This booklet is for men who want to know more about a non-cancerous condition called an enlarged prostate. It explains the causes, symptoms, diagnosis and treatment of an enlarged prostate.
Last updated: December 2017 To be reviewed: December 2020
Alcaraz A, Hammerer P, Tubaro A, Schröder FH, Castro R. Is There Evidence of a Relationship between Benign Prostatic Hyperplasia and Prostate Cancer? Findings of a Literature Review. Eur Urol. 2009;55(4):864–75.
Bouza C, López T, Magro A, Navalpotro L, Amate JM. Systematic review and meta-analysis of Transurethral Needle Ablation in symptomatic Benign Prostatic Hyperplasia. BMC Urol. 2006 Dec;6(1).
Brunken C, Seitz C, Woo HH. A Systematic Review of Experience of 180W XPS GreenLight Laser Vaporization of the Prostate in 1640 men: BPH treatment with the 180W GreenLight laser. BJU Int. 2014 Oct;n/a-n/a.
Castellan P, Castellucci R, Schips L, Cindolo L. Safety, efficacy and reliability of 180-W GreenLight laser technology for prostate vaporization: review of the literature. World J Urol. 2015 May;33(5):599–607.
Cornu J-N, Ahyai S, Bachmann A, de la Rosette J, Gilling P, Gratzke C, et al. A Systematic Review and Meta-analysis of Functional Outcomes and Complications Following Transurethral Procedures for Lower Urinary Tract Symptoms Resulting from Benign Prostatic Obstruction: An Update. Eur Urol. 2015 Jun;67(6):1066–96.
Dong Y, Hao L, Shi Z, Wang G, Zhang Z, Han C. Efficacy and Safety of Tadalafil Monotherapy for Lower Urinary Tract Symptoms Secondary to Benign Prostatic Hyperplasia: A Meta-Analysis. Urol Int. 2013;91(1):10–8.
Egan KB. The Epidemiology of Benign Prostatic Hyperplasia Associated with Lower Urinary Tract Symptoms. Urol Clin North Am. 2016 Aug;43(3):289–97.
Elkoushy MA, Elshal AM, Elhilali MM. Reoperation After Holmium Laser Enucleation of the Prostate for Management of Benign Prostatic Hyperplasia: Assessment of Risk Factors with Time to Event Analysis. J Endourol Endourol Soc. 2015 Jul;29(7):797–804.
Emberton M, Fitzpatrick JM, Garcia-Losa M, Qizilbash N, Djavan B. Progression of benign prostatic hyperplasia: systematic review of the placebo arms of clinical trials. BJU Int. 2008;102(8):981–6.
Emberton M, Fitzpatrick JM, Rees J. Risk stratification for benign prostatic hyperplasia (BPH) treatment. BJU Int. 2011 Mar;107(6):876–80.
European Association of Urology Nurses. Catheterisation: Indwelling catheters in adults - Urethral and suprapubic. Evidence-based guidelines for best practice in urological health care. 2012.
European Association of Urology Nurses. Catheterisation: Urethral intermittent in adults. Evidence-based guidelines for best practice in urological health care. 2013.
Fisher E, Subramonian K, Omar MI. The role of alpha blockers prior to removal of urethral catheter for acute urinary retention in men. Cochrane Database Syst Rev. 2014;(6).
Fitzpatrick JM, Desgrandchamps F, Adjali K, Guerra LG, Hong SJ, Khalid SE, et al. Management of acute urinary retention: a worldwide survey of 6074 men with benign prostatic hyperplasia. BJU Int. 2012 Jan;109(1):88–95.
Gacci M, Corona G, Vignozzi L, Salvi M, Serni S, De Nunzio C, et al. Metabolic syndrome and benign prostatic enlargement: a systematic review and meta-analysis: Metabolic syndrome and BPE. BJU Int. 2015 Jan;115(1):24–31.
Gong M, Dong W, Huang G, Gong Z, Deng D, Qiu S, et al. Tamsulosin combined with solifenacin versus tamsulosin monotherapy for male lower urinary tract symptoms: a meta-analysis. Curr Med Res Opin. 2015 Sep 2;31(9):1781–92.
Gravas S, Bach T, Drake MJ, Gacci M, Gratzke C, Herrmann TRW, et al. EAU Guidelines on management of non-neurogenic male lower urinary tract symptoms (LUTS), incl. benign prostatic obstruction (BPO). European Association of Urology; 2017.
Gupta N, Sivaramakrishna, Kumar R, Dogra PN, Seth A. Comparison of standard transurethral resection, transurethral vapour resection and holmium laser enucleation of the prostate for managing benign prostatic hyperplasia of >40 g. BJU Int. 2006 Jan;97(1):85–9.
