Prostate Health and BPH

What an enlarged prostate does

A larger prostate narrows the channel urine has to pass through. The bladder compensates by pushing harder, and over years that extra work changes the bladder muscle itself. This is why symptoms come in two flavours. Some are about getting urine out, and some are about the bladder becoming irritable and overactive.

Prostate size and symptom severity do not track each other neatly. Some men with a large gland have few complaints, and some with a modestly enlarged gland are badly affected. Treatment follows the symptoms and their effect on daily life, not the measurement on a scan.

Symptoms to look out for

• A weaker stream than you used to have, or one that starts and stops
• Waiting for the flow to begin, or straining to keep it going
• A feeling that the bladder has not emptied fully
• Passing urine more often, particularly getting up several times at night
• Sudden urgency that is difficult to hold
• Dribbling at the end

How the prostate is assessed

A structured symptom questionnaire puts a number on how much this is actually affecting you, which also gives a baseline to measure treatment against.

Examination includes a digital rectal examination to feel the size and texture of the gland. A urine test rules out infection. A flow test measures the stream, and an ultrasound checks how much urine is left behind after passing and looks at the kidneys. A PSA blood test is discussed and offered where appropriate. In selected cases a camera test or pressure studies of the bladder add information before any surgical decision.

Treatment approaches

Watchful waiting and adjustment

Where symptoms are mild and not bothersome, no treatment is needed. Reducing evening fluids, cutting caffeine and alcohol, reviewing medications that affect the bladder and treating constipation often help enough on their own.

Medication

One group of drugs relaxes the muscle at the bladder outlet and improves the flow within days. Another group slowly shrinks the gland itself over months and works better for larger prostates. They are often used together, and other drugs are added when an overactive bladder is the bigger problem.

Surgery to open the channel

When medication is not enough, or when there has been retention, bleeding, stones or damage to the kidneys, the obstructing tissue is removed from inside through the urethra. There is no external cut. Several techniques exist, including laser based ones, and the choice depends mainly on the size of the gland and your other medical conditions.

Surgery for a very large gland

Glands beyond a certain size are better dealt with by enucleating the obstructing tissue as a whole, which clears it thoroughly and reduces the chance of needing a repeat procedure years later.

PSA and the cancer question

PSA is a protein made by the prostate and measured in a blood test. A raised level can indicate cancer, but it also rises with benign enlargement, infection, recent catheterisation and even cycling. A single number rarely settles anything on its own.

The point of PSA testing is not to produce a verdict but to decide whether further assessment is worthwhile. Where the level or the examination raises concern, an MRI scan is usually the next step, and a biopsy is only considered afterwards if the scan supports it. Any man being tested deserves to have that pathway explained before the blood is taken rather than after.

Recovery after prostate surgery

A short hospital stay is usual, with a catheter in place for a day or two while the area settles. The stream is generally noticeably better very soon afterwards.

Some burning and urgency for a few weeks is normal as the raw surface heals. Heavy lifting and strenuous exercise are avoided for a short period. Most men return to office work within one to two weeks.