By Oluwasola Samuel, Freelance Writer. With medical review and editorial support by the DLHA Team
An elderly African man at risk for benign prostatic hyperplasia or enlargement
Have you ever wondered why benign prostatic hyperplasia (BPH), also known as prostate enlargement, or enlarged prostate is more common among people assigned male at birth?
The reason is not far-fetched. People assigned males at birth have a gland called the prostate gland. This gland is located immediately under the urinary bladder and in front of your rectum, the terminal part of the large bowel. The prostate gland is crucial for male fertility. It produces an essential fluid that nourishes and transports sperm (seminal fluid).
Illustration of the normal vs enlarged prostate.Click on image to enlarge
The prostate goes through two stages of growth. The first is during puberty, and the second occurs after age 25. Benign prostatic hyperplasia occurs after the second stage. [1]
In this article, you will learn about the causes, risk factors, symptoms, complications, and other vital information that will help you, your friends, or family members make wise health decisions about living with BPH.
BPH is a condition in people assigned male at birth that is associated with non-cancerous increase in size of the prostate gland thereby causing narrowing or blockage of the tube (urethra) that carries urine out of your bladder and body. The partial or complete blockage of the urethra causes pain while urinating and incomplete bladder emptying. It also causes other health complications that are discussed later
Benign prostatic hyperplasia (BPH) is a common urological condition all over the world. Lots of people assigned male at birth over the age of 50 years experience an enlarged prostate. [2]
The global prevalence documented between 1990 and 2019 showed that there was an increase in recorded cases from 5.48 million in 1990 to 11.26 million in 2019. [3]
In addition, it was found that 5 – 6 of every 10 men in their 60s and 8 -9 of men older than age 70 had benign prostate enlargement when they died.[4]
However, in sub-Saharan Africa, there is a dearth of information about BPH.
A multi-nation study carried out in the United States, Ghana, and South Africa revealed that Africans, Africans in the diaspora, and people of African descent had BPH prevalence of 20 to 60%. [9]
There is a need for more research on BPH in sub-Saharan Africa to help understand its impact on people's lives.
The real cause of benign prostatic hyperplasia is still unclear. As the condition is common in people over 50 years old, age and possibly changes in the balance of sex hormones in aging men could be contributory factors.
It's worthy of note that people who have had their testicles removed at a young age do not develop benign prostatic hyperplasia later in life. This is linked to the absence of testosterone production by the testicles. [5]
Furthermore, scientific studies also suggest that when oestrogen in the prostate is present in large quantities, it could lead to an increase in cell growth, causing prostate enlargement. [1] However, more research is needed to establish this fact.
Below are some of the risk factors you should note:
One of the significant factors in benign prostatic hyperplasia is age. Men at age 40 rarely have this condition. Your chances of having an enlarged prostate increase at age 50 and as you age.
If your family has a history of prostate enlargement, then you might be at risk of having an enlarged prostate as you age.
Lack of the male sex hormones like testosterone and dihydrotestosterone may play a significant role. [6]
4. Lifestyle
Lack of exercise and carrying excess weight (obesity) could be factors. Although lifestyle changes may not necessarily prevent or cure an enlarged prostate, adopting lifestyle changes will surely improve your prostate health.
5. Medical condition
Though not fully established, medical conditions like type 2 diabetes, heart and circulatory diseases, and erectile dysfunction could also play an important role in the development of prostate enlargement.
6. Ethnicity
Africans and people of African descent are at higher risk of having an enlarged prostate, and they may require frequent examinations or screenings.
7. Infection
A recent systematic review has found correlation between prostate infection (prostatitis) and BPH indicating the former to be a risk factor for the latter. [7]
Below are some of the common symptoms you need to know or look out for:
It's important to note that sometimes people with an enlarged prostate might still not exhibit any of the above-mentioned symptoms. This means they are asymptomatic. Their prostate enlargement can only be detected by digital rectal examination or imaging. [8]
Also, the size of the prostate does not determine the severity of the symptoms. It's possible to have a slightly enlarged prostate and feel severe symptoms, while another person with an enlarged prostate might feel little or no symptoms.
The complications of an enlarged prostate may include:
It's important to note that not all men with an enlarged prostate will have any or all of these complications. Early diagnosis and treatment lowers your risk of having complications. Should you or anyone else start experiencing complications, kindly consult your healthcare provider.
