Enlarged prostate (BPH) - causes, symptoms and modern therapies

Apr 14, 2025

An enlarged prostate affects many middle-aged and older men. Benign prostate enlargement, known in medicine as benign prostatic hyperplasia (BPH), is caused by non-cancerous growth of the prostate tissue. This often occurs from around the age of 50 - many men over the age of 70 show signs of BPH. This benign enlargement is not the same as prostate cancer, but can cause annoying symptoms. In this article, you will find out why the prostate enlarges, which symptoms are typical, what the course of the disease can look like, which diagnostic tests are available and which treatments - both conventional and alternative - are scientifically proven. We also explain the differences to prostate cancer and discuss the influence of hormones. In the final section, we discuss which dietary supplements can help as a suitable supplement - based on facts, of course.

By the way: all the studies and sources we have used for this article can be found at the end in the list of sources. Here we go into more detail about the different areas of an enlarged prostate.

Why does the prostate enlarge? Causes and risk factors

The exact causes of BPH are not yet fully understood. However, experts suspect that hormonal changes with age play a central role. The balance of sex hormones changes in the course of life: while testosterone levels in men fall with age, oestrogen (which men also have in small amounts) remains relatively constant. This imbalance - less testosterone, relatively more oestrogen - could promote growth signals in the prostate. Another important hormone is dihydrotestosterone (DHT), a breakdown product of testosterone. Older men often have elevated levels of DHT in prostate tissue, which promotes prostate growth. Interestingly, men who do not have functioning testicles before puberty (e.g. due to a congenital androgen deficiency) do not develop prostate enlargement - a clear indication that male hormones (androgens) are the basic prerequisite for BPH.

In addition to the hormone balance, various risk factors for an enlarged prostate have been identified: First and foremost, age - BPH is rare before the age of 40, after which the risk increases significantly with each decade of life. Genetic predisposition also plays a role: If close relatives (father or brothers) suffer from BPH, this increases your own probability. Obesity and lifestyle also have an influence. For example, BPH is more common in overweight men and those with diabetes, while regular physical activity appears to have a protective effect - men who exercise a lot tend to have fewer BPH symptoms. Certain dietary habits could also play a role (more on this in the Nutrition section). Overall, the older you get, the greater the risk that your prostate will grow benign.

Enlarged prostate - symptoms and first signs

Benign prostate enlargement is mainly noticeable through problems urinating. As the prostate surrounds the urethra, its growth can impede the flow of urine. Typical symptoms of an enlarged prostate are

Frequent urge to urinate - you have to go to the toilet unusually often, especially urination at night(nocturia) increases.
Urgency - a sudden, strong urge to urinate that is difficult to suppress.
Difficulty starting - it takes time for the urine stream to start(delayed start).
Weak urine stream - the urine stream strength is reduced, the stream may appear blocked or may stagnate several times during the course of urination.
Dribbling - urine drips at the end of urination.
Feeling of incomplete bladder emptying - after going to the toilet, you have the feeling that there is still urine left in the bladder.

These symptoms are summarized under the term "lower urinary tract symptoms" (LUTS). Not every man with BPH has all the symptoms - the severity and combination can vary. Sometimes the symptoms are so mild that they are hardly bothersome; in other cases, they can severely impair quality of life.

In rare cases, more complicated symptoms also occur, such as blood in the urine (due to burst small vessels in the case of severe enlargement) or recurring urinary tract infections. Acute urinary retention (the inability to empty the bladder) is also possible, but rather rare in the early stages - it is an emergency that requires immediate medical attention.

Important to know: The size of the prostate alone does not always determine the severity of the symptoms. Some men with only a slightly enlarged prostate can experience considerable discomfort, while others with a significantly enlarged prostate hardly experience any symptoms. You should therefore consult your doctor even if you only have mild symptoms - partly to rule out other causes and partly because untreated problems can increase the risk of sudden urinary retention.

Course of the disease and possible complications

An enlarged prostate typically develops slowly over years. Initially, the symptoms are often mild and many people ignore them. Over time, the symptoms tend to gradually get worse. However, the progression is individual: for some men, the symptoms remain at a constant level for years, and for a small proportion, the symptoms may even improve spontaneously - for example, due to changes in the bladder muscles. Nevertheless, without treatment, the problems usually increase.

