Why does the prostate grow with age?
The prostate is a small gland, about the size of a walnut, located just below the bladder and in front of the rectum. It surrounds the urethra, the tube that carries urine from the bladder out of the body.
With age, the prostate often becomes larger. When this enlargement is benign (i.e., non-cancerous) and causes urinary symptoms, it is known as benign prostatic hyperplasia (BPH).
This is a common process associated with ageing:
- More than half of men over the age of 60 have some degree of prostate enlargement.
- From the age of 80 onwards, the prevalence is even higher.
Not all men with enlarged prostates will experience symptoms. Their severity depends on how much the urethra is compressed and how the bladder responds.
Prostate enlargement is mainly linked to hormonal changes in male ageing, particularly the effects of testosterone and its derivative, dihydrotestosterone (DHT).
It is a gradual process and part of the natural ageing process in men. It is not linked to infections, sexual activity or specific lifestyle habits.
Most common symptoms after the age of 50
The symptoms fall under the term lower urinary tract symptoms (LUTS), which are generally divided into two categories:
Obstructive symptoms
- Difficulty starting urination.
- Weak flow when you urinate.
- Feeling that your bladder hasn’t emptied properly.
- Dribbling urine after you finish urinating.
Irritative symptoms
- Sudden, urgent need to urinate.
- Increased urinary frequency.
- Getting up to pee several times during the night (nocturia).
In advanced stages, complications may occur, such as acute urinary retention, urinary tract infections, bladder stone formation or, less commonly, kidney problems.
Differences from prostate cancer
Benign prostatic hyperplasia is not cancer and does not directly increase the risk of developing prostate cancer.
That said, both diseases can coexist and share some of the same symptoms. For this reason, if urinary symptoms persist, it’s important to have a proper medical assessment to rule out other possible causes.
Impact on quality of life
Benign prostatic hyperplasia can disrupt sleep, cause daytime tiredness, and limit social activities due to the frequent need to urinate.
Although prostate enlargement is common, symptoms can usually be managed and improved with appropriate medical follow-up.
Urinary discomfort: When should you seek medical advice?
After the age of 50, medical assessment is recommended if:
- Urinary symptoms interfere with your sleep or daily life.
- You experience pain when urinating.
- There is blood in your urine.
- You have difficulty or an inability to urinate.
- You suffer from repeated urinary infections.
Getting an early diagnosis can help prevent complications and improve quality of life.
Treatment options
Treatment depends on the severity of symptoms and the impact on quality of life.
Conservative measures
In mild cases, regular monitoring and simple lifestyle adjustments may be enough. These can include reducing fluid intake before bedtime and reducing caffeine and alcohol consumption.
Pharmacological treatment
For moderate or progressive symptoms, the following may be prescribed:
- Drugs that relax the muscles of the prostate.
- Drugs to gradually reduce prostate size.
- Combined treatments when appropriate.
These medicines are generally effective and well tolerated, though potential side effects should be evaluated individually.
Surgical or minimally invasive treatments
These options are considered when symptoms are severe, complications develop, or medical therapy proves insufficient.
Currently, several less invasive techniques are available, allowing faster recovery than traditional surgery.
Of the available treatment options, holmium laser enucleation of the prostate (HoLEP) is widely recognised as one of the most effective techniques, particularly for larger prostates. It removes the prostate adenoma (the enlarged tissue responsible for urinary obstruction), while minimising bleeding and generally allowing for quicker recovery.
Transurethral resection of the prostate (TURP) remains one of the most established surgical procedures for treating urinary obstruction, particularly for smaller prostates.
For very large prostates, robotic adenomectomy may be considered as an alternative to open surgery, offering the benefits of a minimally invasive approach.
Follow-up after 50 years of age
From the age of 50, or earlier if there is a family history, it is advisable to have regular medical check-ups.
An individual assessment helps to:
- Detect prostate problems early.
- Differentiate benign hyperplasia from other prostatic diseases.
- Start treatment when needed.
Benign prostatic hyperplasia is a common and treatable condition. With the appropriate information, early diagnosis, and regular medical follow‑up, most men can maintain a good quality of life.
