Frequently asked questions about prostate conditions

1. Why does the prostate enlarge?
   Prostate enlargement (benign prostatic hyperplasia, BPH) happens in most men as they age. It’s driven by the effect of male hormones, particularly testosterone and its metabolites, on prostate cells. Enlargement itself isn’t a disease and doesn’t always need treatment. Treatment is considered if bothersome urinary symptoms occur (frequent urination, getting up at night, weak stream, hesitancy). In the UK there is no routine national screening; men with symptoms or concerns should discuss assessment with their GP or a urologist. Those at higher risk because of family history should consider earlier review.

2. Are prostate enlargement and prostate cancer the same thing?
   No. BPH is a non-cancerous increase in prostate size that can narrow the urinary channel; it does not spread. Prostate cancer is different: cells grow in an uncontrolled way and may spread. Both are common and many cases are treatable, especially when detected early.

3. Does a raised PSA always mean prostate cancer?
   No. PSA can rise for several reasons, including BPH, inflammation or infection, recent ejaculation and catheterisation, as well as cancer. A raised PSA needs evaluating and, if elevated, an explanation should be sought. Decisions about PSA testing are made through shared decision-making after discussing pros and cons.

4. When should prostate disease be treated with an operation or procedure?
   For BPH, lifestyle measures and medication are usually tried first. A procedure is considered if symptoms remain troublesome, quality of life is poor, or there are complications such as recurrent retention, infections, bladder stones or kidney issues. For prostate cancer, if disease appears confined to the prostate and the person is fit, surgery or radiotherapy may be offered without delay, depending on risk and preferences.

5. Is there a single “best” treatment?
   No. The right option depends on prostate size and shape, severity of symptoms, recovery goals, sexual side-effect profile, other health issues and local expertise. Below are the current main options we focus on in clinic.

Key procedural options

TURP (transurethral resection of the prostate)
What it is: An established endoscopic procedure that “shaves” the obstructing inner tissue via the urethra.
Anaesthetic/setting: Spinal or general; usually 1–2 days in hospital.
Benefits: Strong, predictable symptom relief and flow improvement; widely available.
Considerations: Catheter for a short period; ejaculation usually affected (retrograde ejaculation is common); risks include bleeding, infection, temporary urgency, urethral stricture or bladder neck scarring.

Rezum (water-vapour thermal therapy)
What it is: Steam injections shrink obstructing tissue over weeks.
Anaesthetic/setting: Day-case under local or light sedation.
Benefits: Minimally invasive; many men preserve ejaculation; quick return to normal activity.
Considerations: Symptom relief builds gradually; short catheter period is common; may not suit very large prostates or certain shapes.

Aquablation (robotically guided water-jet ablation)
What it is: High-pressure water jet removes tissue under real-time imaging guidance.
Anaesthetic/setting: Spinal or general; often 1 night, some centres exploring day-case pathways.
Benefits: Significant symptom relief with precise tissue removal; favourable profile for erectile function and a comparatively better chance of preserving ejaculation than some traditional surgeries.
Considerations: Availability varies; requires specialised equipment and team; catheter typically needed for a short time.

iTind (temporary implantable nitinol device)
What it is: A temporary implant placed endoscopically for a few days to reshape the prostatic urethra, then removed.
Anaesthetic/setting: Short endoscopic insertion and removal, often day-case.
Benefits: Minimally invasive; tissue-sparing; designed to preserve sexual and ejaculatory function; quick recovery.
Considerations: Best for selected anatomies and moderate symptoms; retreatment may be needed over time; not suitable for all prostate sizes or median lobe configurations.

1. Where do these fit alongside medication?
   Alpha-blockers and 5-alpha-reductase inhibitors remain first-line for many men. If medicines don’t control symptoms well, or side effects are a problem, a procedural option is reasonable. Choice is personalised after assessment of symptoms, flow rates, residual urine, prostate size and shape on imaging, sexual priorities, bleeding risk and anaesthetic fitness.

2. What are the main risks of endoscopic procedures?
   Potential risks include bleeding, infection, temporary catheterisation, urinary incontinence, urethral stricture or bladder neck contracture, and changes in sexual function (especially ejaculation with TURP). Modern minimally invasive options aim to reduce recovery time and preserve sexual function where possible, but no procedure is risk-free. Your individual risks depend on pre-operative findings and the technique chosen.

3. How is a decision made?
   After history, examination, urine tests, PSA where indicated, flow testing, ultrasound or cross-sectional imaging for size and residual volume, and discussion of your goals. We then align you with the option that best fits your prostate anatomy and priorities:
   • Maximum symptom relief quickly: TURP or Aquablation
   • Preserve ejaculation with minimally invasive approach: Rezum or iTind (anatomy-dependent)
   • Anticoagulation or higher bleeding risk: discuss centre-specific pathways for Rezum, Aquablation or TURP with appropriate planning

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