--- title: "Enlarged prostate: Symptoms & Treatment | HealthAnswers" description: "Benign prostatic hyperplasia (BPH) — urinary symptoms in men, when to see a GP, and NHS treatments including medicines and surgery." url: https://healthanswers.co.uk/conditions/enlarged-prostate/ robots: noindex --- # Enlarged prostate: Symptoms & Treatment | HealthAnswers Health A–Z Benign prostatic hyperplasia (BPH) — urinary symptoms in men, when to see a GP, and NHS treatments including medicines and surgery. Written by HealthAnswers editorial team Medically reviewed by [HealthAnswers UK doctor review panel](https://healthanswers.co.uk/our-doctors/) Reviewed 3 July 2026 ## Quick answer What is enlarged prostate? An enlarged prostate (BPH) is common in men over 50 — the prostate gland grows and presses on the urethra, causing weak stream, hesitancy, frequency, and needing to urinate at night. Not cancer but symptoms overlap — PSA and examination may be needed. Treatments include lifestyle changes, tamsulosin, finasteride, or surgery (TURP). See a GP for urinary symptoms — same-day if unable to urinate at all (retention). ## Who is this page for? This page is for people in the UK who want a plain-English overview of Enlarged prostate, including when to seek help and what NHS care usually involves. It explains general information, not what is wrong with you personally. ## Who should skip this page? Skip this page if you need a diagnosis, a prescription, or emergency care. It cannot replace a GP, pharmacist, NHS 111 or 999. If you are in immediate danger, call 999; for urgent advice that is not life-threatening, call 111 in England, Scotland or Wales, or use your GP out-of-hours service in Northern Ireland. On this page 7 sections ## Key facts about enlarged prostate - BPH affects most men eventually — about half over 50 have urinary symptoms. - Symptoms — poor stream, straining, dribbling, frequency, nocturia (night urination), urgency. - BPH is benign — not prostate cancer — but both can coexist; PSA and examination assess risk. - Alpha-blockers (tamsulosin) relax prostate smooth muscle — improve flow within days. - Acute urinary retention — sudden inability to pass urine — needs A&E catheter immediately. ## Enlarged prostate — benign prostatic hyperplasia (BPH) The **prostate** is a walnut-sized gland below the bladder surrounding the **urethra** — produces fluid for semen. With age, **benign enlargement (BPH)** is **extremely common** — **not cancer** — but **compresses the urethra**, causing **lower urinary tract symptoms (LUTS)**. Most **men over 50** develop some enlargement; **half** develop bothersome symptoms. ## Symptoms **Obstructive (slowing flow):** - hesitancy — delay starting - weak stream , stopping and starting - straining - incomplete emptying feeling - terminal dribbling **Irritative:** - frequency — often daytime - urgency — sudden need - nocturia — waking nights to urinate — sleep disruption **Complications:** - acute urinary retention — cannot pass urine — A&E catheter - recurrent UTIs - bladder stones - hydronephrosis — kidney back-pressure — rare without long neglect - haematuria — blood in urine — needs assessment ## BPH vs prostate cancer | | BPH | Prostate cancer | | --- | --- | --- | | Nature | Benign growth | Malignant | | Examination | Smooth uniform enlargement | Hard irregular nodule may be felt | | PSA | May be mildly elevated | May be elevated | **Both coexist** — symptoms do not distinguish — **GP assessment** including **DRE** (digital rectal exam) and **PSA discussion** where appropriate. **BPH does not become cancer.** ## Assessment - IPSS questionnaire — symptom score - examination — abdomen for distended bladder; DRE - urinalysis — infection, blood, glucose - PSA — shared decision — age 50+ (45 Black African/Caribbean, family history) - renal function if retention history - bladder diary — fluid intake, voiding pattern - ultrasound — post-void residual, kidney dilatation — specialist ## Treatment ladder ### Lifestyle - reduce evening fluids — especially caffeine/alcohol - double voiding — urinate, wait, try again - bladder training - review medicines — anticholinergics, diuretics worsen symptoms ### Medicines **Alpha-blockers** — **tamsulosin**, alfuzosin: - relax smooth muscle - effect within days - side effects — dizziness , retrograde ejaculation **5-alpha reductase inhibitors** — **finasteride**, dutasteride: - shrink prostate over 6 to 12 months - for large prostate on examination - side effects — reduced libido , ED (uncommon) **Combination** — both classes if moderate-severe **Tadalafil 5mg daily** — [ED](https://healthanswers.co.uk/conditions/erectile-dysfunction/) and BPH dual benefit ### Surgery and procedures When medicines insufficient or complications: - TURP — gold standard resection - HoLEP — laser enucleation — large prostates - UroLift — implants hold tissue aside - Rezum — steam ablation - open prostatectomy — very large glands **Catheter** — short-term retention; **trial without catheter** after — may need surgery if fails. ## Red flags — seek urgent care - complete inability to urinate — painful full bladder - fever with urinary symptoms — infection - visible blood clots - back pain with retention — kidney involvement ## Prostate cancer screening **PSA test** — **informed choice** not population screening: - false positives — biopsies for benign disease - overdiagnosis — slow cancers never harmful - benefit — reduced mortality in some trials — individual values matter Discuss with GP from **50** (earlier if high risk). BPH is **normal ageing with treatable symptoms** — **weak stream and nightly waking** deserve GP review, not assumed inevitability — and **rule out cancer** where appropriate. ## ! When to see a GP about enlarged prostate See a GP for new urinary symptoms — weak stream, frequency, blood in urine, or waking multiple times nightly to urinate. Same-day/A&E if unable to pass any urine, severe lower abdominal pain with full bladder, or visible blood clots. Prostate cancer screening decisions — shared decision-making about PSA testing from age 50 (45 if Black family history). ## Common questions about enlarged prostate What are the symptoms of an enlarged prostate? Hesitancy starting urination, weak intermittent stream, straining, feeling bladder not empty, dribbling after finishing, frequency and urgency, nocturia — waking at night to urinate. Irritative and obstructive symptoms together suggest BPH — GP assesses with IPSS score and examination. Is an enlarged prostate cancer? No — BPH is benign growth of prostate tissue. Prostate cancer is separate — can coexist. Enlarged smooth prostate on examination differs from hard cancerous nodules — but PSA blood test and referral if cancer suspected. BPH does not turn into cancer. What medicines treat enlarged prostate? Alpha-blockers — tamsulosin, alfuzosin — relax muscle, improve flow quickly. 5-alpha reductase inhibitors — finasteride, dutasteride — shrink prostate over months — for larger glands. Combination used together. Tadalafil 5mg daily also licensed for BPH symptoms. When is prostate surgery needed? When medicines fail, urinary retention recurs, recurrent UTIs, bladder stones, kidney damage from back-pressure, or patient preference. TURP (transurethral resection) most common — remove inner prostate tissue. Minimally invasive alternatives — UroLift, Rezum — selected cases. Can an enlarged prostate cause erectile dysfunction? BPH itself less direct cause — but same age group; some alpha-blockers rarely cause retrograde ejaculation (dry orgasm). Tadalafil treats both ED and BPH. Severe LUTS affects quality of life and sleep — treat holistically. What is PSA testing? Prostate specific antigen blood test — elevated in BPH, prostatitis, and cancer. Not perfect screening test — false positives and overdiagnosis concerns. NHS offers informed choice from 50 — discuss pros and cons with GP. ## Sources - [NHS — Prostate enlargement](https://www.nhs.uk/conditions/prostate-enlargement/) - [NICE — Lower urinary tract symptoms in men](https://www.nice.org.uk/guidance/ng131)