical activity alone, and physical activity as a part of a self-management program, among others. However, the quality of evidence was very low and therefore it remains uncertain whether physical activity is helpful in men experiencing urinary symptoms caused by benign prostatic hyperplasia.{{cite journal | vauthors = Silva V, Grande AJ, Peccin MS | title = Physical activity for lower urinary tract symptoms secondary to benign prostatic obstruction | journal = The Cochrane Database of Systematic Reviews | volume = 2019 | issue = 4 | pages = CD012044 | date = April 2019 | pmid = 30953341 | pmc = 6450803 | doi = 10.1002/14651858.CD012044.pub2 | collaboration = Cochrane Urology Group }}

Voiding position when urinating may influence urodynamic parameters (urinary flow rate, voiding time, and post-void residual volume).{{cite web |url = http://www.mednet.nl/wosmedia/1718/mictiehouding_tvu.pdf |title = Influence of voiding posture on urodynamic parameters in men: a literature review | vauthors = De Jong Y, Pinckaers JH, Ten Brinck RM, Lycklama à Nijeholt AA |publisher = Nederlands Tijdschrift voor urologie |access-date = 2 July 2014 |url-status = live |archive-url = https://web.archive.org/web/20140714200739/http://www.mednet.nl/wosmedia/1718/mictiehouding_tvu.pdf |archive-date = 14 July 2014}} A meta-analysis found no differences between the standing and sitting positions for healthy males, but that, for elderly males with lower urinary tract symptoms, voiding in the sitting position-- {{cite journal | vauthors = de Jong Y, Pinckaers JH, ten Brinck RM, Lycklama à Nijeholt AA, Dekkers OM | title = Urinating standing versus sitting: position is of influence in men with prostate enlargement. A systematic review and meta-analysis | journal = PLOS ONE | volume = 9 | issue = 7 | pages = e101320 | date = 2014 | pmid = 25051345 | pmc = 4106761 | doi = 10.1371/journal.pone.0101320 | doi-access = free | bibcode = 2014PLoSO...9j1320D }}

• decreased the post-void residual volume;
• increased the maximum urinary flow, comparable with pharmacological intervention; and
• decreased the voiding time.

This urodynamic profile is associated with a lower risk of urologic complications, such as cystitis and bladder stones.

The two main medication classes for BPH management are alpha blockers and 5α-reductase inhibitors.{{cite journal | vauthors = Silva J, Silva CM, Cruz F | title = Current medical treatment of lower urinary tract symptoms/BPH: do we have a standard? | journal = Current Opinion in Urology | volume = 24 | issue = 1 | pages = 21–28 | date = January 2014 | pmid = 24231531 | doi = 10.1097/mou.0000000000000007 | s2cid = 40954757 }}

Selective α₁-blockers are the most common choice for initial therapy.{{cite journal | vauthors = Roehrborn CG, Nuckolls JG, Wei JT, Steers W | title = The benign prostatic hyperplasia registry and patient survey: study design, methods, and patient baseline characteristics | journal = BJU International | volume = 100 | issue = 4 | pages = 813–819 | date = October 2007 | pmid = 17822462 | doi = 10.1111/j.1464-410X.2007.07061.x | hdl-access = free | s2cid = 21001077 | collaboration = BPH Registry and Patient Survey Steering Committee | hdl = 2027.42/73286 }}{{cite journal | vauthors = Black L, Naslund MJ, Gilbert TD, Davis EA, Ollendorf DA | title = An examination of treatment patterns and costs of care among patients with benign prostatic hyperplasia | journal = The American Journal of Managed Care | volume = 12 | issue = 4 Suppl | pages = S99–S110 | date = March 2006 | pmid = 16551208 | url = http://www.ajmc.com/pubMed.php?pii=3096 }}{{cite journal | vauthors = Hutchison A, Farmer R, Verhamme K, Berges R, Navarrete RV | title = The efficacy of drugs for the treatment of LUTS/BPH, a study in 6 European countries | journal = European Urology | volume = 51 | issue = 1 | pages = 207–15; discussion 215–6 | date = January 2007 | pmid = 16846678 | doi = 10.1016/j.eururo.2006.06.012 }} They include alfuzosin,{{cite journal | vauthors = MacDonald R, Wilt TJ | title = Alfuzosin for treatment of lower urinary tract symptoms compatible with benign prostatic hyperplasia: a systematic review of efficacy and adverse effects | journal = Urology | volume = 66 | issue = 4 | pages = 780–788 | date = October 2005 | pmid = 16230138 | doi = 10.1016/j.urology.2005.05.001 }}{{cite journal | vauthors = Roehrborn CG | title = Efficacy and safety of once-daily alfuzosin in the treatment of lower urinary tract symptoms and clinical benign prostatic hyperplasia: a randomized, placebo-controlled trial | journal = Urology | volume = 58 | issue = 6 | pages = 953–959 | date = December 2001 | pmid = 11744466 | doi = 10.1016/S0090-4295(01)01448-0 }} doxazosin,{{cite journal | vauthors = MacDonald R, Wilt TJ, Howe RW | title = Doxazosin for treating lower urinary tract symptoms compatible with benign prostatic obstruction: a systematic review of efficacy and adverse effects | journal = BJU International | volume = 94 | issue = 9 | pages = 1263–1270 | date = December 2004 | pmid = 15610102 | doi = 10.1111/j.1464-410X.2004.05154.x | s2cid = 6640867 | doi-access = free }} silodosin, tamsulosin, terazosin, and naftopidil. They have a small to moderate benefit at improving symptoms.{{cite journal | vauthors = Djavan B, Marberger M | title = A meta-analysis on the efficacy and tolerability of alpha1-adrenoceptor antagonists in patients with lower urinary tract symptoms suggestive of benign prostatic obstruction | journal = European Urology | volume = 36 | issue = 1 | pages = 1–13 | year = 1999 | pmid = 10364649 | doi = 10.1159/000019919 | s2cid = 73366414 }} Selective alpha-1 blockers are similar in effectiveness but have slightly different side effect profiles.{{cite journal | vauthors = Wilt TJ, Mac Donald R, Rutks I | title = Tamsulosin for benign prostatic hyperplasia | journal = The Cochrane Database of Systematic Reviews | issue = 1 | pages = CD002081 | date = 2003 | pmid = 12535426 | doi = 10.1002/14651858.CD002081 | veditors = Wilt T }} Alpha blockers relax smooth muscle in the prostate and the bladder neck, thus decreasing the blockage of urine flow. Common side effects of alpha-blockers include orthostatic hypotension (a head rush or dizzy spell when standing up or stretching), ejaculation changes, erectile dysfunction,{{cite journal | vauthors = Santillo VM, Lowe FC | title = Treatment of benign prostatic hyperplasia in patients with cardiovascular disease | journal = Drugs & Aging | volume = 23 | issue = 10 | pages = 795–805 | year = 2006 | pmid = 17067183 | doi = 10.2165/00002512-200623100-00003 | s2cid = 24428368 }} headaches, nasal congestion, and weakness. For men with LUTS due to an enlarged prostate, the effects of naftopidil, tamsulosin, and silodosin on urinary symptoms and quality of life may be similar. Naftopidil and tamsulosin may have similar levels of unwanted sexual side effects but fewer unwanted side effects than silodosin.

