When Should I Worry About...

What Are the Warning Signs of Enlarged Prostate?

Feb. 1, 2024 - Katie McCallum

An enlarged prostate, also known as benign prostatic hyperplasia (BPH), is a common condition among aging men. In fact, statistics indicate that more than half of men over the age of 60 and up to 90% of men over 80 may notice signs of an enlarged prostate.

Dr. Ricardo Gonzalez, a urologist at Houston Methodist, says it's important to alert your doctor if symptoms arise.

"Enlarged prostate isn't the same thing as prostate cancer, nor does it increase the risk of prostate cancer, but that doesn't mean it can't greatly impact your quality of life," warns Dr. Gonzalez. "The condition can get worse over time and, if allowed to progress, can lead to serious complications."

Here's everything you need to know about BPH, including the symptoms to be on the lookout for and the condition's causes.

What is BPH?

The prostate is a walnut-sized gland, part of the reproductive system, that is located in a man's pelvis. The prostate's position, just below the bladder and surrounding the urethra, can affect the flow of urine.

BPH occurs when the prostate grows in size. Urinary problems typically result from the gland's enlargement.

"Given the anatomical positioning, prostate growth puts pressure on the urethra," explains Dr. Gonzalez. "This can obstruct the flow of urine and cause urinary symptoms, ranging from weak stream to incomplete emptying of the bladder."

All urinary problems are annoying and inconvenient, but it's the latter (not being able to completely empty the bladder) that can lead to serious issues down the line, such as bladder infections, bladder stones, blood in the urine and even kidney failure. It's why you shouldn't ignore the signs of BPH.

Enlarged prostate symptoms include:

  • Increased frequency of urination
  • Increased urgency to urinate
  • Getting up at night to urinate
  • Dribbling after urination
  • Hesitancy of urination (being ready to urinate but taking a while to do so)
  • Intermittent urination (stop-and-go stream while urinating)


What causes enlarged prostate?

"Around age 40 to 50, the prostate naturally begins to grow over time," says Dr. Gonzalez. "There are a number of factors that can increase the rate it grows — some you can't change, but some you can."

Factors (other than age) that influence enlargement of the prostate include:

  • Family history – having a father or brother with BPH increases the risk of developing it yourself
  • Having familial hypercholesterolaemia – an inherited condition that leads to higher cholesterol levels
  • Diet – studies show that the prostate grows faster in men who eat a lot of red meat, dairy and processed foods, as opposed to vegetables and fish


Be sure to let your doctor know if you have an immediate family member who has or had enlarged prostate. Your doctor can explain the habits and behaviors that can help reduce your risk of BPH, as well as make sure you're being screened for symptoms. And if you have familial hypercholesterolemia, it's important to make sure the condition is well managed.

"The prostate is great at metabolizing cholesterol, so anything that increases its levels — including poor diet — makes prostate growth more likely," explains Dr. Gonzalez.

This means that every man should take steps to prevent high cholesterol. Or, if your numbers are already high, they should understand what (not) to eat to lower your cholesterol. As mentioned, limiting red meat and dairy is proven to help reduce BPH risk, but other common foods — ones containing added sugars and refined carbohydrates — are linked to high cholesterol, too. (Related: PODCAST: Does Dietary Cholesterol Matter?)

How is BPH treated?

If you notice the signs of enlarged prostate, alert your primary care doctor. A simple blood test, called a PSA test, is the first step in determining whether you might have BPH.

"PSA stands for prostate specific antigen," says Dr. Gonzalez. "The larger the prostate, the more PSA it produces. Enlarged prostate is one of the most common reasons for PSA levels to be high. If yours are abnormal, your doctor will refer you to a urologist for a comprehensive evaluation."

If diagnostics reveal the prostate is enlarged, a variety of recommendations will be made — ranging from lifestyle changes to medications, in-office procedures or even surgery, if there's a severe obstruction.

"There are simple steps you can take to reduce the worsening of symptoms, including limiting caffeine, carbonated beverages and spicy foods," says Dr. Gonzalez. "All of these are things that irritate the bladder, exacerbating urinary symptoms."

Treatments for BPH include:

  • Medications – including ones that relax the muscles of the bladder (alpha blockers), shrink the prostate (5-alpha reductase inhibitors) or a combination of both
  • In-office procedures – also called minimally invasive surgical therapies (MISTs), which include prostatic urethral lift procedure, water vapor therapy and a temporarily implanted nitinol device
  • Surgeries – including aquablation, laser vaporization and laser enucleation therapies, as well as transurethral resection of the prostate (TURP) and open prostatectomy


"The answer to which of these treatments is right for you lies in the severity of your underlying problem whether you're able to tolerate the medications and how much symptom reduction you're hoping to achieve," says Dr. Gonzalez. "Here at Houston Methodist, we're the only hospital in Houston to offer every one of the treatments above, which means we're able to offer the option that's best for you."

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