Your chances of having an enlarged prostate increase as you age. At age 25, your prostate increases in size, but this does not mean it will cause you any physical issues. The real problem is when it begins to grow beyond normal. Your chances increase significantly as you reach the age of 50 and above.
No, benign prostatic hyperplasia and prostatic cancer are two different conditions that affect the prostate. Having an enlarged prostate does not mean you will have prostate cancer. BPH is non-cancerous and stays in the prostate, while prostate cancer is a cancerous tumour growth in the prostate. It has the potential to invade and spread to other parts of the body.
The medical professional who treats prostate problems is called the urologist. A urologist is someone who specializes in the urinary tract and male reproductive system. They assess your condition, conduct necessary tests, and advise you on the best possible action.
No, infectious diseases are spread by germs like bacteria, fungi, and viruses. The good news is that they are not present in benign prostatic hyperplasia. BPH is caused by changes in hormone levels as men age, not by physical contact or external factors.
Yes, an enlarged prostate can go back to its normal size. A mildly enlarged prostate can return through lifestyle changes or medications. If prostate growth is moderate or severe, an invasive procedure or surgery might be needed to get it back to its normal size.
While BPH might appear to be an inevitable part of aging for men, it doesn't have to steal your peace of mind. Now that you are armed with knowledge about its risk factors, causes, and treatment options, you, as a patient or concerned individual, can regain control.
Understanding the potential impact of benign prostatic hyperplasia on quality of life empowers you to make informed decisions about your health. Remember, early detection and treatment are key to managing BPH effectively.
Don't hesitate to seek guidance from a healthcare professional, who will help ascertain your condition and advice on the best line of management.
1. National Institute of Diabetes and Digestive and Kidney Diseases. Prostate enlargement (Benign prostatic hyperplasia). [Internet. Last reviewed: Sept 2014]. Cited 2024 Feb 15. Available from: https://www.niddk.nih.gov/health-information/urologic-diseases/prostate-problems/prostate-enlargement-benign-prostatic-hyperplasia
2. Urology Care Foundation. What is Benign Prostatic Hyperplasia (BPH)? [[Internet. Updated September 2023]. [Cited 2024 Feb 15]. Available from: https://www.urologyhealth.org/urology-a-z/b/benign-prostatic-hyperplasia-(bph).
3. Xu XF, Liu GX, Guo YS, Zhu HY, He DL, Qiao XM, Li XH. Global, Regional, and National Incidence and Year Lived with Disability for Benign Prostatic Hyperplasia from 1990 to 2019. Am J Mens Health. 2021 Jul-Aug;15(4):15579883211036786. doi: 10.1177/15579883211036786. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8326634/.
4. Ng M, Leslie SW, Baradhi KM. Benign prostatic hyperplasia. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 [cited 2024 Feb 15]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK558920/.
5. NIH. National Library of Medicine. Enlarged Prostate. MedlinePlus. [Internet. Reviewed July 1, 2023] . cited 2024 Feb. 15. Available from https://medlineplus.gov/ency/article/000381.htm.
6. Baas W, Köhler TS. Testosterone Replacement Therapy and BPH/LUTS. What is the Evidence? Curr Urol Rep. 2016 Jun;17(6):46. doi: 10.1007/s11934-016-0600-8. Available from: https://pubmed.ncbi.nlm.nih.gov/27068735.
7. Zhang L, Wang Y, Qin Z, Gao X, Xing Q, Li R, Wang W, Song N, Zhang W. Correlation between Prostatitis, Benign Prostatic Hyperplasia and Prostate Cancer: A systematic review and Meta-analysis. J Cancer. 2020 Jan 1;11(1):177-189. doi: 10.7150/jca.37235. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6930406/.
8. Prakash K, Pirozzi G, Elashoff M, Munger W, Waga I, Dhir R, Kakehi Y, Getzenberg RH. Symptomatic and asymptomatic benign prostatic hyperplasia: molecular differentiation by using microarrays. Proc Natl Acad Sci U S A. 2002 May 28;99(11):7598-603. doi: 10.1073/pnas.112191399. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC124296/
9. Yeboah ED, Hsing AW. Benign prostatic hyperplasia and prostate cancer in Africans and Africans in the diaspora. J West Afr Coll Surg. 2016 Oct-Dec;6(4):x-xviii. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5667724/.
Diagnosis and Treatment of Prostate Enlargement: A Guide for Africans
Published: February 26, 2024
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