Tamsulosin and silodosin are selective α1 receptor blockers that preferentially bind to the α1A receptor in the prostate instead of the α1B receptor in the blood vessels. Less-selective α1 receptor blockers such as terazosin and doxazosin may lower blood pressure. The older, less selective α1-adrenergic blocker prazosin is not a first-line choice for either high blood pressure or prostatic hyperplasia; it is a choice for patients who present with both problems at the same time. The older, broadly non-selective alpha-blocker medications such as phenoxybenzamine are not recommended for control of BPH.{{cite journal | title = AUA guideline on management of benign prostatic hyperplasia (2003). Chapter 1: Diagnosis and treatment recommendations | journal = The Journal of Urology | volume = 170 | issue = 2 Pt 1 | pages = 530–547 | date = August 2003 | pmid = 12853821 | doi = 10.1097/01.ju.0000078083.38675.79 | author1 = AUA Practice Guidelines Committee }} Non-selective alpha-blockers such as terazosin and doxazosin may also require slow dose adjustments as they can lower blood pressure and cause syncope (fainting) if the response to the medication is too strong.

The 5α-reductase inhibitors finasteride and dutasteride may also be used in people with BPH.{{cite journal | vauthors = Blankstein U, Van Asseldonk B, Elterman DS | title = BPH update: medical versus interventional management | journal = The Canadian Journal of Urology | volume = 23 | issue = Suppl 1 | pages = 10–15 | date = February 2016 | pmid = 26924590 | url = http://www.canjurol.com/html/free-articles/V23I1S1F-07_DrElterman.pdf | url-status = live | archive-url = https://web.archive.org/web/20160807134146/http://www.canjurol.com/html/free-articles/V23I1S1F-07_DrElterman.pdf | archive-date = 7 August 2016 }} These medications inhibit the 5α-reductase enzyme, which, in turn, inhibits the production of DHT, a hormone responsible for enlarging the prostate. Effects may take longer to appear than alpha blockers, but they persist for many years.{{cite journal | vauthors = Roehrborn CG, Bruskewitz R, Nickel JC, McConnell JD, Saltzman B, Gittelman MC, Malek GH, Gottesman JE, Suryawanshi S, Drisko J, Meehan A, Waldstreicher J | title = Sustained decrease in incidence of acute urinary retention and surgery with finasteride for 6 years in men with benign prostatic hyperplasia | journal = The Journal of Urology | volume = 171 | issue = 3 | pages = 1194–1198 | date = March 2004 | pmid = 14767299 | doi = 10.1097/01.ju.0000112918.74410.94 | collaboration = Proscar Long-Term Efficacy Safety Study Group }} When used together with alpha-blockers, no benefit was reported in short-term trials, but in a longer-term study (3–4 years) there was a greater reduction in BPH progression to acute urinary retention and surgery than with either agent alone, especially in people with more severe symptoms and larger prostates.{{cite journal | vauthors = Roehrborn CG, Barkin J, Tubaro A, Emberton M, Wilson TH, Brotherton BJ, Castro R | title = Influence of baseline variables on changes in International Prostate Symptom Score after combined therapy with dutasteride plus tamsulosin or either monotherapy in patients with benign prostatic hyperplasia and lower urinary tract symptoms: 4-year results of the CombAT study | journal = BJU International | volume = 113 | issue = 4 | pages = 623–635 | date = April 2014 | pmid = 24127818 | doi = 10.1111/bju.12500 | s2cid = 38243275 }}{{cite journal | vauthors = Greco KA, McVary KT | title = The role of combination medical therapy in benign prostatic hyperplasia | journal = International Journal of Impotence Research | volume = 20 | issue = Suppl 3 | pages = S33–S43 | date = December 2008 | pmid = 19002123 | doi = 10.1038/ijir.2008.51 | doi-access = free }}{{cite journal | vauthors = Kaplan SA, McConnell JD, Roehrborn CG, Meehan AG, Lee MW, Noble WR, Kusek JW, Nyberg LM | title = Combination therapy with doxazosin and finasteride for benign prostatic hyperplasia in patients with lower urinary tract symptoms and a baseline total prostate volume of 25 ml or greater | journal = The Journal of Urology | volume = 175 | issue = 1 | pages = 217–20; discussion 220–1 | date = January 2006 | pmid = 16406915 | doi = 10.1016/S0022-5347(05)00041-8 | collaboration = Medical Therapy of Prostatic Symptoms (MTOPS) Research Group }} Other trials have confirmed reductions in symptoms, within 6 months in one trial, an effect that was maintained after withdrawal of the alpha blocker.{{cite journal | vauthors = Barkin J, Guimarães M, Jacobi G, Pushkar D, Taylor S, van Vierssen Trip OB | title = Alpha-blocker therapy can be withdrawn in the majority of men following initial combination therapy with the dual 5alpha-reductase inhibitor dutasteride | journal = European Urology | volume = 44 | issue = 4 | pages = 461–466 | date = October 2003 | pmid = 14499682 | doi = 10.1016/s0302-2838(03)00367-1 }} Side effects include decreased libido and ejaculatory or erectile dysfunction.{{cite journal | vauthors = Gormley GJ, Stoner E, Bruskewitz RC, Imperato-McGinley J, Walsh PC, McConnell JD, Andriole GL, Geller J, Bracken BR, Tenover JS | title = The effect of finasteride in men with benign prostatic hyperplasia. The Finasteride Study Group | journal = The New England Journal of Medicine | volume = 327 | issue = 17 | pages = 1185–1191 | date = October 1992 | pmid = 1383816 | doi = 10.1056/NEJM199210223271701 | doi-access = free }}{{cite journal | vauthors = Gacci M, Ficarra V, Sebastianelli A, Corona G, Serni S, Shariat SF, Maggi M, Zattoni F, Carini M, Novara G | title = Impact of medical treatments for male lower urinary tract symptoms due to benign prostatic hyperplasia on ejaculatory function: a systematic review and meta-analysis | journal = The Journal of Sexual Medicine | volume = 11 | issue = 6 | pages = 1554–1566 | date = June 2014 | pmid = 24708055 | doi = 10.1111/jsm.12525 }} The 5α-reductase inhibitors are contraindicated in pregnant women because of their teratogenicity due to interference with fetal testosterone metabolism, and as a precaution, pregnant women should not handle crushed or broken tablets.{{cite web | vauthors = Deters L |title = Benign Prostatic Hypertrophy Treatment & Management |url = http://emedicine.medscape.com/article/437359-treatment |website = Medscape |access-date = 14 November 2015 |url-status = live |archive-url = https://web.archive.org/web/20151030062812/http://emedicine.medscape.com/article/437359-treatment |archive-date = 30 October 2015}}

