Prostate

Enlarged prostate (BPH)

An enlarged prostate is common after 50 and is not cancer. Treatment aims to let you pass urine comfortably and sleep through the night.

Overview

The prostate wraps around the urethra just below the bladder, and in most men it slowly grows with age. When it presses on the urethra, symptoms start to affect sleep, work and travel.

How bad the symptoms are doesn't always match the prostate's size, so we measure the symptoms themselves and choose treatment by their effect on your life.

Common symptoms

A weak or interrupted stream
Difficulty or delay starting to pass urine
Waking more than once a night to urinate
A feeling that the bladder hasn't fully emptied
Sudden urgency that is hard to hold

How we diagnose it

Prostate symptom score (IPSS): Seven questions scored 0 to 35. It grades how severe symptoms are and tracks the response to treatment.
Urine flow test: A simple test that measures flow rate and volume.
Post-void residual ultrasound: Shows whether the bladder empties completely.
PSA blood test and examination: To estimate prostate size and rule out anything that needs further checks.

Treatment options

Listed from least invasive. Treatment is chosen after assessment and agreed with you.

Monitoring and lifestyle changes
For mild symptoms: managing evening fluids, cutting caffeine, and reviewing medicines that affect urination.
Medication
Medicines that relax the prostate to improve flow, others that shrink it over time, or a combination.
Rezum water vapour therapy
A minimally invasive treatment that uses water vapour to shrink the prostate tissue pressing on the urethra, with no incision, and usually preserves ejaculation.
Laser prostate treatment
Removes or vaporises prostate tissue with a laser through a scope. Suits a range of prostate sizes, often with less bleeding.
Transurethral resection (TURP)
Removes the part pressing on the urethra through a scope, with no external incision.

Frequently asked questions

Can an enlarged prostate turn into cancer?

No. BPH and prostate cancer are different conditions, though they can exist together, so the assessment includes checks that rule cancer out.

Will I need an operation?

Most men improve on medication. Surgery comes up when medicines aren't enough, or with repeated retention, bladder stones or effects on the kidneys.

Does prostate surgery affect sexual function?

Some procedures can cause retrograde ejaculation. We explain the likely effects of each option clearly before you decide.

Related conditions

Urologic cancer

Early detection, diagnosis and surgical care for prostate, bladder, kidney and testicular cancer.

Read about this Bladder & continence

Incontinence & overactive bladder

Assessment of leakage, urgency and frequency, with treatment that starts with simple exercises before medicines or procedures.

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