Prostate Hyperplasia

Prostate hyperplasia – medically referred to as benign prostatic hyperplasia (BPH) – is a benign enlargement of the prostate gland, which mainly affects older, intact male dogs. The prostate sits just below the bladder and surrounds the urethra in a ring; its actual function is the production of part of the seminal fluid. With age, the glandular tissue becomes increasingly sensitive to sex hormones – and grows. For the dog, this means: pressure on the urethra and intestines, sometimes as early as six or seven years of age.

What lies behind prostate hyperplasia?

BPH is explicitly not cancer, but hormonally controlled tissue growth. The main driver is testosterone – more precisely its metabolite dihydrotestosterone (DHT). Over the course of life, prostate gland cells become more sensitive to DHT and start to multiply. The enlarged organ then comes into spatial conflict with the urethra and the rectum, leading to the typical symptoms. Intact male dogs are almost without exception affected – it is less a disease in the classical sense than a natural, but disruptive, ageing process.

Causes: Why does the prostate grow?

At its core, this is due to the long-term effect of testosterone and its breakdown product DHT. This alone suffices as an explanation for most cases. Three factors stand out:

1. Age: BPH typically occurs from 6–7 years onwards. With each additional year of life, the probability – and the degree of manifestation – increases.
2. Lack of castration: Without testes, there is no testosterone; without testosterone, there is no DHT excess – castrated male dogs simply do not develop BPH. The condition is therefore almost exclusively a topic for intact male dogs.
3. Prolonged hormonal exposure: The longer the prostate is exposed to DHT, the more pronounced the growth. Castration can stop this process and demonstrably reduce the size of the gland.

Symptoms: What do dog owners notice?

The symptoms usually develop insidiously – initially barely noticeable, then increasingly obvious. Where the prostate presses makes itself felt in two places: the bladder and the intestines. Typical signs:

Changed urination behaviour:

• The male dog urinates more frequently but only passes small amounts. The stream is thin or intermittent. In severe cases, urinary retention occurs – the dog strains and strains without any significant urine flowing. This is an emergency.
• Sometimes you see the dog standing in a tense posture, as if urination is difficult.

Blood in urine or discharge:

• Reddish urine or slightly bloody drops from the prepuce may indicate concomitant inflammation of the prostate or irritated mucous membranes. This finding always requires veterinary clarification.

Problems with defecation:

• If the prostate presses against the rectum, bowel movements become difficult. The dog strains for a long time, and the faeces come out ribbon-like or flat. Some owners describe their male dog looking exhausted and tense after defecating.

Pain and changed body posture:

• Some dogs avoid sitting or stand slightly hunched. They show discomfort in the lower abdomen and perineal area, especially during defecation.

Visible swelling in the perineal area:

• In cases of a significantly enlarged prostate, a bulge may become visible in the area between the anus and the penis – a sign of an advanced condition.

Diagnosis: What does the vet do?

The assessment is usually straightforward and combines several methods:

1. Rectal palpation: Via the rectum, the vet directly feels the size, shape, and consistency of the prostate. An enlarged gland can be assessed well this way – even though the examination is uncomfortable for the dog.
2. Ultrasound: Sonography is the most reliable tool. It shows the exact volume of the prostate and makes cysts or calcifications visible. Even more importantly: it helps distinguish a benign enlargement from a tumour.
3. Blood count and urine analysis: Inflammation markers in the blood and abnormalities in the urine – blood, bacteria, protein – provide clues about concomitant diseases such as prostatitis or urinary tract infections.
4. Fine-needle biopsy: A tissue sample is only taken if a tumour cannot be reliably ruled out. In everyday practice, this is the exception, not the rule.

Treatment: What really helps?

How intensively treatment is carried out depends on the dog’s distress and the size of the gland. There is a clear favourite – and alternatives for special situations:

1. Castration: It remains the most effective measure. After removal of the testicles, testosterone production drops off, and the prostate shrinks – often noticeably within a few weeks. Most male dogs are symptom-free afterwards. For breeding or working dogs where surgical castration is not desired, there is also the hormonal variant via implant.
2. Medication options: If castration is not an option, two paths are open:
   • Anti-androgens such as finasteride block the conversion of testosterone into DHT and slow down gland growth. However, complete regression is rarely achievable with this.
   • GnRH analogues (gonadotropin-releasing hormone agonists) temporarily suppress hormone production and achieve similar effects to temporary castration – the implant lasts six to twelve months depending on the preparation.
3. Antibiotics: In the case of concomitant prostatitis or bacterial infection, antibiotics are necessary – but they treat the concomitant disease, not the cause.
4. Pain management: Anti-inflammatories or analgesics can be used as a bridge when the dog is suffering acutely – they are not intended as a standalone long-term solution.
5. Surgery on the prostate itself: Direct surgical intervention on the gland is only considered for tumours or large cysts that do not respond to medication. This is rare in practice.

Prevention: Acting early pays off

Owners who castrate their male dog early protect it reliably against BPH – there is no way around this. Even castration in old age, when the dog already shows symptoms, brings about a significant improvement in almost all cases. Owners should therefore discuss this with the vet promptly for male dogs not used for breeding – even if nothing seems amiss currently.

Prognosis

The outlook is good. Those who detect and treat BPH early generally restore complete freedom from symptoms to the dog. Castration yields the fastest and most reliable results. Medication requires close monitoring so that symptoms do not gradually increase again. A normal, symptom-free life for the dog is the realistic goal in both cases.

Conclusion

Prostate hyperplasia is one of the most common age-related diseases in intact male dogs – and at the same time, it is among those that are well treatable. The crucial step is to look early: if the dog strains when urinating or defecating, appears tense in the hindquarters, or has bloody discharge, this belongs in the vet’s practice. The earlier the diagnosis, the more straightforward the solution.