Enlarged prostate, also known as benign prostatic hyperplasia or BPH, is hands down the most common prostate problem among men over 50. And while the word "benign" is part of the name, that doesn't mean it doesn't cause issues for men.

It's estimated that about half of men in their 50s experience BPH, and the numbers creep up as the years do. About 70% of men in their 60s experience it, and after 70, about 80% of men do.

But enlarged prostate treatments have improved greatly, and more options exist than ever before.

Dr. Ricardo Gonzalez, a urologist at Houston Methodist, talks with us about the condition and what these newer treatments offer patients.

What is an enlarged prostate, or BPH?

Benign prostatic hyperplasia, or BPH, is a condition where there is benign, or noncancerous, prostate growth — meaning there are more cells than normal within the prostate.

In adult men, a prostate is generally considered enlarged when its volume is 30 milliliters or greater. The volume of a normal prostate gland is about 25 ml and its weight typically ranges from 15 to 25 grams.

"The normal prostate is the size of a walnut, but after puberty, it continues to grow as we age, and it grows at different rates," Dr. Gonzalez says. "Prostate growth is regulated by genetics but also diet. People with high cholesterol or diets rich in cholesterol are probably more likely to have this problem."

As men age, the prostate grows from the size of a walnut to a ping pong ball. In many older men, it can become the size of a tennis ball or even larger.

In a normal prostate, the bladder wall is thin. But as the prostate grows, Dr. Gonzales says the bladder wall thickens, which results in a less-elastic bladder, causing BPH symptoms.

BPH signs and symptoms

"The sign of a prostate growing is a weak or slow urine stream," Dr. Gonzalez says. "People who have lived with the condition for some time will experience frequency urgency. They need to urinate often and will get up at night to use the restroom."

Other signs of BPH can include:

• A sense that you cannot empty the bladder
• Difficulty or delay in starting urination
• A urinary stream that starts and stops

Dr. Gonzalez says it is common for men to feel that their quality of life can suffer due to lack of sleep and productivity as symptoms worsen, and depression may set in. And over time without treatment, BPH can cause issues such as bladder stones, blood in the urine, urinary tract infections (UTIs) and kidney damage due to urine backflow.

How is BPH diagnosed?

Doctors use the International Prostate Symptom Score (IPSS), a screening tool that helps them understand and gauge the elements of a person's urination habits, including:

• Incomplete emptying
• Frequency
• Intermittent stream
• Urgency
• Weak stream
• Straining
• Nocturia (getting up at night to urinate)
• Quality of life, meaning how your bladder habits impact your ability to do everyday tasks

The IPSS questionnaire is scaled, with the maximum score being 35. An IPSS score above 20 is considered severe BPH symptoms, and anything below 8 is considered mild. In addition to an IPSS, a prostate exam will be conducted to assess the prostate size and check for growth.

Other tests can include a flow test to measure the speed of the urine stream, an ultrasound to check how much urine is in the bladder after urination, and a cystoscopy, an exam that checks the inside of the bladder and urethra.

With all necessary tests completed, a urologist will discuss your treatment goals, taking your IPSS into account.

"The IPSS helps doctors gauge how to target treatment for the patient's individual goals," Dr. Gonzalez says. "Knowing the patient's score can help us choose a treatment based on how many points a treatment will reduce their score."

Enlarged prostate treatments depend on symptoms and your individual goals

"When I'm asked about what's the best treatment, it's not about what's the best treatment but what is the right treatment for you," Dr. Gonzalez says.

Recommended treatments will depend on factors such as prostate size, symptom severity, any complications and individual choices.

In addition, it's important to note that the effects of prostate growth can vary. In some men, minor enlargement may cause debilitating symptoms, while other men can have very large prostates with minimal symptoms or complications.

For those with mild symptoms, no treatment may be necessary. This approach to "watchfully wait" may include regular follow-ups with your urologist to ensure symptoms do not worsen.

Others with mild to moderate symptoms may get relief from medications that relax the muscles around the bladder, reducing tension in the urethra. Other medications can help with urine flow, and some slow the prostate gland's growth by reducing the hormone DHT's production.

Dr. Gonzalez says that individuals with a smaller-sized prostate, between 30 and 80 grams, and not having issues completely emptying the bladder, have options for treatment. In addition to medications, there are a few different in-office procedures that use local anesthesia available to relieve symptoms, including:

• Rezum: A water vapor thermal therapy that shrinks the prostate
• Urolift: This prostatic urethral lift procedure widens the urethra by separating the enlarged prostate lobes
• Temporary implantable nitinol device (iTIND): This removable device is inserted and helps reshape the urethra

Dr. Gonzalez says these minimally invasive procedures are available to patients who may not want to be on a medication for the long term or who wish to preserve their sexual function.

"These procedures are fast, minimally invasive, and you just have to go to your urologist's office," Dr. Gonzalez says.

Individuals with significant BPH symptoms and a prostate whose volume is 30 to 80 ml or more may not find relief with medications and are usually not candidates for in-office minimally invasive procedures, since they may have complications with their BPH.

"Procedures such as Urolift or Rezum are usually not for these individuals," Dr. Gonzalez says. "Often, these patients experience urinary retention, have a catheter or have kidney failure, or they're having chronic infections, chronic blood in the urine or bladder stones — these are all surgical problems."

Surgical options can include:

• Aquablation: This procedure uses high-pressure jets of water to remove excessive prostate tissue
• Photoselective vaporization of the prostate (PVP): A laser is used to reduce the size of the prostate
• Anatomic endoscopic enucleation (AEEP): This procedure type, which can be completed using various types of lasers (GreenLight LEP, HoLEP, ThuLEP), removes prostate tissue to help restore urinary function
• Prostatectomy: A surgery that can be performed open or robotically to remove part or all of the prostate

Talk with a urologist to explore your choices

"Men with BPH have more choices than ever before," Dr. Gonzalez says. "Some men may remember their fathers having their prostates scraped, on catheters or experiencing incontinence — we've come a long way since then. Medications are low risk, they have good benefits, and we have more procedures than ever before that can help men find relief. One shoe does not fit every foot, so talk with your urologist about options to know what's available for your unique situation."