SYMPTOMS OF AN ENLARGED PROSTATE (Benign Prostatic Hyperplasia – BPH)

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1. What is the prostate?

The prostate is a small gland that only men have. It sits just below the bladder and surrounds the first part of the water pipe (urethra) that carries urine out through the penis.

Its main job is to produce a fluid that mixes with sperm to form semen. This fluid helps to nourish and protect sperm.

All men are born with a prostate. During puberty it grows under the influence of male hormones. Later in life, usually from the age of 40–50 onwards, it often starts to grow again. This age-related growth is called benign prostatic hyperplasia (BPH), which means “non-cancerous enlargement of the prostate”.

An enlarged prostate is only considered a medical problem when it starts to block the flow of urine or causes troublesome urinary symptoms.

2. How common is prostate enlargement?

Enlarged prostate is very common:

• Many men over 50 have some degree of enlargement

• The likelihood increases with age

However:

• Not all men with a large prostate have symptoms

• Some men with only mild enlargement can still have marked urinary problems

The size of the prostate is only one factor. Where the tissue grows and how it affects the urine channel are just as important.

3. What symptoms can prostate enlargement cause?

As the prostate enlarges, it can squeeze the urethra and make it harder for urine to flow freely. This can cause “lower urinary tract symptoms”. These fall into two main groups.

Storage symptoms (when the bladder is filling):

• Going to the toilet more often than before

• Getting up at night to pass urine (nocturia)

• Sudden, strong urges to pass urine

• Leakage of urine if you cannot reach the toilet in time

Voiding symptoms (while passing urine):

• Difficulty getting the flow started

• Weak or thin flow

• Stopping and starting several times (intermittent stream)

• Splitting or spraying of the stream

• Feeling that the bladder has not emptied completely

• Dribbling after finishing

In more advanced cases you may also experience:

• Blood in the urine

• Repeated urine infections

• A build-up of urine in the bladder (residual urine)

• Sudden inability to pass urine at all, needing an emergency catheter

• Over time, possible strain on the kidneys if the blockage is severe and long-standing

Symptoms can vary a lot from person to person. Some men are very bothered by relatively mild changes; others cope for years with more significant problems.

4. Is enlarged prostate the same as prostate cancer?

No. These are two different conditions.

Benign Prostatic Hyperplasia (BPH):

• “Benign” means non-cancerous

• It is age-related overgrowth of prostate tissue, usually in the central part that surrounds the urethra

• It can squeeze the urine channel and cause urinary symptoms

• It does not spread to other organs

Prostate cancer:

• “Malignant” means cancerous

• It usually starts in the outer part of the prostate

• It can, in some cases, spread beyond the prostate if not detected and treated appropriately

• The treatment (surgery, radiotherapy, active surveillance, etc.) and course are very different from BPH

Having BPH does not mean you will get prostate cancer. A small prostate does not rule cancer out either. This is why regular checks are important from a certain age or if you have risk factors.

5. What happens at a prostate check? What is PSA?

From around the age of 50, many men are offered a prostate health check. Men with a strong family history of prostate cancer or men of higher-risk ethnic backgrounds may start earlier, for example from 45.

A typical assessment includes:

History

• Questions about urinary symptoms (daytime and night-time)

• How much these bother you and affect your daily life and sleep

• Any blood in the urine, infections, pain or weight loss

Examination

• A digital rectal examination (DRE), in which a doctor gently feels the prostate through the back passage to assess its size, shape and texture

PSA blood test

• PSA stands for Prostate Specific Antigen

• It is a protein made by the prostate and measured in a sample of blood

• PSA can be raised in prostate cancer, but also in benign enlargement, inflammation (prostatitis), urine infection, after ejaculation or after catheter insertion and prostate examinations

A raised PSA does not automatically mean cancer. It does mean:

• The result needs to be interpreted in context (age, prostate size, family history, examination findings)

• Sometimes the test is repeated

• In selected cases, further tests such as MRI scan and, if needed, prostate biopsy may be advised

Your urologist will discuss the meaning of your PSA result and whether any further investigation is appropriate.