Prostate enlargement (mate repe tātea) is a gradual enlargement of the prostate that commonly occurs as men age.
On this page, you can find the following information:
- What is the prostate?
- Why does the prostate get bigger?
- Does a bigger prostate mean I have a greater risk of getting cancer?
- What are the symptoms?
- When should I see the doctor?
- How does the doctor diagnose an enlarged prostate?
- Do I need treatment?
- Prostate enlargement is when your prostate gets bigger. Hyperplasia is another word for enlarged.
- It is very common (about half of men aged over 50 and 80% of men aged 80 or older will get it).
- Benign means it is not cancer.
- While you can read about the symptoms below, do not self-diagnose. See your doctor as they may need to make sure your prostate is not enlarged for some other reason.
The prostate is a gland found only in men. It is about the size of a walnut, lies just below the bladder and surrounds the tube (urethra) that drains urine from the bladder. Its job is to secrete a milky fluid, which becomes part of the semen and nourishes the sperm.
Image credit: Canva
The prostate reaches its adult size by 20 years of age. For some men, it starts to grow again around middle age. A possible reason for this is that as you get older, the prostate cells become more sensitive to hormones in the bloodstream and this makes the cells grow. This leads to a gradual enlargement of the prostate gland.
A large prostate can be the size of an apple and sometimes can grow as large as a grapefruit.
Many men worry that having an enlarged prostate means they have an increased risk of developing prostate cancer but this is not the case. The risk of prostate cancer is no greater for men with an enlarged prostate than it is for men without an enlarged prostate – which is why it is described as benign (non-cancerous).
As the prostate gland gets bigger it can put pressure on the bladder and urethra, which is the tube that urine passes through. The picture below shows the narrowing of the urethra as the prostate gland gets bigger.
Image credits: NHS Prostate enlargement
Symptoms can include:
- a slow, delayed start or straining when passing urine
- poor or variable urinary flow
- frequency – having to pass urine (pee) more often
- urinary urgency – needing to go straight away and not being able to hold on
- dribbling of urine
- nocturia – having to wake at night to pass urine multiple times
- incomplete emptying of the bladder
- urinary tract infection.
About 30% of men will have ‘waterworks’ problems. Only a quarter to a half of men with an enlarged prostate have any symptoms.
As the symptoms of prostate enlargement are similar to prostate cancer, it’s important to see your doctor if you have any of the symptoms of an enlarged prostate. Even if the symptoms are mild, they could be caused by a condition that needs to be investigated. Any blood in your urine must be investigated by a GP to rule out other more serious conditions.
To find out whether your prostate gland is enlarged, you'll need to have a few tests. Your doctor will also ask you about any medicines you are taking that they may not know about. Some medicines can make urinary symptoms worse.
Some tests will be done by a GP and, if needed, others will be carried out by a doctor who specialises in urinary problems (urologist).
Your doctor will ask about your symptoms and concerns, and how they affect your quality of life. It’s useful to have a diary of your symptoms when you speak to your doctor.
To assess your symptoms you and your doctor could use the International Prostate Assessment Score. It includes questions such as:
"In the last 4 weeks, how often have you noticed the following symptoms:
- A feeling of not having emptied your bladder after you have finished urinating.
- Needing to go again within 2 hours of urinating.
- Stopping and starting while urinating.
- Finding it difficult to wait before passing urine."
Your doctor may want to do a physical examination. They may examine your stomach and genital area. They may also feel your prostate gland through the wall of your bottom (rectum). This is called a rectal examination. It involves inserting a gloved finger into your anus to feel your prostate through the wall of your rectum. The doctor will check if your prostate is hard or soft, as well as the size and shape of your prostate.
This can be an uncomfortable and stressful procedure and the doctor will always ask for your consent before doing a rectal examination.
Your doctor may order a blood test to check that your kidneys are working properly. They may advise you to have a prostate-specific antigen (PSA) blood test to rule out prostate cancer. PSA is a protein made by your prostate. Higher than normal levels can occur when there is a problem with your prostate, such as an infection, an enlarged prostate or prostate cancer.
You may be offered a urine test, for example to check for glucose or blood in your pee. This is to see if you have diabetes or an infection.
Treatment for an enlarged prostate will depend on how much your symptoms bother or trouble you. The main treatments are lifestyle changes, medicines and surgery.
You may be able to relieve your symptoms by making some simple changes to your lifestyle. See the self care section below.
If lifestyle changes do not help, or are not suitable for you, you may be offered medicine. Medications can work by relaxing the muscles around the prostate or blocking the action of the hormone testosterone, shrinking the prostate. Examples of medicines used for prostate enlargement are doxazosin or finasteride.
Surgical treatment of BPH often involves removing excess prostate tissue (about 25% of men with BPH will require this). It is usually only for people with moderate to severe symptoms that have not responded to medicine.
- Don't just put up with your symptoms. See your doctor for help.
- Avoid or cut down on alcohol and caffeine. They can irritate your bladder and make your symptoms worse.
- Limit your fluid intake in the evening and try to not drink anything 2 hours before you go to sleep. Make sure you still drink enough water earlier in the day.
- Empty your bladder completely, especially at night or before going on a long journey. Try sitting to pee or peeing twice.
- Start a symptom diary to record how much liquid you drink, how much urine you pass, how often you have to pee and if you have any leakage.
- Pelvic floor exercises and bladder retraining exercises can help.
- Exercise regularly.
- Avoid being constipated (finding it hard to pass poo) as this can put pressure on your bladder.
- Use pads inside your underwear. They can soak up any leaks.
Symptoms of prostate problems Prostate Cancer Foundation, NZ
Prostate enlargement HealthInfo Canterbury, NZ
Enlarged prostate Southern Cross, NZ
Benign prostate enlargement NHS, UK
Benign rostate hyperplasia – prostate enlargement Healthy Male, Australia
Bladder diary with instructions The Continence Foundation of Australia