[[File:NHS-medicines-effectiveness.png|none|thumb|650x650px|The effectiveness of alpha-blockers and 5-ARIs, and a combination of the two, versus placebo pills, in improving symptoms of an enlarged prostate.{{cite journal | vauthors = McConnell JD, Roehrborn CG, Bautista OM, Andriole GL, Dixon CM, Kusek JW, Lepor H, McVary KT, Nyberg LM, Clarke HS, Crawford ED, Diokno A, Foley JP, Foster HE, Jacobs SC, Kaplan SA, Kreder KJ, Lieber MM, Lucia MS, Miller GJ, Menon M, Milam DF, Ramsdell JW, Schenkman NS, Slawin KM, Smith JA | title = The long-term effect of doxazosin, finasteride, and combination therapy on the clinical progression of benign prostatic hyperplasia | journal = The New England Journal of Medicine | volume = 349 | issue = 25 | pages = 2387–2398 | date = December 2003 | pmid = 14681504 | doi = 10.1056/NEJMoa030656 }}{{cite journal | vauthors = Roehrborn CG, Siami P, Barkin J, Damião R, Major-Walker K, Nandy I, Morrill BB, Gagnier RP, Montorsi F | title = The effects of combination therapy with dutasteride and tamsulosin on clinical outcomes in men with symptomatic benign prostatic hyperplasia: 4-year results from the CombAT study | journal = European Urology | volume = 57 | issue = 1 | pages = 123–131 | date = January 2010 | pmid = 19825505 | doi = 10.1016/j.eururo.2009.09.035 }}{{cite journal | vauthors = Kaplan SA, Roehrborn CG, Rovner ES, Carlsson M, Bavendam T, Guan Z | title = Tolterodine and tamsulosin for treatment of men with lower urinary tract symptoms and overactive bladder: a randomized controlled trial | journal = JAMA | volume = 296 | issue = 19 | pages = 2319–2328 | date = November 2006 | pmid = 17105794 | doi = 10.1001/jama.296.19.2319 }}

Graphic from NHS England.]]

[[File:NHS-medicines-sideeffects.png|none|thumb|676x676px|The frequency of side effects from alpha-blockers and 5-ARIs.{{cite journal | vauthors = van Dijk MM, de la Rosette JJ, Michel MC | title = Effects of alpha(1)-adrenoceptor antagonists on male sexual function | journal = Drugs | volume = 66 | issue = 3 | pages = 287–301 | date = 2006-02-01 | pmid = 16526818 | doi = 10.2165/00003495-200666030-00002 }}{{cite journal | vauthors = Descazeaud A, de La Taille A, Giuliano F, Desgrandchamps F, Doridot G | title = [Negative effects on sexual function of medications for the treatment of lower urinary tract symptoms related to benign prostatic hyperplasia] | journal = Progres en Urologie | volume = 25 | issue = 3 | pages = 115–127 | date = March 2015 | pmid = 25605342 | doi = 10.1016/j.purol.2014.12.003 }}{{Cite web |date=2010-05-23 |title=Evidence {{!}} Lower urinary tract symptoms in men: management {{!}} Guidance {{!}} NICE |url=https://www.nice.org.uk/guidance/cg97/evidence |access-date=2024-09-08 |website=www.nice.org.uk}}

Graphic from NHS England.]]

A 2018 Cochrane review of studies on men over 60 with moderate to severe lower urinary tract symptoms analyzed the impacts of phosphodiesterase inhibitors (PDE) in comparison to other drugs.{{cite journal | vauthors = Pattanaik S, Mavuduru RS, Panda A, Mathew JL, Agarwal MM, Hwang EC, Lyon JA, Singh SK, Mandal AK | title = Phosphodiesterase inhibitors for lower urinary tract symptoms consistent with benign prostatic hyperplasia | journal = The Cochrane Database of Systematic Reviews | volume = 2018 | issue = 11 | pages = CD010060 | date = November 2018 | pmid = 30480763 | pmc = 6517182 | doi = 10.1002/14651858.CD010060.pub2 | collaboration = Cochrane Urology Group }} These drugs may improve urinary symptoms slightly and reduce urinary bother but may also cause more side effects than placebo. The evidence in this review found that there is probably no difference between PDE and alpha blockers, however when used in combination they may provide a greater improvement in symptoms (with more side effects). PDE also likely improves symptoms when used with 5-alpha reductase inhibitors.

