Benign Prostatic Hyperplasia (BPH): Why Timely Treatment Is Important
In January of this year, the British royal family announced that King Charles III (75) had canceled official engagements to undergo treatment for benign prostatic hyperplasia (BPH). Because the British royal family rarely discloses detailed information about the health of senior members of the monarchy, this announcement was considered unusual. In a statement, the royal family explained that the King chose to share details of his diagnosis publicly in order to encourage other men experiencing similar symptoms to seek medical evaluation.
Although BPH is a common condition among middle-aged and older men, the actual treatment rate remains below 50%, according to a survey on BPH awareness conducted by the Korean Urological Association. In that survey, 66.9% of respondents who had not received treatment reported that they believed the symptoms were simply a natural part of aging and did not require medical attention. However, delaying treatment for BPH can increase the risk of complications such as acute urinary retention, hydronephrosis, bladder dysfunction, and urinary tract infections. For this reason, it is important not to miss the appropriate timing for treatment.
Benign prostatic hyperplasia refers to a condition in which the prostate gland enlarges and compresses the urethra, preventing urine from flowing normally and causing various urinary symptoms. In younger men, the prostate is approximately the size of a walnut, but it gradually enlarges with age. BPH typically begins to develop after the age of 40. It affects approximately 60–70% of men in their 60s and occurs in nearly all men in their 70s. The most common symptoms include a weak urinary stream, frequent urination (often more than eight times per day), and a sensation of incomplete bladder emptying even after urination.
When a patient is diagnosed with BPH and experiences bothersome symptoms, treatment usually begins with medication therapy. Medication strategies may vary depending on the type and severity of symptoms. Some patients may be prescribed only a single medication, while others may require a combination of four or five different medications.
The most commonly used first-line medication for BPH is an alpha-blocker. Alpha-blockers work by relaxing the muscles of the prostate and bladder neck, which helps widen the urethra and improve urine flow. These medications act by blocking alpha-1 receptors. Common alpha-blockers include naftopidil, silodosin, tamsulosin, alfuzosin, doxazosin, and terazosin. Each medication has slightly different effects and potential side effects, so treatment typically begins with medications that have fewer side effects and may be adjusted gradually based on the patient’s response.
Another commonly used class of medications for BPH treatment is the 5-alpha reductase inhibitor (5ARI). The enzyme 5-alpha reductase converts testosterone into dihydrotestosterone (DHT), a hormone that plays a key role in prostate growth. By blocking this enzyme, 5-alpha reductase inhibitors can reduce the size of the prostate gland. The most commonly used medications in this class include finasteride and dutasteride. When taken for approximately six months, these medications can reduce prostate size by roughly 30%.
Although these medications can be effective, they may also cause side effects such as decreased libido and erectile dysfunction. In addition, 5-alpha reductase inhibitors can lower prostate-specific antigen (PSA) levels by approximately 50%, which may make prostate cancer screening more challenging.
Patients with BPH often present with a wide variety of symptoms. Some patients experience symptoms related to overactive bladder, while others may have nocturnal polyuria, which causes excessive nighttime urination. Because of this variation, treatment often includes medications beyond alpha-blockers and 5-alpha reductase inhibitors in order to address individual symptoms.
In some cases, surgery may be recommended. Surgical treatment may be considered when long-term medication therapy does not improve symptoms, when patients prefer to avoid additional medications due to already taking multiple drugs, when medication side effects are severe, or when complications related to BPH have already developed. Surgical treatment can provide a more definitive and effective solution in such situations.
Because BPH can significantly affect the quality of life of middle-aged and older men, it should not be ignored. If left untreated, the condition may eventually damage bladder or kidney function, and these changes can be difficult to reverse. For this reason, active evaluation and appropriate treatment are strongly recommended when symptoms appear.
As men enter middle age and beyond, urologic conditions become increasingly common. By providing useful information about urinary diseases that interfere with daily life, the goal is to help individuals maintain a healthier and more comfortable quality of life.