April 4, 2023
Benign prostatic hyperplasia, BPH or prostatic hyperplasia, is the benign (non-cancerous) expansion of the prostate that affects most men as they age. BPH isn’t prostate cancer and it doesn’t lead to prostate cancer, however, BPH can increase a man’s serum (blood) PSA levels just as cancer can. As the prostate continues its growth beyond its most useful size when a man is in his teens to late 20s, this enlargement can begin causing lower urinary tract symptoms or LUTS for some men as they reach their late 30s and into their 40s. More men will experience benign prostatic hyperplasia and its associated urinary symptoms as they reach their 50s and 60s, while most men will eventually have to deal with BPH and urinary issues if they live long enough. When prostatic hyperplasia takes the next step and begins causing lower urinary tract symptoms, it becomes BPH with LUTS. As men age, urinary tract symptoms are often the first indication that BPH may be present.  

What is the Prostate Gland?

Having the size of a walnut or ping pong ball and weighing about 1 ounce or 25-30 grams in young men, the prostate gland is a key organ within the male reproductive system.  Located just below the bladder, in front of the rectum, and straddling the upper urethra or urinary tube, the prostate consists of connective and glandular tissues and is encased by a stretchable connective tissue called the prostatic fascia.  Even though men can live without a prostate, it is essential for the reproductive health of a man.  Although the prostate is a normal size for the first 30 years or so, it gradually grows larger in many men as they get older and these men can begin experiencing the effects of benign prostatic hyperplasia via lower urinary tract symptoms.  

How Does the Prostate Work?

The function of the prostate is to provide about a quarter of the fluid needed for ejaculation, with the rest coming from the testes, seminal vesicles, and the bulbourethral gland.  Prostatic fluid adds important components such as zinc, calcium, citric acid, and other enzymes which are vital for keeping sperm healthy so they can fully function and achieve their greatest motility (ability to move fast and effectively).1 The prostate also contracts, along with the vas deferens and seminal vesicles, to further propel semen out of the penis during ejaculation.  The prostate works in conjunction with a man’s other sexual organs to produce an energy and nutrient-rich fluid called semen to fuel and protect sperm as they make their long journey to a woman’s egg for fertilization.  When benign prostatic hyperplasia and lower urinary tract symptoms are present, a man’s hormone levels have changed enough over time to enlarge the prostate and begin causing problems.  

Prostate Growth with Age

For most men, the prostate continues growing throughout their lives and can eventually cause benign prostatic hyperplasia and lower urinary tract symptoms.  However, it appears that there are different growth rates according to age.  There are a couple of slow growth periods and a couple of fast growth phases in a man’s life.  This helps to explain why more men over the age of 50 have to deal with prostatic hyperplasia than men in their 30s and 40s. In a 2002 study, prostatic volume determination by B-ultrasonography in 1601 males (1301 normal subjects and 300 BPH patients) pointed out that the age-stratified growth of the human prostate could be categorized into 4 life stages: (1) the first slow-growing phase (from newborn to 9 years): the prostate grows slowly at a rate of 0.14 g per year; (2) the first rapid growing phase (from 10 to 30 years): the prostate grows at a rate of 0.84 g per year; (3) the second slow-growing phase (from 30 to 50 years), the prostate grows at a rate of 0.21 g per year; (4) the second rapid growing phase (from 50 to 90 years): the prostate grows at one of the following rates: in one group the growth rate is 0.50 g per year and in the other 1.20 g per year, leading to benign prostatic hyperplasia or BPH.  The volumes of the prostate are different in different age groups and the prostate grows with age at different rates in four life phases.2 When benign prostatic hyperplasia starts to take hold as a man ages, the normally useful prostate begins to be more of a burden as lower urinary tract symptoms begin dictating daily routines.  

How Do I Know if I have an Enlarged Prostate?

A man should begin to suspect that he has an enlarged prostate or prostatic hyperplasia when he experiences lower urinary tract symptoms – and prostatitis, a urinary tract infection (UTI), bladder or kidney infection, irritation, or an obstruction such as a kidney or bladder stone have been ruled out.  Urinary tract symptoms caused by benign prostatic hyperplasia can include a weak urinary stream or dribbling, hesitancy, straining to urinate, starting and stopping, suddenly having to go, frequent urination, nocturia (needing to go often at night), or feeling like the bladder isn’t fully emptying.  A diagnosis of BPH with LUTS typically results when all other reasons for urinary tract symptoms can be ruled out.  


Lower urinary tract symptoms or LUTS due to BPH is typically the diagnosis when all other possibilities are eliminated.  Benign prostatic hyperplasia tends to become more prevalent the older a man gets and LUTS typically increases its breadth and intensity as a man ages unless action is taken in the form of lifestyle modification, medication, or surgical intervention.  Even though there is no magical cure for BPH, short of completely removing the prostate, prostatic hyperplasia and its associated urinary tract symptoms can be managed or taken care of for good if the right individual therapy is chosen. The prostate grows to a normal size during puberty and into a man’s 20s and is a vital component of a man’s reproductive system.  However, with another slow and fast growth phase still ahead, many men experience benign prostatic hyperplasia and its resulting lower urinary tract symptoms which tend to impact the quality of life unless lifestyle, medication, or surgical interventions are implemented.  BPH with LUTS is an unfortunate consequence of being male for many men as they age.  BPH isn’t associated with prostate cancer, but prostate cancer and other ailments such as prostatitis, a UTI, and kidney or bladder stones have to be ruled out first before a BPH with LUTS diagnosis can be made.   References
  1. https://my.clevelandclinic.org/health/body/23965-prostate
  2. Xia SJ, Xu XX, Teng JB, Xu CX, Tang XD. Characteristic pattern of human prostatic growth with age. Asian J Androl. 2002 Dec;4(4):269-71. PMID: 12508127.


    All surgical treatments have inherent and associated side effects. Individual’s outcomes may depend on a number of factors, including but not limited to patient characteristics, disease characteristics and/or surgeon experience. The most common side effects are mild and transient and may include mild pain or difficulty when urinating, discomfort in the pelvis, blood in the urine, inability to empty the bladder or a frequent and/or urgent need to urinate, and bladder or urinary tract infection. Other risks include ejaculatory dysfunction and a low risk of injury to the urethra or rectum where the devices gain access to the body for treatment. Further, there may be other risks as in other urological surgery, such as anesthesia risk or the risk of infection, including the potential transmission of blood borne pathogens. For more information about potential side effects and risks associated with Aquablation therapy for Benign Prostatic Hyperplasia (BPH) treatment, speak with your urologist or surgeon. Prior to using our products, please review the Instructions for Use, Operator’s Manual or User Manual, as applicable, and any accompanying documentation for a complete listing of indications, contraindications, warnings, precautions and potential adverse events. No claim is made that the AquaBeam Robotic System will cure any medical condition, or entirely eliminate the diseased entity. Repeated treatment or alternative therapies may sometimes be required.

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