Several phosphodiesterase-5 inhibitors are also effective but may require multiple doses daily to maintain adequate urine flow.{{cite journal | vauthors = Wang Y, Bao Y, Liu J, Duan L, Cui Y | title = Tadalafil 5 mg Once Daily Improves Lower Urinary Tract Symptoms and Erectile Dysfunction: A Systematic Review and Meta-analysis | journal = Lower Urinary Tract Symptoms | volume = 10 | issue = 1 | pages = 84–92 | date = January 2018 | pmid = 29341503 | doi = 10.1111/luts.12144 | s2cid = 23929021 }}{{cite journal | vauthors = Pattanaik S, Mavuduru RS, Panda A, Mathew JL, Agarwal MM, Hwang EC, Lyon JA, Singh SK, Mandal AK | title = Phosphodiesterase inhibitors for lower urinary tract symptoms consistent with benign prostatic hyperplasia | journal = The Cochrane Database of Systematic Reviews | volume = 2018 | issue = 11 | pages = CD010060 | date = November 2018 | pmid = 30480763 | pmc = 6517182 | doi = 10.1002/14651858.CD010060.pub2 }} Tadalafil, a phosphodiesterase-5 inhibitor, was considered then rejected by NICE in the UK for the treatment of symptoms associated with BPH.{{cite web |title = Hyperplasia (benign prostatic) – tadalafil (terminated appraisal) (TA273) |url = http://guidance.nice.org.uk/TA273 |work = National Institute for Health and Clinical Excellence (NICE) |date = 23 January 2013 |access-date = 27 January 2013 |url-status = live |archive-url = https://web.archive.org/web/20130224050938/http://guidance.nice.org.uk/TA273 |archive-date = 24 February 2013}} In 2011, the U.S. Food and Drug Administration approved tadalafil to treat the signs and symptoms of benign prostatic hyperplasia, and for the treatment of BPH and erectile dysfunction (ED), when the conditions occur simultaneously.{{cite web |title = FDA approves Cialis to treat benign prostatic hyperplasia |url = https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm274642.htm |work = U.S. Food and Drug Administration (FDA) |access-date = 7 May 2013 |url-status = dead |archive-url = https://web.archive.org/web/20170118091151/https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm274642.htm |archive-date = 18 January 2017}}

Antimuscarinics such as tolterodine may also be used, especially in combination with alpha-blockers.{{cite journal | vauthors = Kaplan SA, Roehrborn CG, Rovner ES, Carlsson M, Bavendam T, Guan Z | title = Tolterodine and tamsulosin for treatment of men with lower urinary tract symptoms and overactive bladder: a randomized controlled trial | journal = JAMA | volume = 296 | issue = 19 | pages = 2319–2328 | date = November 2006 | pmid = 17105794 | doi = 10.1001/jama.296.19.2319 | doi-access = free }} They act by decreasing acetylcholine effects on the smooth muscle of the bladder, thus helping control symptoms of an overactive bladder.{{cite journal | vauthors = Abrams P, Andersson KE | title = Muscarinic receptor antagonists for overactive bladder | journal = BJU International | volume = 100 | issue = 5 | pages = 987–1006 | date = November 2007 | pmid = 17922784 | doi = 10.1111/j.1464-410x.2007.07205.x | s2cid = 30983780 | doi-access = free }}

Intermittent urinary catheterization is used to relieve the bladder in people with urinary retention. Self-catheterization is an option in BPH when it is difficult or impossible to empty the bladder.{{cite web|url=http://www.harvardhealthcontent.com/SpecialHealthReports/70,PA0212?Page=Section9|title=Prostate enlargement (benign prostatic hyperplasia)|website=Harvard Health Content|publisher=Harvard Health Publications|url-status=dead|archive-url=https://web.archive.org/web/20150403012629/http://www.harvardhealthcontent.com/SpecialHealthReports/70%2CPA0212?Page=Section9|archive-date=3 April 2015|access-date=2 February 2015}} Urinary tract infection is the most common complication of intermittent catheterization.{{cite journal | vauthors = Wyndaele JJ | title = Complications of intermittent catheterization: their prevention and treatment | journal = Spinal Cord | volume = 40 | issue = 10 | pages = 536–541 | date = October 2002 | pmid = 12235537 | doi = 10.1038/sj.sc.3101348 | doi-access = free }} Several techniques and types of catheter are available, including sterile (single-use) and clean (multiple use) catheters, but, based on current information, none is superior to others in reducing the incidence of urinary tract infection.{{cite journal | vauthors = Prieto JA, Murphy CL, Stewart F, Fader M | title = Intermittent catheter techniques, strategies and designs for managing long-term bladder conditions | journal = The Cochrane Database of Systematic Reviews | volume = 10 | issue = 10 | pages = CD006008 | date = October 2021 | pmid = 34699062 | pmc = 8547544 | doi = 10.1002/14651858.CD006008.pub5 }}

{{Main|Surgery for benign prostatic hyperplasia}}

File:Rtu.jpg

If medical treatment is not effective, surgery may be performed. Surgical techniques used include the following:

• Transurethral resection of the prostate (TURP): the gold standard.{{cite journal | vauthors = Franco JV, Garegnani L, Escobar Liquitay CM, Borofsky M, Dahm P | title = Transurethral microwave thermotherapy for the treatment of lower urinary tract symptoms in men with benign prostatic hyperplasia | journal = The Cochrane Database of Systematic Reviews | volume = 2021 | issue = 6 | pages = CD004135 | date = June 2021 | pmid = 34180047 | pmc = 8236484 | doi = 10.1002/14651858.CD004135.pub4 }} TURP is thought to be the most effective approach for improving urinary symptoms and urinary flow, however, this surgical procedure may be associated with complications in up to 20% of men. Surgery carries some risk of complications, such as retrograde ejaculation (most commonly), erectile dysfunction, urinary incontinence, urethral strictures.{{Cite web|url=https://www.nhs.uk/conditions/transurethral-resection-of-the-prostate-turp/risks/|title=Transurethral resection of the prostate (TURP) - Risks|date=2017-10-24|website=nhs.uk|language=en|access-date=2020-03-08}}
• Transurethral incision of the prostate (TUIP): rarely performed; the technique is similar to TURP but less definitive.
• Open prostatectomy: not usually performed nowadays due to its high morbidity, even if the results are excellent.