Hoekstra RJ, Van Melick HHE, Kok ET, Ruud Bosch JLH. A 10-year follow-up after transurethral resection of the prostate, contact laser prostatectomy and electrovaporization in men with benign prostatic hyperplasia; long-term results of a randomized controlled trial. BJU Int. 2010 Sep;106(6):822–6.
Hoffman RM, Monga M, Elliott SP, MacDonald R, Langsjoen J, Tacklind J, et al. Microwave thermotherapy for benign prostatic hyperplasia (Review). Cochrane Database Syst Rev. 2012;(9).
Hollingsworth JM, Wilt TJ. Lower urinary tract symptoms in men. BMJ. 2014 Aug 14;349:g4474–g4474.
Jarvis TR, Chughtai B, Kaplan SA. Bladder Outlet Obstruction and BPH. Curr Bladder Dysfunct Rep. 2014 Dec;9(4):372–8.
Kim M, Piao S, Lee H-E, Kim SH, Oh S-J. Efficacy and safety of holmium laser enucleation of the prostate for extremely large prostatic adenoma in patients with benign prostatic hyperplasia. Korean J Urol. 2015;56(3):218.
Konwar R, Chattopadhyay N, Bid HK. Genetic polymorphism and pathogenesis of benign prostatic hyperplasia. BJU Int. 2008;102(5):536–44.
Lee CH, Akin-Olugbade O, Kirschenbaum A. Overview of Prostate Anatomy, Histology, and Pathology. Endocrinol Metab Clin North Am. 2011 Sep;40(3):565–75.
Lourenco T, Shaw M, Fraser C, MacLennan G, N’Dow J, Pickard R. The clinical effectiveness of transurethral incision of the prostate: a systematic review of randomised controlled trials. World J Urol. 2010;28(1):23–32.
Martin DJ, Mulhall JP. Enlarging the scope of managing benign prostatic hyperplasia: addressing sexual function and quality of life. Int J Clin Pract. 2005;59(5):579–90.
National Institute for Health and Care Excellence. GreenLight XPS for treating benign prostatic hyperplasia. Medical technology guidance 29. 2016.
National Institute for Health and Care Excellence. Lower urinary tract symptoms in men: assessment and management. NICE Clinical Guideline 97. (modified June 2015); 2010.
National Institute for Health and Care Excellence. Mirabegron for treating symptoms of overactive bladder. NICE technology appraisal guidance 290. 2013.
National Institute for Health and Care Excellence. Prostate artery embolisation for benign prostatic hyperplasia. NICE Interventional Procedure Guidance 453. 2013.
National Institute for Health and Care Excellence. UroLift for treating lower urinary tract symptoms of benign prostatic hyperplasia. Medical technology guidance 26. 2015.
Nickel JC, Barkin J, Koch C, Dupont C, Elhilali M. Finasteride monotherapy maintains stable lower urinary tract symptoms in men with benign prostatic hyperplasia following cessation of alpha blockers. Can Urol Assoc J. 2008;2(1):16.
Oelke M, Shinghal R, Sontag A, Baygani SK, Donatucci CF. Time to Onset of Clinically Meaningful Improvement with Tadalafil 5 Mg Once Daily in the Treatment of Men with Lower Urinary Tract Symptoms Secondary to Benign Prostatic Hyperplasia: Analysis of Data Pooled from 4 Pivotal, Double-Blind, Placebo Controlled Studies. J Urol [Internet]. 2014 Nov [cited 2015 Mar 1]; Available from: http://linkinghub.elsevier.com/retrieve/pii/S0022534714050307
Ørsted DD, Bojesen SE. The link between benign prostatic hyperplasia and prostate cancer. Nat Rev Urol. 2012;10(1):49–54.
Parsons JK, Kashefi C. Physical Activity, Benign Prostatic Hyperplasia, and Lower Urinary Tract Symptoms. Eur Urol. 2008;53(6):1228–35.
Parsons JK. Benign Prostatic Hyperplasia and Male Lower Urinary Tract Symptoms: Epidemiology and Risk Factors. Curr Bladder Dysfunct Rep. 2010 Dec;5(4):212–8.
Popiolek M, Rider JR, Andrén O, Andersson S-O, Holmberg L, Adami H-O, et al. Natural History of Early, Localized Prostate Cancer: A Final Report from Three Decades of Follow-up. Eur Urol. 2013;63(3):428–35.
Public Health England. Prostate cancer risk management programme (PCRMP): benefits and risks of PSA testing [Internet]. GOV.UK; 2016. Available from: https://www.gov.uk/government/publications/prostate-cancer-risk-management-programme-psa-test-benefits-and-risks/prostate-cancer-risk-management-programme-pcrmp-benefits-and-risks-of-psa-testing
Raheem OA, Parsons JK. Associations of obesity, physical activity and diet with benign prostatic hyperplasia and lower urinary tract symptoms: Curr Opin Urol. 2014;24(1):10–4.
