A swollen prostate is very common in men with age. Most often, this increase in volume corresponds to a benign prostatic hypertrophy (BPH), also called prostate adenoma.
This condition is not cancer. However, it can become bothersome when the prostate grows large enough to compress the urethra and disrupt the flow of urine.
Difficulty urinating, a weaker stream, nighttime awakenings, or the sensation of an incompletely emptied bladder may then appear.
Why does the prostate swell? What symptoms should prompt a consultation? And what treatments, particularly minimally invasive ones, can be offered?
What is an enlarged prostate?
The prostate is a gland located beneath the bladder and around the initial part of the urethra, the channel that allows urine to be eliminated.
In young men, it is generally small in size. With age, prostate cells can progressively multiply and lead to an increase in its volume.
It is then called’benign prostatic hyperplasia.
This increase in volume is particularly common after the age of 50.
The problem does not come solely from the size of the prostate. It is above all its position around the urethra that can cause symptoms: when it increases in volume, it can progressively compress this canal and make the passage of urine more difficult.
Why does the prostate enlarge?
There is no single cause explaining the onset of benign prostatic hyperplasia.
Age
Age is the primary factor associated with the increase in prostate volume.
Progressive changes in prostate tissue generally appear after the age of 40 to 50 and become more frequent with aging.
Hormonal changes
Male hormones also play a role in the development and maintenance of prostatic tissue.
With age, hormonal balance changes, particularly regarding testosterone and dihydrotestosterone. These phenomena likely contribute to the progressive growth of the prostate.
Family history and certain metabolic factors
A family predisposition can also promote the onset of BPH.
Furthermore, certain studies highlight associations with obesity, metabolic syndrome, diabetes, or a sedentary lifestyle.
However, these risk factors must be distinguished from direct causes: an enlarged prostate generally results from several associated mechanisms.
What are the symptoms of an enlarged prostate?
Symptoms vary greatly from one man to another.
A relatively large prostate can sometimes cause little discomfort, whereas a smaller prostate can lead to significant obstruction depending on its shape and position.
The most common symptoms are:
- a weaker urinary stream ;
- difficulty starting to urinate; ;
- an intermittent jet ;
- the need to strain to urinate ;
- frequent urges to urinate; ;
- urgent cravings ;
- repeated night wakings; ;
- a feeling of not having completely emptied the bladder; ;
- post-micturition dribble.
These disorders are grouped under the term lower urinary tract symptoms.
They can have a significant impact on sleep, travel, professional activities, and more broadly on the quality of life.
Does an enlarged prostate mean cancer?
No.
Benign prostatic hyperplasia and prostate cancer are two different diseases.
BPH corresponds to a non-cancerous growth of prostate tissue.
However, some symptoms can be common to multiple prostate or urinary tract conditions. It is therefore important not to automatically attribute urinary difficulties to simple hypertrophy.
A medical evaluation makes it possible in particular to check for an infection, bladder disease, or a prostate condition requiring specific management.
How is an enlarged prostate diagnosed?
The diagnosis begins with an interview regarding urinary symptoms, how long they have been present, and their impact on daily life.
Several examinations can then be offered.
The PSA test
A blood test can measure PSA, a protein produced by the prostate.
A high PSA does not automatically mean that cancer is present. Its level can also increase with prostate volume, age, or certain types of inflammation.
The clinical examination
The doctor can perform a digital rectal examination to roughly evaluate the volume and consistency of the prostate.
Ultrasound and prostate volume measurement
An ultrasound makes it possible in particular to evaluate the size of the prostate and sometimes the amount of urine remaining in the bladder after urination.
Depending on the situation, other tests may be necessary: urinary flowmetry, urinalysis, MRI, cystoscopy, or additional examinations.
The goal is to precisely understand the origin of the symptoms before choosing a treatment.
When should an enlarged prostate be treated?
Not all prostate hypertrophies require immediate intervention.
When symptoms are only mildly bothersome, simple monitoring and a few lifestyle adjustments can sometimes be enough.
On the other hand, treatment may become necessary when symptoms significantly impair the quality of life or when complications arise.
These include in particular:
- urinary retention ;
- recurrent urinary tract infections; ;
- the presence of stones in the bladder ;
- significant incomplete bladder emptying; ;
- progressive impairment of the urinary tract in certain situations.
What treatments are available for benign prostatic hyperplasia?
Treatment depends on the severity of the symptoms, prostate volume, age, health status, and patient preferences.
The medications
Alpha-blockers help, in particular, to relax the muscles around the prostate and the bladder neck to facilitate urination.
5-alpha-reductase inhibitors can progressively reduce prostate volume in some patients.
These treatments can be effective, but they sometimes have to be taken over a long period and can cause side effects.
Surgical or endoscopic treatments
When medications are no longer enough, several procedures can be considered: transurethral resection of the prostate, laser treatments, enucleation, or other endoscopic techniques.
The choice depends mainly on the anatomy and volume of the prostate.
Embolization: a minimally invasive treatment for an enlarged prostate
L'prostatic artery embolization represents another option for certain patients with symptomatic BPH.
Unlike transurethral surgical techniques, the procedure does not involve directly removing prostate tissue.
It acts on the vascularization of the prostate.
How does embolization work?
The procedure is performed by an interventional radiologist.
A very thin catheter is inserted into an artery, usually at the wrist or groin, and then guided under radiological control to the arteries supplying the prostate.
Tiny particles are then injected to selectively reduce the blood supply to the prostate tissue.
The prostate then gradually decreases in size over the following weeks and months, which can reduce compression of the urethra and improve urinary symptoms.
Embolization is recognized as a BPH treatment option for certain patients with moderate to severe symptoms. It is generally performed under local anesthesia and can be done on an outpatient basis.
What are the benefits of prostate embolization?
For some patients, this technique presents several interesting features:
- absence of surgical incision of the prostate ;
- no endoscopic procedure through the urethra; ;
- local anesthesia in the majority of cases; ;
- generally short hospital stay; ;
- relatively quick recovery; ;
- low risk of incontinence; ;
- generally favorable preservation of sexual function and ejaculation.
Embolization may also be considered in certain men with a very enlarged prostate.
However, it is not automatically suitable for all patients. The anatomy of the prostatic arteries, symptoms, bladder condition, and any associated pathologies must be evaluated before the procedure.
Embolization or surgery: how to choose?
There is no universally superior treatment for all prostatic hyperplasias.
Certain surgical techniques can provide a greater improvement in urinary flow or obstruction, while embolization has the advantage of being less invasive and avoiding a procedure through the urethra.
The choice depends in particular on:
- the volume and shape of the prostate; ;
- on the severity of the symptoms; ;
- of potential urinary retention; ;
- on the effectiveness of medications; ;
- of the patient's general condition; ;
- the importance given to the preservation of sexuality; ;
- preferences regarding the type of intervention.
Therefore, a personalized assessment makes it possible to determine which approach offers the best balance between efficacy, constraints, and side effects.
In summary
A An enlarged prostate is most often linked to benign prostatic hyperplasia, a common condition with age.
It can compress the urethra and cause a weak stream, frequent urges to urinate, waking up at night, or poor bladder emptying.
When symptoms become bothersome, several solutions exist: monitoring, medication, endoscopic treatments, surgery, or minimally invasive techniques.
Prostatic artery embolization is a minimally invasive option for certain patients wishing to treat their BPH without transurethral surgery.
To find out if embolization is suitable for your situation, contact our team for a personalized assessment.