Other less invasive surgical approaches (requiring spinal anesthesia) include:

• Holmium laser ablation of the prostate (HoLAP)
• Holmium laser enucleation of the prostate (HoLeP)
• Thulium laser transurethral vaporesection of the prostate (ThuVARP)
• Photoselective vaporization of the prostate (PVP)
• Aquablation therapy: a type of surgery using a water jet to remove prostatic tissue.

Some less invasive procedures are available according to patients' preferences and co-morbidities. These are performed as outpatient procedures with local anesthesia.

• Prostatic artery embolization: an endovascular procedure performed in interventional radiology.{{cite journal | vauthors = Kuang M, Vu A, Athreya S | title = A Systematic Review of Prostatic Artery Embolization in the Treatment of Symptomatic Benign Prostatic Hyperplasia | journal = CardioVascular and Interventional Radiology | volume = 40 | issue = 5 | pages = 655–663 | date = May 2017 | pmid = 28032133 | doi = 10.1007/s00270-016-1539-3 | s2cid = 12154537 }} Through catheters, embolic agents are released in the main branches of the prostatic artery, in order to induce a decrease in the size of the prostate gland, thus reducing the urinary symptoms.{{cite journal | vauthors = Pisco J, Bilhim T, Pinheiro LC, Fernandes L, Pereira J, Costa NV, Duarte M, Oliveira AG | title = Prostate Embolization as an Alternative to Open Surgery in Patients with Large Prostate and Moderate to Severe Lower Urinary Tract Symptoms | journal = Journal of Vascular and Interventional Radiology | volume = 27 | issue = 5 | pages = 700–708 | date = May 2016 | pmid = 27019980 | doi = 10.1016/j.jvir.2016.01.138 }}
• Water vapor thermal therapy (marketed as Rezum): This is a newer office procedure for removing prostate tissue using steam aimed at preserving sexual function.
• Prostatic urethral lift (marketed as UroLift): This intervention consists of a system of a device and an implant designed to pull the prostatic lobe away from the urethra.{{cite journal | vauthors = McNicholas TA | title = Benign prostatic hyperplasia and new treatment options - a critical appraisal of the UroLift system | journal =Medical Devices: Evidence and Research | volume = 9 | pages = 115–123 | date = May 2016 | pmid = 27274321 | pmc = 4876946 | doi = 10.2147/MDER.S60780 | doi-access = free }}
• Transurethral microwave thermotherapy (TUMT) is an outpatient procedure that is less invasive compared to surgery and involves using microwaves (heat) to shrink prostate tissue that is enlarged.
• Temporary implantable nitinol device (TIND and {{Proper name|iTIND}}): is a device that is placed in the urethra that, when released, is expanded, reshaping the urethra and the bladder neck.{{cite journal | vauthors = Porpiglia F, Fiori C, Bertolo R, Garrou D, Cattaneo G, Amparore D | title = Temporary implantable nitinol device (TIND): a novel, minimally invasive treatment for relief of lower urinary tract symptoms (LUTS) related to benign prostatic hyperplasia (BPH): feasibility, safety and functional results at 1 year of follow-up | journal = BJU International | volume = 116 | issue = 2 | pages = 278–287 | date = August 2015 | pmid = 25382816 | doi = 10.1111/bju.12982 | hdl-access = free | s2cid = 5712711 | hdl = 2318/1623503 }}

