Around the time of a man’s 50th birthday (though sometimes sooner), his prostate begins to grow. This natural enlargement is called benign prostatic hyperplasia (BPH). It is called benign because it is not cancerous, and hyperplasia is the medical term for an increase in the number of cells in a tissue or an organ. BPH is the most common cause of prostate enlargement; indeed, if a man lives long enough, he will almost certainly experience some degree of BPH. It is a benign condition that does not lead to prostate cancer, although the two problems can coexist.
No one knows exactly why BPH occurs. One popular theory suggests that the prostate begins to grow because of shifts in the balance between testosterone, a male hormone, and estrogen, a female hormone that is present in men in small amounts. Testosterone production declines with advancing age, changing the ratio of testosterone to estrogen. Some animal studies have shown that this shift in hormone balance may start a chain reaction, causing the rapid cell multiplication that results in BPH. Other animal studies suggest that the accumulation of another male hormone, dihydrotestosterone (DHT), in the prostate may encourage cells in the prostate to divide. Researchers are also beginning to investigate whether inflammatory processes might underlie BPH.
Risk factors for BPH include abdominal obesity, diabetes, and lack of physical activity. Research shows that even light exercise cuts the risk of developing BPH by around 35%. Drinking alcohol also seems to lower the risk of BPH but not the risk of the lower urinary tract symptoms it may cause. Whether African American men are more likely to get BPH than white men isn’t clear; the results from epidemiological studies remain split on that question.
Diet definitely seems to matter. Several large studies have found a correlation between Western dietary patterns (high intake of red meat, refined grains, and sugar) and prostate enlargement.
Between 50% and 60% of men with BPH may never develop symptoms, while others find that BPH can make life miserable, causing lower urinary tract symptoms, or LUTS, and seek treatment.
Indeed, BPH is not considered to be a health problem unless it results in LUTS or other mechanical problems, such as the development of bladder stones or ruptured blood vessels. The odds of experiencing these symptoms increase with age; half of all men over 70 experience LUTS to some degree.
Although the size of the prostate would seem to be related to symptoms, that’s not always the case: some men with large glands never have symptoms, while others with small glands do. When symptoms do occur, patients and their physicians have several therapeutic options to choose from, including medications, surgery, or laser treatments that vaporize portions of the prostate with intense pulses of light. If one therapy doesn’t do the trick, another one might. Thanks to some important refinements, both surgical and laser treatments like the REVOLIX surgical laser are more effective now than they used to be and have fewer side effects.