The prostate grows with age and can weaken the urine flow. Benign enlargement does not always need treatment, and a high PSA alone does not mean cancer.

What is the prostate and where is it?

The prostate is a small, walnut-sized gland found only in men. It sits below the bladder, and the urethra runs through it. The fluid it makes mixes with sperm to form semen. That is why any change in its size can affect the flow of urine.

Benign prostate enlargement

This is common in men over 50 and is not usually dangerous. An enlarged prostate presses on the urethra, and these symptoms develop slowly:

Difficulty starting, or having to strain
A weak flow, or one that stops and starts
A feeling that the bladder has not fully emptied
Dribbling after you finish
Frequency and urgency, including getting up at night

How is it assessed?

The doctor asks about your symptoms and may examine your abdomen and prostate. You are usually asked to record for at least three days how much you drink and how often and how much you pass urine. A urine test and PSA are common. Some patients need a urine flow test, a bladder ultrasound or a cystoscopy.

What are the options?

An enlarged prostate does not always need treatment. It depends on how severe your symptoms are and how they affect your life.

Changed habits: cutting down on caffeine and alcohol, drinking less before bed while drinking enough during the day, preventing constipation and keeping a healthy weight
Medicine: some medicines make passing urine easier, some help frequency and urgency, and some stop the prostate growing. All can have side effects and must be prescribed by a doctor.
Surgery: considered if medicine has not helped or symptoms are severe. The most common operation removes part of the prostate through the urethra (TURP). There are other methods, but not all suit every patient.

What does PSA mean?

PSA is a blood test that measures a protein made in the prostate. A high PSA means something in the prostate needs checking, but on its own it does not say what. Benign enlargement, inflammation and infection raise it too. The result is not always accurate and can lead to tests that turn out not to have been needed, so it is worth going over the benefits and risks with your doctor first. A high PSA is usually repeated, and an MRI and, if needed, a biopsy may follow.

Prostate cancer

This cancer usually starts in the outer part of the prostate, so it often has no symptoms at first and does not press on the urethra until it has grown. Family history matters, so tell your doctor about it.

Not all of these cancers need immediate treatment. If the cancer is small and causes no symptoms, it is sometimes only monitored. Other options are surgery, radiotherapy and hormone therapy, and each has its own side effects, including leaking urine and erection problems. Talk these through with your doctor before you decide.

When not to wait

If you cannot pass urine at all or have severe pain low in your abdomen, go to the emergency department at once. Blood in the urine, pain when passing urine, and back pain or unexplained weight loss also need checking soon.

The prostate