File:NHS-surgeries-effectiveness.png

File:NHS-surgeries-effectiveness2.png

[[File:NHS-surgeries-sideeffects.png|none|thumb|800x800px|Frequencies of side-effects from different surgeries and minimally-invasive procedures for enlarged prostate.{{cite journal | vauthors = Knight L, Dale M, Cleves A, Pelekanou C, Morris R | title = UroLift for Treating Lower Urinary Tract Symptoms of Benign Prostatic Hyperplasia: A NICE Medical Technology Guidance Update | journal = Applied Health Economics and Health Policy | volume = 20 | issue = 5 | pages = 669–680 | date = September 2022 | pmid = 35843995 | pmc = 9385790 | doi = 10.1007/s40258-022-00735-y }}{{Cite web |date=2010-05-23 |title=Evidence {{!}} Lower urinary tract symptoms in men: management {{!}} Guidance {{!}} NICE |url=https://www.nice.org.uk/guidance/cg97/evidence |access-date=2024-09-08 |website=www.nice.org.uk}}{{cite journal | vauthors = Cacciamani GE, Cuhna F, Tafuri A, Shakir A, Cocci A, Gill K, Gómez Rivas J, Dourado A, Veneziano D, Okhunov Z, Capogrosso P, Hueber PA, Alberseen M, Abreu A, Migliorini F, Fiori C, Porcaro AB, Porpiglia F, Desai M, Russo GI | title = Anterograde ejaculation preservation after endoscopic treatments in patients with bladder outlet obstruction: systematic review and pooled-analysis of randomized clinical trials | journal = Minerva Urologica e Nefrologica = the Italian Journal of Urology and Nephrology | volume = 71 | issue = 5 | pages = 427–434 | date = October 2019 | pmid = 31487977 | doi = 10.23736/s0393-2249.19.03588-4 }}{{cite journal | vauthors = Lokeshwar SD, Valancy D, Lima TF, Blachman-Braun R, Ramasamy R | title = A Systematic Review of Reported Ejaculatory Dysfunction in Clinical Trials Evaluating Minimally Invasive Treatment Modalities for BPH | journal = Current Urology Reports | volume = 21 | issue = 12 | pages = 54 | date = October 2020 | pmid = 33104947 | doi = 10.1007/s11934-020-01012-y }}{{cite journal | vauthors = Calik G, Laguna MP, Gravas S, Albayrak S, de la Rosette J | title = Preservation of antegrade ejaculation after surgical relief of benign prostatic obstruction is a valid endpoint | journal = World Journal of Urology | volume = 39 | issue = 7 | pages = 2277–2289 | date = July 2021 | pmid = 33796882 | doi = 10.1007/s00345-021-03682-w }}{{cite journal | vauthors = Kuntz RM, Ahyai S, Lehrich K, Fayad A | title = Transurethral holmium laser enucleation of the prostate versus transurethral electrocautery resection of the prostate: a randomized prospective trial in 200 patients | journal = The Journal of Urology | volume = 172 | issue = 3 | pages = 1012–1016 | date = September 2004 | pmid = 15311026 | doi = 10.1097/01.ju.0000136218.11998.9e }}{{cite journal | vauthors = Capitán C, Blázquez C, Martin MD, Hernández V, de la Peña E, Llorente C | title = GreenLight HPS 120-W laser vaporization versus transurethral resection of the prostate for the treatment of lower urinary tract symptoms due to benign prostatic hyperplasia: a randomized clinical trial with 2-year follow-up | journal = European Urology | volume = 60 | issue = 4 | pages = 734–739 | date = October 2011 | pmid = 21658839 | doi = 10.1016/j.eururo.2011.05.043 }}{{cite journal | vauthors = Ghobrial FK, Shoma A, Elshal AM, Laymon M, El-Tabey N, Nabeeh A, Shokeir AA | title = A randomized trial comparing bipolar transurethral vaporization of the prostate with GreenLight laser (xps-180watt) photoselective vaporization of the prostate for treatment of small to moderate benign prostatic obstruction: outcomes after 2 years | journal = BJU International | volume = 125 | issue = 1 | pages = 144–152 | date = January 2020 | pmid = 31621175 | doi = 10.1111/bju.14926 }}{{cite journal | vauthors = Krambeck AE, Handa SE, Lingeman JE | title = Experience with more than 1,000 holmium laser prostate enucleations for benign prostatic hyperplasia | journal = The Journal of Urology | volume = 183 | issue = 3 | pages = 1105–1109 | date = March 2010 | pmid = 20092844 | doi = 10.1016/j.juro.2009.11.034 }}{{cite journal | vauthors = Elshal AM, Soltan M, El-Tabey NA, Laymon M, Nabeeh A | title = Randomised trial of bipolar resection vs holmium laser enucleation vs Greenlight laser vapo-enucleation of the prostate for treatment of large benign prostate obstruction: 3-years outcomes | journal = BJU International | volume = 126 | issue = 6 | pages = 731–738 | date = December 2020 | pmid = 32633020 | doi = 10.1111/bju.15161 }}{{cite journal | vauthors = Geavlete B, Georgescu D, Multescu R, Stanescu F, Jecu M, Geavlete P | title = Bipolar plasma vaporization vs monopolar and bipolar TURP-A prospective, randomized, long-term comparison | journal = Urology | volume = 78 | issue = 4 | pages = 930–935 | date = October 2011 | pmid = 21802121 | doi = 10.1016/j.urology.2011.03.072 }}{{cite journal | vauthors = Rai P, Srivastava A, Dhayal IR, Singh S | title = Comparison of Safety, Efficacy and Cost Effectiveness of Photoselective Vaporization with Bipolar Vaporization of Prostate in Benign Prostatic Hyperplasia | language = en-US | journal = Current Urology | volume = 11 | issue = 2 | pages = 103–109 | date = February 2018 | pmid = 29593470 | pmc = 5836246 | doi = 10.1159/000447202 }}{{cite journal | vauthors = Law KW, Tholomier C, Nguyen DD, Sadri I, Couture F, Zakaria AS, Bouhadana D, Bruyère F, Cash H, Reimann M, Cindolo L, Ferrari G, Vasquez-Lastra C, Borelli-Bovo TJ, Becher EF, Misrai V, Elterman D, Bhojani N, Zorn KC | title = Global Greenlight Group: largest international Greenlight experience for benign prostatic hyperplasia to assess efficacy and safety | journal = World Journal of Urology | volume = 39 | issue = 12 | pages = 4389–4395 | date = December 2021 | pmid = 33837819 | doi = 10.1007/s00345-021-03688-4 }}{{cite journal | vauthors = Bachmann A, Tubaro A, Barber N, d'Ancona F, Muir G, Witzsch U, Grimm MO, Benejam J, Stolzenburg JU, Riddick A, Pahernik S, Roelink H, Ameye F, Saussine C, Bruyère F, Loidl W, Larner T, Gogoi NK, Hindley R, Muschter R, Thorpe A, Shrotri N, Graham S, Hamann M, Miller K, Schostak