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Benjamin Franklin reportedly suffered from it; so did Thomas Jefferson. So will most men, if they live long enough.

This almost inevitable condition is called benign prostatic hyperplasia (BPH), or enlargement of the prostate. The risk of BPH increases every year after age 40: BPH is present in 20% of men in their fifties, 60% of men in their sixties, and 70% of men by age 70.

One-quarter of men with BPH—more than 350,000 a year in the United States alone—eventually will require treatment, some more than once, to relieve the urinary obstruction BPH causes.

In recent years, as medical therapy has become available, more men have sought treatment to relieve their symptoms. Based on the figures mentioned above, it’s likely that after age 60, a majority of men will either be taking medication for BPH or considering it. However, not all of these men will be helped by the medicine: for men with severe symptoms or men who wait until the disease is far advanced before they seek treatment, surgery is still the best option.

Important Note: Growth is not the same thing as cancer. BPH is not prostate cancer, and having BPH doesn't mean a man is more or less likely to get prostate cancer. They are two different diseases—and in some ways, the prostate is almost like two different glands rolled into one.

Prostate cancer begins in the outer peripheral zone of the prostate, and grows outward, invading surrounding tissue. BPH begins in a tiny area of the inner prostate called the transition zone, a ring of tissue that makes a natural circle around the urethra.

In BPH, the growth is inward toward the prostate’s core, constantly tightening around the urethra (the tube that carries urine from the bladder through the prostate to the penis) and interfering with urination. This is why BPH produces such annoying, difficult-to-ignore symptoms—but why prostate cancer is often “silent,” producing no symptoms for months or even years.

The key word here is benign. (The word hyperplasia simply means an increase in the number of cells in the prostate, which causes it to become enlarged.) By itself, an enlarged prostate causes no symptoms and does no harm. If it weren’t for the fact that the prostate encircles the urethra, BPH might never require treatment.

BPH Treatment Options

Current treatment options for BPH include medications that relax the muscles of the urinary sphincter, called alpha blockers (like doxazosin or flomax/tamsulosin) or medications that actually shrink the volume of the prostate called DHT inhibitors (like finasteride ((Proscar)) or dutasteride ((Avodart))). Often these medications will be combined for more severe cases to prevent urinary obstruction and help with symptoms.

The DHT inhibitors have also been shown to reduce a man’s risk over time of developing prostate cancer by about 25%. The ability to prevent prostate cancer may have a real benefit in preventing the treatments down the road that cause side effects. It can also make prostate cancer a bit easier to detect, by shrinking the gland. However, aggressive prostate cancers may not be as effectively prevented with these hormonal agents, and these medicines have not yet been shown to save lives due to prostate cancer. As always, it’s important to discuss the risks and benefits of these medicines with your doctor.

(Some of the information on this page is adapted from Dr. Patrick Walsh's Guide to Surviving Prostate Cancer.)

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