Long-term untreated prostate enlargement can lead to complications. The constant formation of residual urine increases the risk of urinary tract infections or the formation of bladder stones. In severe cases, this can lead to the aforementioned acute urinary retention, in which the bladder suddenly cannot be emptied at all - often associated with severe pain and pressureful overstretching of the bladder. In addition, the backing up of urine into the kidneys can cause long-term damage to kidney function. Kidney damage and chronic bladder damage are therefore also potential consequences if a severely enlarged prostate remains untreated for a long time. Fortunately, these complications can usually be prevented with appropriate treatment. It is important that you do not shy away from seeing a urologist if you have increasing or very troublesome symptoms - there are numerous treatment options available today, which we explain below.

Diagnosis: How is an enlarged prostate diagnosed?

If you go to the doctor with symptoms, he will first take a thorough medical history - i.e. ask questions about your symptoms (for example, how long they have been present, how severe they are, how much they bother you). A standardized questionnaire, such as the IPSS (International Prostate Symptom Score), is often used to objectively assess the severity of the symptoms.

This is usually followed by a physical examination:

Digital rectal examination (DRU): palpation of the prostate via the rectum - assessment of size, shape and consistency
Urinalysis: exclusion of infections or blood in the urine
PSA test: determination of the prostate-specific antigen in the blood to assess a possible tumor risk
Ultrasound (TRUS or abdominal): Measurement of prostate size and assessment of residual urine
Uroflowmetry: test to measure the urine flow rate
Cystoscopy (cystoscopy): Viewing of the bladder and urethra in case of unclear findings

During the DRU, the doctor looks for typical features of BPH (e.g. elastic, smooth, enlarged) and checks for hardening or lumps that could indicate prostate cancer.

All of these methods together enable the urologist to reliably diagnose BPH and differentiate it from other causes of similar complaints.

Conventional therapy: medication and surgical procedures

The recommended treatment for an enlarged prostate depends on the severity of the symptoms and the level of suffering. In the case of very mild symptoms, active treatment is often not yet necessary. This is referred to as "watchful waiting" (waiting and regular checks). During this phase, the urologist will mainly give you lifestyle tips, e.g. drink less in the evening, reduce alcohol and caffeine and always empty your bladder well. As long as the symptoms are tolerable and there is no threat of complications, this wait-and-see approach may be sufficient. However, regular check-ups are important in order to be able to intervene in good time if anything worsens.

If the symptoms become distressing or worsen, various medications are used. Here are the most common options:

Alpha-1 blockers: These drugs (e.g. tamsulosin, alfuzosin, doxazosin) relax the smooth muscles in the prostate and bladder neck. This reduces the resistance to urination and facilitates the flow of urine. Alpha-blockers work relatively quickly and primarily improve the symptoms (stronger stream, less residual urine, less frequent urge to urinate). However, they do not reduce the size of the prostate. Possible side effects are low blood pressure (dizziness) and ejaculation disorders.

5-alpha-reductase inhibitors: These active ingredients (finasteride, dutasteride) interfere with hormone metabolism. They block the enzyme 5-alpha-reductase, which converts testosterone into the more effective DHT. This reduces the DHT level in the prostate and slows down excessive cell growth.

PDE-5 inhibitors: Surprisingly, certain drugs for erectile dysfunction (phosphodiesterase-5 inhibitors such as tadalafil) are also used in low doses for BPH therapy.

Combination therapy: Alpha-blockers and 5-alpha-reductase inhibitors are often administered together - this can both quickly alleviate the symptoms and reduce the size of the prostate in the long term.

If the symptoms remain severe despite drug therapy or complications occur (e.g. repeated urinary retention, kidney damage), surgical treatment should be considered.

TURP (transurethral prostate resection): This involves the removal of prostate tissue constricting the urethra using an electric snare under endoscopic vision.

In recent years, several new, minimally invasive treatment options have been developed that can be considered as alternatives to TURP.

Alternative treatment approaches and naturopathic options

Many men would like to be able to alleviate the symptoms of an enlarged prostate naturally, for example through herbal remedies or lifestyle changes. In fact, there are a number of alternative therapies that have been researched. It is important to emphasize here: None of these approaches can "magic away" a very large prostate - especially in cases of advanced BPH with complications, there is hardly any way around conventional medicine. However, certain remedies and measures can certainly provide relief for mild to moderate symptoms. Let's take a look at the best-known ones:

Saw palmetto extract (Serenoa repens): It is obtained from the berries of the saw palmetto plant. Saw palmetto extract is said to inhibit 5-alpha-reductase and have an anti-inflammatory effect, similar to finasteride - but milder. Earlier studies and field reports indicated that saw palmetto can reduce symptoms such as the urge to urinate at night. Some studies even showed a comparable effectiveness compared to drugs such as tamsulosin or finasteride. At the same time, the side effects were lower, which makes it attractive. However, it must be clearly stated that the reliable study situation is contradictory. The methodologically best placebo-controlled studies found no significant improvement with saw palmetto compared to placebo.
Nevertheless, some men report subjective improvement, and more recent research is trying to find out whether certain special extracts are more effective. For example, a recent study using a beta-sitosterol-rich saw palmetto oil in higher doses showed a significant improvement in symptoms and urine flow compared to placebo. The bottom line is that saw palmetto may be worth a try for mild symptoms - but don't expect miracles.

