Enlarged prostate: symptoms, causes and treatment options

What is an enlarged prostate?

An enlarged prostate means the prostate gland has grown bigger than it was in early adulthood. Doctors call it benign prostate enlargement (BPE) or benign prostatic hyperplasia (BPH). “Benign” is the important word: it is not cancer. Because the prostate wraps around the urethra, extra growth can narrow the tube and make the bladder work harder, which is what causes the symptoms. If you want the basics first, start with what the prostate does.

It is mainly a normal part of getting older. The NHS says it is thought to be caused by changes in hormone levels with age, and you may be more likely to get it if you are over 50 or if others in your family have had an enlarged prostate. Being overweight can make the symptoms worse.

How common is an enlarged prostate by age?

Very common. The British Association of Urological Surgeons (BAUS) estimates that about 50% of men have an enlarged prostate by the age of 65, and about 90% by the age of 90. Around 1 in 3 men will have prostate-related urinary symptoms at some point.

Size and symptoms don’t always go together. Many men with an enlarged prostate have no problems, and BAUS says 30–40% of men with prostate symptoms find they don’t get worse over time and may not need any treatment.

What are the first signs of an enlarged prostate?

Symptoms usually creep up slowly over months or years. Doctors group them into two kinds, and many men have some of both:

Peeing more often and at night has many other causes too, from caffeine to diabetes – our guide to frequent urination covers them.

Is an enlarged prostate serious?

Usually not. It is common, often mild and very treatable. The NHS and Prostate Cancer UK are clear that having an enlarged prostate does not increase your risk of prostate cancer – though because the two can cause similar symptoms, and a man can have both, a GP should check any new urinary symptoms.

Left untreated, a significantly enlarged prostate can occasionally lead to complications such as urinary infections, bladder stones or the bladder not emptying properly. BAUS puts the risk of sudden, painful urinary retention at about 1 in 100.

How is an enlarged prostate diagnosed?

Your GP will ask about your symptoms and how much they bother you. Expect some or all of these:

• A symptom questionnaire, often the International Prostate Symptom Score (IPSS), which rates your symptoms from mild to severe.
• A bladder diary kept for at least three days, recording what you drink, how often you pee and how much.
• A urine test to check for infection or blood.
• A rectal examination, where the GP feels the prostate with a gloved finger to judge its size and texture. It is usually over quickly, and you can ask for someone else to be in the room.
• A PSA blood test – BAUS says PSA is raised in 50–60% of men with an enlarged prostate, so a high result doesn’t automatically mean cancer. See our guide to PSA levels.

If you are referred to a urology clinic, you may also have a urine flow test, an ultrasound scan to see how much urine is left in your bladder afterwards, or a look inside the bladder with a thin camera (cystoscopy).

Can an enlarged prostate go back to normal size?

Diet and supplements have not been shown to shrink it. Some prescription medicines (5-alpha-reductase inhibitors such as finasteride and dutasteride) can gradually shrink a larger prostate – they take at least six months to work fully – and surgery removes or opens up the tissue that is blocking the flow. Many men don’t need the prostate to shrink at all – treatment is about easing symptoms.

What is the best treatment for an enlarged prostate?

The honest answer is: the one your GP or urologist recommends for your symptoms. Treatment follows a ladder, starting with the simplest step:

• Watchful waiting and lifestyle changes for mild symptoms: cutting down on caffeine and alcohol, drinking less before bed (while still drinking enough during the day), eating enough fibre, keeping to a healthy weight and taking time to empty your bladder fully. Bladder training can help with urgency.
• Alpha-blockers such as tamsulosin, alfuzosin or doxazosin relax the muscles in the prostate and bladder neck, so urine flows more easily. They can start to help within hours or days, but may take a few weeks to work fully.
• 5-alpha-reductase inhibitors such as finasteride or dutasteride shrink a larger prostate over several months. They lower your PSA level by at least half, so always tell anyone testing your PSA that you take one.
• Other medicines for urgency and frequency, or a combination of tablets, if one alone isn’t enough.
• Surgery when symptoms are severe or medicines don’t help. TURP (transurethral resection of the prostate) is the most common operation; laser, steam and implant procedures are alternatives.

No supplement has been shown to treat an enlarged prostate. Prostate Cancer UK says studies suggest herbal remedies such as saw palmetto are unlikely to improve symptoms, and some may interfere with prostate medicines or affect your PSA level. If you take medicine for an enlarged prostate, talk to your doctor or pharmacist before taking any supplement, and tell your doctor about any herbal remedies you use.

Can an enlarged prostate cause bowel problems or constipation?

An enlarged prostate doesn’t usually affect your bowels. It works the other way round more often: constipation can press on the bladder and prostate and make urinary symptoms worse, which is why the NHS suggests eating enough fibre and drinking enough fluid if you have prostate symptoms. Straining hard on the toilet is also worth avoiding.

A change in bowel habit that lasts several weeks, blood in your poo or pain in your back passage should always be checked by a GP – don’t put these down to your prostate.