A man's prostate gland usually starts to enlarge after he reaches 40 years of age. This condition is called benign prostate hyperplasia (BPH).

The prostate gland secretes a fluid that helps to nourish sperm. The gland itself surrounds the urethra, which is the tube that carries urine from the bladder out through the tip of the penis (see multimedia file 1). As the prostate grows larger, it may press on the urethra. This narrowing of the urethra can cause some men with prostate enlargement to have trouble with urination. Prostate enlargement may be the most common health problem in men older than 60 years of age.

The prostate gland, which is normally about the size and shape of a walnut, wraps around the urethra between the pubic bone and the rectum, below the bladder. In the early stage of prostate enlargement, the bladder muscle becomes thicker and forces urine through the narrowed urethra by contracting more powerfully. As a result, the bladder muscle may become more sensitive, causing a need to urinate more often and more suddenly.
The prostate grows larger due to an increase in the number of cells (hyperplasia). However, the precise reason for this increase is unknown. A variety of factors may be involved, including androgens (male hormones), estrogens, growth factors and other cell signaling pathways.
As the prostate grows larger and the urethra is squeezed more tightly, the bladder might not be able to fully compensate for the problem and completely empty. In some cases, blockage from prostate enlargement may cause repeated urinary tract infections and gradually result in bladder or kidney damage. It may also cause a sudden inability to urinate (acute urinary retention) -- a medical emergency.

Many men with a Prostate Enlargement have no symptoms. If symptoms are present, they commonly include the following:

1. A weak stream of urine;
2. Difficulty starting urination;
3. Dribbling of urine, especially after urinating;
4. A sense of not fully emptying the bladder;
5. Leaking of urine;
6. More frequent urination and a strong and sudden desire to urinate, especially at night; and
7. Blood in the urine.

• A physical exam is required to see if other medical problems may be causing your symptoms. The doctor will conduct a digital rectal exam to examine the prostate gland. He or she can feel the prostate by inserting a gloved, lubricated finger into the rectum. This procedure allows your doctor to estimate the size and condition of the prostate. Most importantly, it allows the doctor to feel for lumps or hard areas that could indicate the presence of prostate cancer.
• Your doctor may check your urine (urinalysis) for blood or signs of infection. Your blood may be tested for kidney problems or sent for a prostate-specific antigen (PSA) level -- a screening test for prostate cancer.
• Some men are referred to a specialist (urologist) for further tests. Urologists specialize in diseases of the male and female urinary tracts and of the male genital tract. Before you are treated for benign prostate enlargement, it is important to rule out other possible causes of an Prostate Enlargement, such as cancer.

Once the diagnosis of prostate enlargement is made, your doctor may not recommend immediate treatment if symptoms are mild. Likely, one or more exams will be conducted per year to be sure that you are not developing any complications from prostate enlargement. Should your symptoms become more severe, both medical and surgical treatments are available.

Some precautions can help to avoid worsening of symptoms of prostate enlargement and complications.
Do not delay urination once you experience an urge. Urinate as soon as you feel the urge, and empty the bladder completely.

Watchful waiting: This conservative and often wise program of care is used because, for many men, symptoms can lessen without treatment. On the other hand, medications should be started early for moderate symptoms. Also, if there are complications or if symptoms are severe, your doctor may recommend surgery. For most men, the decision to treat the symptoms of an Prostate Enlargement is based on the patient's desire to improve his quality of life.

Medications
Two types of medications have been approved for treatment of prostate enlargement:

• Alpha-blockers, such as terazosin (Hytrin), prazosin (Minipress), or doxazosin (Cardura), relax the muscles in the prostate and thus may relieve symptoms. Newer alpha blockers, such as tamsulosin (Flomax) and alfuzosin (Uroxatral), are more commonly prescribed because they may have fewer side effects.
• Finasteride (Proscar) or dutasteride (Avodart) can cause the prostate to shrink. As a result, the urinary symptoms may improve. These drugs are most helpful in men who have at least moderate enlargement of the prostate.
• More recent studies have indicated that the best results may be seen in men who take a combination of an alpha blocker and a drug to shrink the prostate.

There is no known way to prevent prostate enlargement. It is a common part of aging.

• Avoid drinking liquids after 6 p.m. to reduce the need to urinate frequently during the night.
• Drinking more fluid, up to eight glasses of water per day, may help prevent infection. However, for men already suffering with increased urinary frequency, this may only exacerbate the problem. In most cases, drinking a normal amount of fluid based on thirst is all that is necessary.
• There is evidence that cranberry juice may be helpful in the prevention of urinary tract infections in those who are prone to developing these.

The list of complications that have been mentioned in various sources for Prostate Enlargement includes:

• Urinary blockage (see Lack of urine)
• See complications of Benign Prostate Hyperplasia
• Urinary retention
• Renal insufficiency
• Recurrent urinary tract infections
• Gross hematuria
• Bladder calculi
• Renal failure or uremia