The prostate gland

The prostate is a gland about the size of a walnut that is only present in men. It is located just below the bladder and surrounds the urethra, the tube through which urine flows from the bladder and out through the penis.

One of the main functions of the prostate is to produce an important liquefying component of semen, which allows the sperm to move freely. The gland is divided into three zones, peripheral, transitional and central. With BPH, it is the central part where overgrowth of cells takes place.

BPH is very common, affecting about one third of men over 50. Although it is not prostate cancer, the symptoms of BPH are similar to those of prostate cancer so you should see your doctor if you start to experience problems passing urine. A separate BUPA factsheet on prostate cancer covers that topic in more detail.        

Symptoms

You should seek medical advice if you notice any of the following symptoms:

       - hesitancy (difficulty in starting to pass urine),

       - a weak stream,

       - the need to strain to pass urine,

       - the feeling that your bladder isn't empty after urination,

       -the need to pass urine urgently,

       -frequent trips to the toilet, including having to get up several times in the night,

       - feeling a burning sensation or pain when passing urine.

Diagnosis

Your doctor will ask you questions about your symptoms and your general health. You may be asked to fill in a urination questionnaire to help work out the severity of your symptoms.

A digital rectal examination (DRE) will be performed to examine the size and consistency of your prostate by inserting a finger into the rectum. Although this can be uncomfortable, it is not painful. Many men find the prospect of a DRE embarrassing, but should bear in mind that it's a simple procedure, performed routinely by GPs.

Your doctor will also feel your abdomen to find out if the bladder is distended. A distended bladder may indicate that you are not completely emptying it (chronic urinary retention, which is painless).

Other tests will be carried out to make sure that your urinary problems are due to BPH and not other conditions. A urine test will be done to check for infection or blood. Blood tests, including a prostate specific antigen (PSA) test may be carried out. This measures the amount of an enzyme produced by the prostate. High levels of the enzyme can indicate prostate cancer. Other blood tests include one to assess your kidney function and another for blood sugar to check for diabetes. Both of these problems can cause urinary symptoms.

Other tests

Less common tests may include: urine flow tests; ultrasound to measure urine left in the bladder and to check for bladder stones; urodynamic measurements using a catheter inserted into the bladder to measure the pressure of urine there; and transrectal ultrasonography (TRUS) where an ultrasound probe is passed into the rectum to give a view of the prostate.

A biopsy (samples of the prostate) may be collected using a needle to check for cancerous cells.