Pumpkin seeds and pumpkin seed extract (Cucurbita pepo): Pumpkin seeds are rich in zinc and antioxidants and are also said to have a decongestant effect on the prostate. Many men drink pumpkin seed oil or take capsules in the hope of relief. The scientific evidence here is thin: some small studies showed positive effects on urinary flow and quality of life, others did not. One study found no significant difference between treatment with pumpkin seed extract and a placebo. Nevertheless, pumpkin seeds are often recommended as an adjunct, as they are healthy and at least do no harm. It is possible that slight improvements occur - also due to the placebo effect, which can certainly have a real effect.

Nettle root (Urtica dioica): Extracts from the root of the stinging nettle are often used in Europe in combination with saw palmetto. Nettle root has diuretic properties and is also said to inhibit the local conversion of testosterone. In some studies, the combination of saw palmetto + stinging nettle led to a similar improvement in symptoms as the standard medication - presumably because the modes of action complement each other. On the other hand, there is a lack of clear evidence in high-quality studies here too. Nettle root can therefore be regarded as a supportive measure, but is not a substitute for effective drug therapy if this is necessary.

African plum bark (Pygeum africanum): This plant extract is traditionally used for prostate conditions, particularly in France and Africa. A meta-analysis of several studies showed that Pygeum extracts were able to moderately but significantly improve urological symptoms and maximum urinary flow. Tolerability was good. Pygeum is less well known in Germany, but is contained in some combination preparations.

Rye pollen extract (Cernilton): An extract obtained from flower pollen of grasses (mainly rye), which has shown some improvement in BPH symptoms in studies. The exact mechanisms of action are unclear - it may relax the urethra and have an anti-inflammatory effect. Cernilton is used in some countries as a herbal medicine for BPH. The data is less extensive, but tends to be positive. For men who want a "gentle" treatment, it could be worth a try.

Beta-sitosterol: Many of the plants mentioned above contain beta-sitosterol, a plant sterol. Isolated beta-sitosterol as a dietary supplement has also been studied. Several high-quality studies show that beta-sitosterol supplements can indeed improve symptom scores (IPSS) and increase urinary flow compared to placebo. Some of the improvements were impressive - e.g. an average of 5 points less in symptom score and +3 ml/s in maximum urine flow in a randomized study. Beta-sitosterol could therefore be an effective component of phytotherapeutics. However, like all these remedies, it only treats the symptoms and not the cause - if it is discontinued, the symptoms may return. Nevertheless, more studies are needed to 100% confirm its scope and effectiveness.

Diet and lifestyle: As well as herbal extracts, it is worth taking a look at your diet. There is evidence that certain dietary habits influence the risk of BPH. Studies have found that eating lots of fruit and vegetables tends to have a protective effect, while a very high-fat, meat-heavy diet could increase the risk. For example, a study in Greece found that men who regularly ate fresh fruit were less likely to suffer from BPH, while high consumption of butter and margarine could increase the risk of BPH. The antioxidant and anti-inflammatory effects of plant foods probably play a role here. In general, a healthy diet with lots of vegetables, fruit, wholegrain products, vegetable fats (e.g. olive oil, nuts) and little red meat is probably also good for the prostate. Care should also be taken to maintain a normal body weight - obesity and metabolic syndrome may promote prostate enlargement. Losing weight and exercising can therefore also have an indirect positive effect on prostate health.

In summary, it can be said that alternative therapies can be helpful for an enlarged prostate, especially in the early stages or in addition to other treatments. Herbal preparations such as saw palmetto, pumpkin seed or nettle root are well tolerated by many men. However, the scientific evidence for their effectiveness is not as clear as with conventional medicines. You should not expect miracle cures - if the symptoms are severe, do not hesitate to use conventional therapies. It is best to talk to your urologist if you would like to try herbal remedies, especially in combination with other medications. And don't forget: a healthy lifestyle with a balanced diet, weight control and exercise is always a good support for the prostate and overall health.

