- Weak flow and night-time trips are usually a benign enlarged prostate, not cancer.
- Tablets help most men. Surgery is for those they do not help, or where the bladder or kidneys are affected.
- A PSA test is part of the check-up. A raised PSA on its own does not mean cancer.
If no urine comes at all and the lower belly is swollen and painful, this is retention. A catheter is needed the same day. Waiting stretches the bladder and pushes pressure back on the kidneys. Also come today for fever with difficulty passing urine, or blood with clots blocking the flow.
Why It Needs Checking
Two reasons not to simply put up with it.
- Blocked flow can quietly damage the kidneys. Urine left in the bladder pushes pressure back up. The kidneys swell and slowly weaken. There is no pain to warn you. A creatinine test and an ultrasound settle it in a day.
- An enlarged prostate and prostate cancer feel the same. They are separate conditions and one does not become the other. But both happen at the same age, and both raise PSA. That is why PSA is checked — so a rising level is not missed.
Symptoms
They fall into two groups. Which group troubles you more guides the treatment.
- Blocked flow: Weak or slow stream, waiting for it to start, straining, stopping and starting, dribbling at the end, feeling not fully empty.
- Bladder irritation: Going often, sudden urge that is hard to hold, and getting up at night. These usually disturb daily life the most.
| IPSS score | Severity | Usual approach |
|---|---|---|
| 0–7 | Mild | Fluid timing and review. Tablets rarely needed |
| 8–19 | Moderate | Tablets are usually started |
| 20–35 | Severe | Tablets tried; surgery more likely |
The score measures symptoms only. How much they bother you matters just as much.
Tests You May Need
- Urine test: Infection causes the same symptoms and must be ruled out first.
- Flow test: You pass urine into a machine that measures the speed.
- Residual urine: An ultrasound straight after you pass urine, to see how much is left behind.
- Ultrasound KUB: Prostate size, bladder stones, and whether the kidneys are swollen.
- Creatinine: Kidney function.
- PSA: Read alongside your age and prostate size.
- Blood sugar: Undiagnosed diabetes often shows up as frequent urination.
Download the bladder diary → Two or three days of it often explains night-time trips better than any scan.
Treatment
- Simple measures: Drink more earlier in the day and less in the evening. Cut evening tea, coffee and alcohol. Treat constipation. Wait a few seconds after passing urine and try again.
- Alpha-blockers (tamsulosin, silodosin) — relax the muscle at the bladder outlet. Flow improves within days. They do not shrink the prostate. Can cause dizziness on standing and reduced semen. Tell your eye surgeon before cataract surgery.
- 5-alpha reductase inhibitors (finasteride, dutasteride): Actually shrink the gland over six to twelve months. Best for larger prostates. They halve the PSA reading, so later results must be read with that in mind.
- Both together: For larger glands with troublesome symptoms.
- TURP: The standard operation. A telescope passes along the urine passage and removes the blocking tissue. No cut on the body. One to two nights in hospital, catheter out in a day or two, normal activity in two to four weeks. Suits glands up to about 80 g.
- HoLEP or laser: For larger glands, where more tissue needs removing.
- Urine stops more than once, or does not restart after a catheter comes out.
- Kidney function has dropped, or the kidneys are swollen.
- Bladder stones, or infections that keep returning.
- Repeated bleeding from the prostate.
An enlarged prostate keeps changing. A flow test, residual urine and creatinine show whether the tablets are still doing their job.
What to Bring
- Any ultrasound mentioning prostate size or residual urine.
- Old PSA reports with dates — the trend matters more than one number.
- Recent creatinine, sugar and urine reports.
- A bladder diary, if you managed one.
- All your medicines. Water tablets and some cold remedies make this worse.
Related
- When tablets are enough and when surgery is needed
- What is TURP? · Enlarged prostate or cancer?
- Prostate cancer — when to get checked
This page provides general information only. It is not a substitute for medical advice, diagnosis or treatment. Consult a qualified urologist for assessment appropriate to your situation.