Frequent urination, which you wait a long time to start and is still weak and slow - you know the symptoms of an enlarged prostate. What are the others?

The technical term for prostate enlargement is benign prostatic hyperplasia (BPH) and refers to a non-malignant growth (= hyperplasia) of prostate tissue. This can lead to the development of symptoms in the lower urinary tract (2). The older men are, the higher their risk of prostate enlargement; according to many studies, “50 to 60% of men over 60 years of age and 80 to 90% of men over 70 years of age are at risk”. (2) (3) Prostatic hyperplasia can reach such a degree that it compresses the urethra, which can lead (among other things) to the development of infection due to incomplete emptying of the bladder (4).

Symptoms of an enlarged prostate are always related to urinary problems

Benign prostatic hyperplasia (BPH) is a benign enlargement of the prostate gland. It is characterized by the overgrowth of cells in the part of the prostate that surrounds the urethra, which can lead to compression of the urethra and difficulty urinating (4). However, not all men with BPH develop symptoms, and there is no direct correlation between the degree of enlargement and the development of symptoms.

Symptoms of benign prostatic hyperplasia include:

• frequent and urgent need to urinate, especially at night, which can be postponed only with great difficulty; however, urine leakage usually occurs (5),
• waiting an unreasonable amount of time to start urinating and even then the urine stream is weak and slow (5),
• incomplete emptying of the bladder; shortly after leaving the toilet, the need to urinate again occurs, a feeling of incomplete emptying of the bladder (5),
• pain in the lower abdomen.

Complications of BPH

• if left untreated, the risk of repeated kidney infections, kidney damage and even failure (5),
• development of incontinence, urine constantly flows out in small amounts,
• in extreme cases, the prostate enlarges so much that urination stops or urine comes out in drops (5),
• acute urinary retention, when the bladder does not empty at all during urination, associated with severe pain and bladder overfilling.

Untreated disease can lead to the development of chronic urinary retention with high pressure on the bladder (a potentially life-threatening condition). Long-term disease can also lead to permanent changes in the bladder muscle and deformation of its outlet (6).

Risk factors for the development of benign prostatic hyperplasia – watch out for diabetes, obesity or metabolic syndrome

A variety of risk factors contribute to the development of benign prostatic hyperplasia. Some cannot be influenced, especially age, which is the strongest risk factor for BPH.

Hereditary predispositions also play a significant role, of those that can be influenced, the most common are diabetes, obesity or metabolic syndrome (2) (7). BPH risk factors also include recurrent localized inflammation of the prostate. The use of antidiabetic drugs, especially insulin, may increase the risk of developing BPH and prostate surgery for BPH (8).

Does diet and lifestyle affect prostate enlargement?

The impact of lifestyle and diet has also been studied for a long time, but for many foods and nutrients, the results are controversial.

1. Some studies have shown that a diet high in calories, starch, and red meat can increase the risk of BPH, while a diet low in calories, polyunsaturated fats, and saturated fats, vegetables, fruits, vitamin A, and vitamin D can potentially reduce it. (9)
2. Zinc and vitamin C have been associated with both increased and decreased risk of BPH in various studies. However, this is controversial; other studies, on the contrary, have found no connection between diet and the risk of prostate enlargement. (9)
3. The same is true for alcohol and smoking. There are studies that describe an increase in the risk of BPH with lower alcohol consumption, but not with higher alcohol consumption. Some studies, on the other hand, describe a lower risk of BPH but a higher risk of lower urinary tract symptoms. It is similar with smoking, with some studies observing a higher risk of BPH, others, on the contrary, a lower risk, and according to others, there is no association between smoking and the risk of BPH (9).

One of the main risk factors is genetic predisposition. In one study, first-degree relatives of men who underwent prostate removal for BPH had a fourfold higher risk of developing BPH compared to controls, brothers had a sixfold higher risk (10), and the same applies to identical twins (11).

The mechanism of the influence of obesity on BPH is not yet satisfactorily understood, but it is assumed to be multifactorial, since obesity is one aspect of the metabolic syndrome. Experts discuss the possibility of increased levels of systemic inflammation or higher levels of estrogens (12).

Metabolic syndrome is a cluster of health problems that includes high blood pressure, poor glucose and blood lipids. Research has shown that obese people with this syndrome have a much higher incidence of prostate enlargement (13). Similarly, men who have long-term high blood sugar levels (= elevated levels of glycated hemoglobin (Hba1c) are associated with a higher risk of lower urinary tract infection symptoms (8)).

Laboratory examination of urine and blood plays an irreplaceable role in diagnosis

Diagnosis of symptoms in the lower urinary tract is based on a thorough history, especially a detailed description of urination problems. For a “home” evaluation of problems, experts from IKEM recommend completing the so-called international prostate symptom test (I-PSS). Do not delay a visit to the doctor if you find blood in your urine, experience pain in the lower abdomen, cannot hold urine or stop urinating completely (14).

A rectal examination of the prostate is one of the basic examinations for men over 40 years of age with symptoms of a lower urinary tract infection. Among laboratory examinations, a microscopic examination of the urinary sediment is essential in a patient with urination difficulties. It can be helpful in detecting kidney and urinary tract infections, the presence of blood in the urine that is not visible to the naked eye, or diabetes (glucose in the urine).

In the blood, creatinine and urea levels can reveal kidney function disorders, and glucose and glycated hemoglobin (Hba1c) levels diabetes, which is considered a risk factor for BPH. When diagnosing BPH, it is necessary to exclude other causes of problems and prostate enlargement, such as cancer, if suspected.

In the Unilabs Online e-shop, you can purchase blood tests for prostate examination, which measure the prostate parameters PHI and PSA.

1. PSA is a prostate-specific antigen, which is examined as part of screening for possible prostate cancer in men. PSA is a protein that helps dilute the viscous fluid in sperm, thereby improving sperm motility. It occurs in two forms: free and bound. Both can be examined in the laboratory. Their level can be increased for various reasons. For example, inflammation, manipulation of the prostate during palpation, and also in BPH.
2. PHI stands for Prostate Health Index; serves to empirically estimate the risk of prostate cancer and helps doctors decide whether a biopsy is necessary to confirm the diagnosis.

Note: Benign prostate enlargement is not a risk factor for prostate cancer in itself.

In addition, urine flow tests (uroflowmetry) and imaging tests, especially ultrasound, are used.

An enlarged prostate, also known as benign prostatic hyperplasia (BPH), is a common disease in men, especially in older age. It is often manifested by problems with urination, frequent urge to urinate, weak urine flow, or a feeling of incomplete emptying of the bladder. If left untreated, it can lead to urinary tract infections, the formation of urinary stones, or even kidney fail.