Current study situation and research

Research into prostate hyperplasia is not standing still. Scientists are constantly trying to better understand why the prostate grows and how these processes can be influenced. One exciting area of current research is the role of inflammation in the prostate. It has been discovered that signs of chronic inflammation can be found in many enlarged prostates. There is now increasing evidence that such chronic prostate inflammation promotes the development and progression of BPH. Inflammatory cells release growth factors and cytokines, which could stimulate the prostate cells to divide. Research is currently being carried out into whether anti-inflammatory therapies (such as certain medications or a diet with an anti-inflammatory effect) can improve BPH symptoms or slow down growth. One example is omega-3 fatty acids or certain inhibitors of interleukin-8/17, which are being investigated in studies.

Another focus of research is the connection between BPH and metabolic syndrome (i.e. obesity, high blood pressure, lipometabolic disorders, diabetes). Epidemiological studies have shown a clear correlation: Men with metabolic syndrome are more likely to develop full-blown BPH. Conversely, an improvement in lifestyle appears to have positive effects. There are exciting studies in which severely overweight men were observed after bariatric surgery (gastric bypass for weight reduction) - their BPH symptoms improved, in some cases significantly, with weight loss. The exact mechanisms are still being researched, but reduced inflammatory factors and altered hormone levels (e.g. less insulin and leptin) probably play a role. These findings underline how important a healthy lifestyle is for the prostate.

On the therapeutic side, new drugs and procedures are being tested. One class of substances currently being tested, for example, are selective beta-3-adrenoceptor agonists (such as mirabegron) in combination with conventional BPH drugs to treat bladder overactivity and bladder outlet obstruction at the same time. Stem cells as a therapy to regenerate damaged bladder tissue are also an innovative approach in early stages of research. In addition, the development of minimally invasive techniques continues: studies are currently underway to monitor the long-term results of procedures such as Urolift and Rezum over 5-10 years to see whether the one-off treatment lasts or whether follow-up treatments are necessary.

Research into biomarkers is also interesting: are there molecular patterns in the blood or urine that can predict in whom BPH will progress quickly? Such markers could help to tailor therapy more precisely - those with a high risk of progression could be treated more intensively at an early stage, while others may only require observation. Initial candidates for such markers are certain inflammatory proteins, hormonal parameters or gene polymorphisms, but none have yet reached routine use.

To summarize: The current study situation confirms many known recommendations (e.g. on lifestyle and proven therapies) and provides new findings, particularly on inflammatory processes and systemic influences on the prostate. The coming years will show whether completely new treatment strategies can be developed from this - for example, an "anti-inflammatory" prostate therapy to complement existing approaches. As a patient, you benefit from the fact that existing therapies are continually being refined and new options are being added that could be even gentler and more effective.

Dietary supplements and prostate health

Finally, let's take a look at dietary supplements. Many micronutrients are important for the normal function of the prostate and male hormone metabolism. Although vitamins and trace elements cannot cure an enlarged prostate, a good supply of them supports general bodily functions that indirectly affect the prostate.

Here are a few active ingredients that you can take as natural supplements to actively promote your health:

Zinc contributes to normal testosterone levels in the blood. A good zinc status is important so that your body can produce sufficient male hormones. Testosterone, in turn, is central to many functions - but the following also applies: too much DHT in the prostate promotes BPH, so the level should be within the normal range. Zinc is contained in many prostate preparations (e.g. also abundant in pumpkin seeds).
Vitamin B6 contributes to the regulation of hormone activity. This vitamin helps the body to maintain hormonal balance. For middle-aged men, this can mean that B6 is involved in the breakdown of excess oestrogen, for example, and thus supports the interaction of the sex hormones.
Selenium contributes to normal spermatogenesis. Selenium is a trace element that is required for the production of healthy sperm. Indirectly, it is also an antioxidant that protects cells - including prostate cells - from oxidative stress. An adequate supply of selenium is part of men's health.
Vitamin D has a function in cell division. This vitamin affects many tissues in the body. In the prostate, normal vitamin D levels can help to ensure that cells divide in a controlled manner. A deficiency, on the other hand, has been linked to prostate changes in some studies (although a direct link to BPH has not yet been proven).

Such information has been officially verified and may be used. As you can see, dietary supplements can have a supportive effect by ensuring normal bodily functions. It is important to remain realistic - they are not medicines. A zinc or selenium supplement will not reverse your prostate hyperplasia, but it can help to provide your body with the best possible care. Targeted supplements can be useful to prevent deficiencies, especially if your diet does not always provide you with sufficient amounts of everything you need.

Ultimately, it is best to discuss the intake of supplements with your doctor, especially if you are already taking medication, so that there are no interactions. With the right expectations, food supplements can be a building block for you

You can find our Prosta Plus Complex capsules here.

Disclaimer

This article is intended to provide general information and does not replace medical advice. If you have individual questions or complaints about the prostate, please contact a urologist or doctor you trust.