Enlarged Prostate
A non-cancerous enlargement of the prostate that comes with age, causing a weak stream, hesitancy, dribbling and night-time trips to the toilet. Common, not cancer, and very treatable.
The enlarged prostate ladder
Mild symptoms often need only step 1. Tablets help most men with bothersome symptoms; surgery is for when they don’t, or for complications.
- Step 1 · Self-careBladder-friendly habitsCut back caffeine and alcohol, drink less in the 2 hours before bed (but enough through the day), avoid constipation, and empty your bladder twice, a minute apart.
- Works
- Often enough for mild symptoms; no trials in numbers
- Cost
- Free
- How long
- Ongoing
- Watch for
- Don’t cut fluids so much that you get dehydrated or constipated.
Evening beer plus late-night tea is a guaranteed 3 a.m. wake-up.
- Step 2 · Self-carePelvic floor and bladder trainingPelvic floor squeezes, and squeezing behind the scrotum to clear the last drops after peeing. A continence physio can teach both.
- Works
- Helps after-dribble and leakage; no trials in numbers for BPH itself
- Cost
- Free at home; continence physio about $80–120 a session
- How long
- At least 3 months
- Watch for
- If you can’t pee at all, exercises are not the answer: get urgent help.
The squeeze-and-sweep stops the damp patch on your trousers.
- Step 3 · PrescriptionAlpha blockers (tamsulosin, alfuzosin)Relax the muscle around the bladder neck and prostate so urine flows more easily.
- Works
- Improve symptom scores by a few points (on a 35-point scale) more than a dummy pill; effects show within days
- Cost
- Under the $25 PBS co-payment for generics
- How long
- Long term while they help; review after 4–6 weeks
- Watch for
- Dizziness on standing (take at night), a blocked nose, and less or no fluid on ejaculation. Tell your eye surgeon before cataract surgery.
Quick to work, quick to tell if it suits you.
- Step 4 · PrescriptionProstate-shrinking tablets (finasteride, dutasteride)Slowly shrink a larger prostate. Often combined with an alpha blocker.
- Works
- Over about 4.5 years, cut the risk of being unable to pass urine by about two-thirds and the need for surgery by about two-thirds
- Cost
- Under the $25 PBS co-payment for generics
- How long
- Takes months to work; long term
- Watch for
- Lower sex drive, erection or ejaculation problems in a few in 100. They halve the PSA result, so tell anyone testing your PSA.
The slow cooker of prostate medicines. Patience pays.
- Step 5 · PrescriptionMedicines for an urgent or overactive bladderFor urgency, frequency and leaks that remain once flow is sorted.
- Works
- Reduce urgency and trips to the toilet for many men; not for everyone
- Cost
- Under the $25 PBS co-payment for many; some cost more
- How long
- Review after 4–6 weeks
- Watch for
- Dry mouth, constipation, and some types can affect memory in older people. Can rarely make emptying harder.
Fixing the flow sometimes reveals a jumpy bladder underneath.
- Step 6 · SpecialistUrologist and surgeryOptions include removing the inner prostate through the urethra (TURP), laser surgery, steam treatment and small implants that hold it open.
- Works
- Usually improves symptoms more than tablets; best for severe symptoms, retention, recurrent infections, bladder stones or kidney problems
- Cost
- Public waiting lists; private fees vary, with Medicare rebates
- How long
- Day surgery to a short hospital stay; recovery over weeks
- Watch for
- Ejaculating backwards into the bladder is common after TURP; bleeding, infection and leakage are less common. Ask what each option means for your sex life.
The best choice depends on prostate size, health and priorities. Ask about all of them.
Save your money
Popular, heavily marketed or often asked about, but the evidence is weak or says no.
- Saw palmettoA large Cochrane review found it no better than a dummy pill for urinary symptoms. A pricey placebo.
- Combination ‘prostate health’ supplementsIn the same review, saw palmetto mixed with other herbal extracts made little or no difference either.
- Cutting right back on fluidsRisks dehydration and constipation, which can make bladder symptoms worse. Time your drinks instead: less in the evening, enough through the day.
What you can do
- Keep a 3-day bladder diary (what you drink, when you pee and how much) and take it to your GP.
- Ask your GP or pharmacist to review your medicines; some can make urinary symptoms worse.
- Learn pelvic floor squeezes with our pelvic floor handout, especially if you leak or dribble.
- Ask your GP about the pros and cons of a PSA test; urinary symptoms alone don’t mean cancer.
See your GP if
- Your stream is weak, you’re straining, or you feel you haven’t emptied
- You’re getting up more than once or twice a night to pee
- You leak urine, or have urgency that’s affecting life
- Symptoms come on quickly over weeks rather than years
Get urgent help if you can’t pass urine at all, especially with a painful, swollen lower tummy, or if you have urinary symptoms with fever, shivers or back pain: go to an emergency department or call 000 (Australia) or your local emergency number. From a mobile, 112 works in most countries. See your GP promptly for any blood in your urine.
Common questions
What are the symptoms?
A weak or stop-start stream, trouble getting started, straining, dribbling at the end, feeling you haven’t emptied, needing to go often or urgently, and getting up at night to pee.
Who gets it?
It becomes more common with age: about half of men over 50 and more than 8 in 10 men over 80. Hormone changes with age drive the growth; the exact cause isn’t fully understood.
Does it mean I’ll get prostate cancer?
No. An enlarged prostate isn’t cancer and doesn’t raise your risk of it. Your GP may still discuss checking for cancer, as both are common in older men.
How is it diagnosed?
Your GP asks about your symptoms, often using a short symptom score, checks your medicines, tests your urine and may examine your prostate through the back passage. Blood tests check kidney function and sometimes PSA. An ultrasound or urologist review may follow.
Helpful resources
- Healthy Male: Prostate enlargementClear guide to symptoms and treatment options, including newer procedures. Free, Australia.
- National Continence HelplineFree, confidential advice from continence nurses, including prostate and male bladder issues. 1800 33 00 66, Australia.
- Pelvic floor exercise handoutPrintable, one page, for men and women, including after prostate surgery. Free, from us.
Evidence and more information
- Healthdirect: Benign prostate hypertrophy
- Healthy Male: Prostate enlargement
- NHS: Prostate enlargement treatment
- Therapeutics Initiative: Drug treatment of BPH
- NEJM (2003): MTOPS trial of finasteride and doxazosin
- Cochrane (2023): Saw palmetto for BPH
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