M, Capitán C, Knispel H, Thomas JA | title = 180-W XPS GreenLight laser vaporisation versus transurethral resection of the prostate for the treatment of benign prostatic obstruction: 6-month safety and efficacy results of a European Multicentre Randomised Trial--the GOLIATH study | journal = European Urology | volume = 65 | issue = 5 | pages = 931–942 | date = May 2014 | pmid = 24331152 | doi = 10.1016/j.eururo.2013.10.040 }}{{cite journal | vauthors = Gratzke C, Barber N, Speakman MJ, Berges R, Wetterauer U, Greene D, Sievert KD, Chapple CR, Patterson JM, Fahrenkrug L, Schoenthaler M, Sonksen J | title = Prostatic urethral lift vs transurethral resection of the prostate: 2-year results of the BPH6 prospective, multicentre, randomized study | journal = BJU International | volume = 119 | issue = 5 | pages = 767–775 | date = May 2017 | pmid = 27862831 | doi = 10.1111/bju.13714 }}{{cite journal | vauthors = Gao YA, Huang Y, Zhang R, Yang YD, Zhang Q, Hou M, Wang Y | title = Benign prostatic hyperplasia: prostatic arterial embolization versus transurethral resection of the prostate--a prospective, randomized, and controlled clinical trial | journal = Radiology | volume = 270 | issue = 3 | pages = 920–928 | date = March 2014 | pmid = 24475799 | doi = 10.1148/radiol.13122803 }}{{cite journal | vauthors = Dixon C, Cedano ER, Pacik D, Vit V, Varga G, Wagrell L, Tornblom M, Mynderse L, Larson T | title = Efficacy and Safety of Rezūm System Water Vapor Treatment for Lower Urinary Tract Symptoms Secondary to Benign Prostatic Hyperplasia | journal = Urology | volume = 86 | issue = 5 | pages = 1042–1047 | date = November 2015 | pmid = 26216644 | doi = 10.1016/j.urology.2015.05.046 }}{{Cite journal | vauthors = Kaplan-Marans E, Cochran J, Wood A, Dubowitch E, Lee M, Schulman A |date=September 2021 |title=PD18-04 Urolife and Rezum: A Comparison of Device Related Adverse Events in a National Registry |url=http://www.auajournals.org/doi/10.1097/JU.0000000000002007.04 |journal=Journal of Urology |language=en |volume=206 |issue=Supplement 3 |doi=10.1097/JU.0000000000002007.04 |issn=0022-5347|url-access=subscription }}{{cite journal | vauthors = Pisco JM, Bilhim T, Costa NV, Torres D, Pisco J, Pinheiro LC, Oliveira AG | title = Randomised Clinical Trial of Prostatic Artery Embolisation Versus a Sham Procedure for Benign Prostatic Hyperplasia | journal = European Urology | volume = 77 | issue = 3 | pages = 354–362 | date = March 2020 | pmid = 31831295 | doi = 10.1016/j.eururo.2019.11.010 | hdl = 10400.17/3575 | hdl-access = free }}{{cite journal | vauthors = Carnevale FC, Iscaife A, Yoshinaga EM, Moreira AM, Antunes AA, Srougi M | title = Transurethral Resection of the Prostate (TURP) Versus Original and PErFecTED Prostate Artery Embolization (PAE) Due to Benign Prostatic Hyperplasia (BPH): Preliminary Results of a Single Center, Prospective, Urodynamic-Controlled Analysis | journal = CardioVascular and Interventional Radiology | volume = 39 | issue = 1 | pages = 44–52 | date = January 2016 | pmid = 26506952 | doi = 10.1007/s00270-015-1202-4 }}{{cite journal | vauthors = Gilling P, Barber N, Bidair M, Anderson P, Sutton M, Aho T, Kramolowsky E, Thomas A, Cowan B, Kaufman RP, Trainer A, Arther A, Badlani G, Plante M, Desai M, Doumanian L, Te AE, DeGuenther M, Roehrborn C | title = Three-year outcomes after Aquablation therapy compared to TURP: results from a blinded randomized trial | journal = The Canadian Journal of Urology | volume = 27 | issue = 1 | pages = 10072–10079 | date = February 2020 | pmid = 32065861 | url = https://www.canjurol.com/html/free-articles/Cdn_JU27_I1_05_FREE_DrGilling.pdf | publication-date = 2020 }}{{cite journal | vauthors = Desai M, Bidair M, Bhojani N, Trainer A, Arther A, Kramolowsky E, Doumanian L, Elterman D, Kaufman RP, Lingeman J, Krambeck A, Eure G, Badlani G, Plante M, Uchio E, Gin G, Goldenberg L, Paterson R, So A, Humphreys M, Roehrborn C, Kaplan S, Motola J, Zorn KC | title = WATER II (80-150 mL) procedural outcomes | journal = BJU International | volume = 123 | issue = 1 | pages = 106–112 | date = January 2019 | pmid = 29694702 | doi = 10.1111/bju.14360 }}{{Cite journal | vauthors = De Los Reyes TJ, Bhojani N, Zorn KC, Elterman DS |date=2020-09-01 |title=WATER II Trial (Aquablation) |url=https://link.springer.com/article/10.1007/s11884-020-00596-y |journal=Current Bladder Dysfunction Reports |language=en |volume=15 |issue=3 |pages=225–228 |doi=10.1007/s11884-020-00596-y |issn=1931-7220|url-access=subscription }}{{cite journal | vauthors = Porpiglia F, Fiori C, Bertolo R, Garrou D, Cattaneo G, Amparore D | title = Temporary implantable nitinol device (TIND): a novel, minimally invasive treatment for relief of lower urinary tract symptoms (LUTS) related to benign prostatic hyperplasia (BPH): feasibility, safety and functional results at 1 year of follow-up | journal = BJU International | volume = 116 | issue = 2 | pages = 278–287 | date = August 2015 | pmid = 25382816 | doi = 10.1111/bju.12982 | hdl = 2318/1623503 | hdl-access = free }}{{cite journal | vauthors = Elterman D, Alshak MN, Martinez Diaz S, Shore N, Gittleman M, Motola J, Pike S, Hermann C, Terens W, Kohan A, Gonzalez R, Katz A, Schiff J, Goldfischer E, Grunberger I, Tu L, Kaminetsky J, Chughtai B | title = An Evaluation of Sexual Function in the Treatment of Lower Urinary Tract Symptoms Secondary to Benign Prostatic Hyperplasia in Men Treated with the Temporarily Implanted Nitinol Device | journal = Journal of Endourology | volume = 37 | issue = 1 | pages = 74–79 | date = January 2023 | pmid = 36070450 | pmc = 9810348 | doi = 10.1089/end.2022.0226 }}{{cite journal | vauthors = Kadner G, Valerio M, Giannakis I, Manit A, Lumen N, Ho BS, Alonso S, Schulman C, Barber N, Amparore D, Porpiglia F | title = Second generation of temporary implantable nitinol device (iTind) in men with LUTS: 2 year results of the MT-02-study | journal = World Journal of Urology | volume = 38 | issue = 12 | pages = 3235–3244 | date = December 2020 | pmid = 32124019 | doi = 10.1007/s00345-020-03140-z }}

