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).
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 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.
Common questions
- 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.