Rees J, Bultitude M, Challacombe B. The management of lower urinary tract symptoms in men. BMJ. 2014 Jun 24;348(1):g3861–g3861.
Robert G, Cornu J-N, Fourmarier M, Saussine C, Descazeaud A, Azzouzi A-R, et al. Multicentre prospective evaluation of the learning curve of holmium laser enucleation of the prostate (HoLEP). BJU Int. 2016 Mar;117(3):495–9.
Roehrborn CG, Barkin J, Gange SN, Shore ND, Giddens JL, Bolton DM, et al. Five year results of the prospective randomized controlled prostatic urethral L.I.F.T. study. Can J Urol. 2017 Jun;24(3):8802–13.
Roehrborn CG. BPH progression: concept and key learning from MTOPS, ALTESS, COMBAT, and ALF-ONE. BJU Int. 2008;101 Suppl 3:17–21.
Russo GI, Castelli T, Urzì D, Privitera S, La Vignera S, Condorelli RA, et al. Emerging links between non-neurogenic lower urinary tract symptoms secondary to benign prostatic obstruction, metabolic syndrome and its components: A systematic review. Int J Urol. 2015 Nov;22(11):982–90.
Sanda MG, Beaty TH, Stutzman RE, Childs B, Walsh PC. Genetic susceptibility of benign prostatic hyperplasia. J Urol. 1994;152(1):115–9.
Schenk JM, Kristal AR, Arnold KB, Tangen CM, Neuhouser ML, Lin DW, et al. Association of Symptomatic Benign Prostatic Hyperplasia and Prostate Cancer: Results from the Prostate Cancer Prevention Trial. Am J Epidemiol. 2011;173(12):1419–28.
Speakman M, Kirby R, Doyle S, Ioannou C. Burden of male lower urinary tract symptoms (LUTS) suggestive of benign prostatic hyperplasia (BPH) - focus on the UK: Burden of male LUTS suggestive of BPH. BJU Int. 2015 Apr;115(4):508–19.
Tacklind J, Fink HA, MacDonald R, Rutks I, Wilt TJ. Finasteride for benign prostatic hyperplasia. Tacklind J, editor. Cochrane Database Syst Rev. 2010;
Tacklind J, MacDonald R, Rutks I, Stanke JU, Wilt TJ. Serenoa repens for benign prostatic hyperplasia. In: Cochrane Database of Systematic Reviews. Chichester, UK: John Wiley & Sons, Ltd; 2012.
Thomas JA, Tubaro A, Barber N, d’Ancona F, Muir G, Witzsch U, et al. A Multicenter Randomized Noninferiority Trial Comparing GreenLight-XPS Laser Vaporization of the Prostate and Transurethral Resection of the Prostate for the Treatment of Benign Prostatic Obstruction: Two-yr Outcomes of the GOLIATH Study. Eur Urol. 2016 Jan;69(1):94–102.
Vignozzi L, Gacci M, Maggi M. Lower urinary tract symptoms, benign prostatic hyperplasia and metabolic syndrome. Nat Rev Urol. 2016 Jan 12;13(2):108–19.
Vignozzi L, Rastrelli G, Corona G, Gacci M, Forti G, Maggi M. Benign prostatic hyperplasia: a new metabolic disease? J Endocrinol Invest. 2014 Apr;37(4):313–22.
Vuichoud C, Loughlin KR. Lower urinary tract symptoms, benign prostatic hyperplasia and metabolic syndrome. Can J Urol. 2015;
Wang X, Wang X, Li S, Meng Z, Liu T, Zhang X. Comparative Effectiveness of Oral Drug Therapies for Lower Urinary Tract Symptoms due to Benign Prostatic Hyperplasia: A Systematic Review and Network Meta-Analysis. Tu Y-K, editor. PLoS ONE. 2014 Sep 12;9(9):e107593.
Wilt TJ, N’Dow J. Benign prostatic hyperplasia. Part 1--Diagnosis. BMJ. 2008;336(7636):146–9.
Wynder JL, Nicholson TM, DeFranco DB, Ricke WA. Estrogens and Male Lower Urinary Tract Dysfunction. Curr Urol Rep [Internet]. 2015 Sep [cited 2017 Apr 6];16(9). Available from: http://link.springer.com/10.1007/s11934-015-0534-6
Young JM, Muscatello DJ, Ward JE. Are men with lower urinary tract symptoms at increased risk of prostate cancer? A systematic review and critique of the available evidence. BJU Int. 2000;85:1037–48.