Graphic from NHS England.{{Cite web |title=NHS England » Decision support tool: making a decision about enlarged prostate (BPE) |url=https://www.england.nhs.uk/publication/decision-support-tool-making-a-decision-about-enlarged-prostate-bpe/ |access-date=2024-09-08 |website=www.england.nhs.uk}}]]

While herbal remedies are commonly used, a 2016 review found the herbs studied to be no better than placebos.{{cite journal | vauthors = Keehn A, Taylor J, Lowe FC | title = Phytotherapy for Benign Prostatic Hyperplasia | journal = Current Urology Reports | volume = 17 | issue = 7 | pages = 53 | date = July 2016 | pmid = 27180172 | doi = 10.1007/s11934-016-0609-z | s2cid = 25609876 }} Particularly, several reviews found that saw palmetto extract, while one of the most commonly used, is no better than a placebo both in symptom relief and in decreasing prostate size.{{cite journal | vauthors = Bent S, Kane C, Shinohara K, Neuhaus J, Hudes ES, Goldberg H, Avins AL | title = Saw palmetto for benign prostatic hyperplasia | journal = The New England Journal of Medicine | volume = 354 | issue = 6 | pages = 557–566 | date = February 2006 | pmid = 16467543 | doi = 10.1056/NEJMoa053085 | s2cid = 13815057 | doi-access = free }}{{cite journal | vauthors = Dedhia RC, McVary KT | title = Phytotherapy for lower urinary tract symptoms secondary to benign prostatic hyperplasia | journal = The Journal of Urology | volume = 179 | issue = 6 | pages = 2119–2125 | date = June 2008 | pmid = 18423748 | doi = 10.1016/j.juro.2008.01.094 }}{{cite journal | vauthors = Franco JV, Trivisonno L, Sgarbossa NJ, Alvez GA, Fieiras C, Escobar Liquitay CM, Jung JH | title = Serenoa repens for the treatment of lower urinary tract symptoms due to benign prostatic enlargement | journal = The Cochrane Database of Systematic Reviews | volume = 2023 | issue = 6 | pages = CD001423 | date = June 2023 | pmid = 37345871 | pmc = 10286776 | doi = 10.1002/14651858.CD001423.pub4 }}

File:Benign prostatic hypertrophy world map - DALY - WHO2004.svg for benign prostatic hyperplasia per 100,000 inhabitants in 2004{{cite web|year=2009|title=WHO Disease and injury country estimates|url=https://www.who.int/healthinfo/global_burden_disease/estimates_country/en/index.html|url-status=live|archive-url=https://web.archive.org/web/20091111101009/http://www.who.int/healthinfo/global_burden_disease/estimates_country/en/index.html|archive-date=11 November 2009|access-date=11 November 2009|work=World Health Organization}}{{Div col|small=yes|colwidth=10em}}

{{legend|#b3b3b3|no data}}

{{legend|#ffff65|less than 20}}

{{legend|#fff200|20–28}}

{{legend|#ffdc00|28–36}}

{{legend|#ffc600|36–44}}

{{legend|#ffb000|44–52}}

{{legend|#ff9a00|52–60}}

{{legend|#ff8400|60–68}}

{{legend|#ff6e00|68–76}}

{{legend|#ff5800|76–84}}

{{legend|#ff4200|84–92}}

{{legend|#ff2c00|92–100}}

{{legend|#cb0000|more than 100}}

{{div col end}}]]

Globally, benign prostatic hyperplasia affects about 94 million males {{as of|lc=yes|2019}}.

The prostate gets larger in most men as they get older. For a symptom-free man of 46 years, the risk of developing BPH over the next 30 years is 45%. Incidence rates increase from 3 cases per 1000 man-years at age 45–49 years, to 38 cases per 1000 man-years by the age of 75–79 years. While the prevalence rate is 2.7% for men aged 45–49, it increases to 24% by the age of 80 years.{{cite journal | vauthors = Verhamme KM, Dieleman JP, Bleumink GS, van der Lei J, Sturkenboom MC, Artibani W, Begaud B, Berges R, Borkowski A, Chappel CR, Costello A, Dobronski P, Farmer RD, Jiménez Cruz F, Jonas U, MacRae K, Pientka L, Rutten FF, van Schayck CP, Speakman MJ, Sturkenboom MC, Tiellac P, Tubaro A, Vallencien G, Vela Navarrete R | title = Incidence and prevalence of lower urinary tract symptoms suggestive of benign prostatic hyperplasia in primary care--the Triumph project | journal = European Urology | volume = 42 | issue = 4 | pages = 323–328 | date = October 2002 | pmid = 12361895 | doi = 10.1016/S0302-2838(02)00354-8 | collaboration = Triumph Pan European Expert Panel }}

{{clear}}

{{Reflist}}

{{Portal|Medicine}}

{{Commons category|Benign prostatic hyperplasia}}

• [https://web.archive.org/web/20140708202105/http://www.endoatlas.com/co_ge_18.html Extrinsic Compression by Prostate]

{{Medical condition classification and resources

| DiseasesDB = 10797

| ICD10 = {{ICD10|N|40||n|40}}

| ICD9 = {{ICD9|600}}

| ICDO =

| OMIM = 600082

| MedlinePlus = 000381

| eMedicineSubj = med

| eMedicineTopic = 1919

| MeshID = D011470

}}

{{Male diseases of the pelvis and genitals}}

{{Authority control}}

Category:Andrology

Category:Men's health

Category:Neoplastic and hyperplastic prostate disorders

Category:Wikipedia medicine articles ready to translate