Benign prostatic enlargement (BPH) is a non-cancerous growth of the prostate that comes with age and becomes more common after 50. Because the prostate surrounds the urethra, enlargement can press on it and cause urinary symptoms. The good news is that most men improve with lifestyle changes or medicines, and surgery has specific indications.
Medically reviewed by Prof. Dr. Samir Ahmed Al-Samarrai, consultant urologist. Last reviewed:
Symptoms
- Voiding symptoms: weak stream, difficulty starting, an interrupted flow and straining.
- Storage symptoms: frequent urination, getting up at night and sudden urgency.
- After voiding: feeling the bladder is not empty, and dribbling.
These symptoms are not specific to the prostate; a weak bladder, a urethral stricture or diabetes can cause them too, so diagnosis needs an assessment.
Diagnosis
European and NICE guidelines recommend an assessment that includes:
- Medical history, medicines and a symptom score (IPSS).
- A bladder diary for a few days, especially with night-time urination.
- Digital rectal examination to estimate size.
- Urine test.
- PSA, after the doctor explains its value, when the result would change management. Read our PSA test guide.
- Urine flow test and ultrasound for residual urine and prostate size.
- Kidney function when it may be affected.
Treatment
Monitoring and lifestyle changes
For mild symptoms that do not bother you much: drink less before bedtime, cut down on caffeine and alcohol, try bladder training, and review medicines that worsen symptoms, with regular follow-up.
Medicines
- Alpha-blockers (such as tamsulosin) relax the muscle of the prostate and bladder neck and work within days to weeks. Side effects include dizziness and reduced semen at ejaculation.
- 5-alpha reductase inhibitors (finasteride, dutasteride) shrink a large prostate (above about 40 ml), take several months to work and roughly halve the PSA value, so tell your doctor you take them when PSA is interpreted.
- Combination therapy with both for a large prostate and moderate to severe symptoms.
- Daily tadalafil for some men, especially with erectile dysfunction.
- Overactive bladder medicines when storage symptoms dominate, after confirming the bladder empties well.
Evidence for herbal products is limited and varies between products, so do not rely on them instead of a medical assessment.
When is surgery discussed?
- Repeated urinary retention, or retention that does not settle.
- Repeated urinary infections caused by enlargement.
- Bladder stones.
- Repeated bleeding from the prostate.
- Kidney function affected by bladder outlet obstruction.
- No improvement with, or intolerance of, medicines, or the patient’s choice after the options are explained.
Surgical options, depending on prostate size and the patient’s health, include transurethral resection of the prostate (TURP), laser enucleation, vaporisation, water vapour therapy (Rezum) and prostatic urethral lift. The doctor and patient choose together after discussing the benefits and side effects of each.
Complications if left untreated
Acute urinary retention, repeated urinary infections, bladder stones, bleeding and, less often, kidney damage. Do not ignore symptoms that are getting worse.
Articles on enlarged prostate
- Is an enlarged prostate dangerous?
- Prostate problems in young men
- Enlarged prostate medicines: types and side effects
- Prostate surgery for BPH: TURP, laser and steam compared
- Enlarged prostate, erections and fertility
- Prostate herbal supplements: what is proven
- Benign Prostatic Enlargement, Part 1: Aetiology and Diagnostic Evaluation
- Part 2: Pharmacological Treatment and Phytotherapy
- Part 3: Surgical Therapy
- Part 4: Management of Nocturia in Men with LUTS
- What is the latest treatment for enlarged prostate?
- Methods for treating benign prostatic enlargement
- Prostatic enlargement, causes and symptoms
- The prostate: general guide
Frequently asked questions
Does an enlarged prostate turn into cancer?
No. Benign enlargement is a different condition and does not become cancer, but a man can have both, so the doctor and patient decide together whether a PSA test is needed.
Can an enlarged prostate be treated without surgery?
Yes. Most men improve with lifestyle changes or medicines. Surgery is discussed when symptoms do not improve or when complications such as repeated urinary retention occur.
Does a bigger prostate mean worse symptoms?
Not always. A large prostate can cause mild symptoms and a smaller one troublesome symptoms, so treatment depends on symptoms and tests, not size alone.
Do prostate medicines affect sex life?
Some can reduce the amount of semen at ejaculation or affect desire or erections in some men. Discuss this with your doctor, as there are alternatives.
When is an enlarged prostate an emergency?
When you cannot pass urine at all and have pain and swelling in the lower abdomen. This is acute urinary retention and needs a catheter quickly.
Sources
Book a consultation
Prof. Al-Samarrai and Dr. Amer Mousa assess prostate enlargement symptoms at Prof. Al-Samarrai Medical Center, Dubai Healthcare City, and discuss the options that suit your case. Medical consultations are confidential.
This information is for health education and does not replace a medical examination. See our medical content policy.