What Is BPH?
Benign prostatic hyperplasia is a non-cancerous enlargement of the prostate gland that compresses the urethra as it passes through the prostate, causing lower urinary tract symptoms (LUTS). It is extremely common in ageing men and is not related to prostate cancer.
Symptoms (LUTS)
- Urinary frequency — needing to urinate often, including at night (nocturia)
- Urgency — sudden, difficult-to-control urge to urinate
- Weak or intermittent urine stream
- Hesitancy — difficulty starting urination
- Feeling of incomplete bladder emptying
- Terminal dribbling
Tests
| Test | Purpose |
|---|---|
| PSA | Screens for prostate cancer (BPH raises PSA — must distinguish from cancer) |
| Urine dipstick + culture | Rules out UTI as alternative cause |
| eGFR + creatinine | Checks for hydronephrosis if severe obstruction has affected kidneys |
| Post-void residual ultrasound | Measures how much urine remains after voiding |
| IPSS questionnaire | International Prostate Symptom Score — quantifies symptom severity |
| Flexible cystoscopy | If doubt about obstruction cause or haematuria present |
Treatment
| Treatment | Type | How It Works |
|---|---|---|
| Lifestyle changes | Behavioural | Reduce caffeine/alcohol; timed voiding; fluid management |
| Alpha-blockers (tamsulosin) | Medication | Relax prostate and bladder neck smooth muscle — rapid effect |
| 5-alpha reductase inhibitors (finasteride) | Medication | Shrink prostate — takes 6+ months to work |
| TURP (transurethral resection of prostate) | Surgery | Gold standard surgery; removes obstructing tissue |
| Laser prostatectomy / UroLift | Minimally invasive | Less bleeding, suitable for higher-risk patients |
FAQs
Does BPH cause cancer?
No — BPH is benign. However, both BPH and prostate cancer are common in older men and can co-exist. PSA screening helps distinguish them.
Can BPH be ignored?
Mild symptoms can be managed watchfully. Untreated severe BPH can cause urinary retention, bladder damage or kidney failure — these need intervention.
What if I can't urinate at all?
Acute urinary retention is an emergency — a urinary catheter is needed immediately. Do not delay.
Medical Disclaimer: BPH and prostate cancer can co-exist. A rising PSA in a man with known BPH should always be investigated further.