Symptoms worth acting on
Most men over sixty have some prostate enlargement. The size on ultrasound matters far less than what the bladder is doing about it.
- Weak or interrupted stream, straining to start
- Getting up two or more times at night to urinate
- A sense that the bladder is never fully empty
- Sudden urgency, or leaking before reaching the toilet
- Blood in the urine
- Retention — being unable to pass urine at all, which is an emergency
How the decision is made
Assessment is straightforward: an IPSS symptom score, a uroflowmetry test, an ultrasound for post-void residual urine and prostate size, and a PSA to rule out cancer. Together these tell us whether tablets are enough or whether the obstruction has reached the point of harming the bladder and kidneys.
- Mild symptoms: fluid timing, bladder habits, review in six months
- Moderate: alpha blockers, 5-alpha reductase inhibitors, or a combination
- Severe or complicated: TURP, HoLEP or laser prostate surgery
Surgery becomes the clear answer when there is retention, recurrent infection, bladder stones, blood in the urine from the prostate, or a rising creatinine from back pressure on the kidneys.
What treatment does and does not fix
A well-done prostate operation restores flow and usually ends night-time trips. It does not reverse a bladder that has already been damaged by years of straining, which is the strongest argument against postponing treatment indefinitely. Sexual function, continence and what changes after surgery are discussed openly before you decide — including retrograde ejaculation, which is common and harmless but should never be a surprise.
Prostate Enlargement (BPH) Treatment — common questions
Does an enlarged prostate turn into cancer?
No. BPH and prostate cancer are different conditions and one does not become the other, though a man can have both. That is why a PSA test and examination are part of the assessment.
Can BPH be treated without surgery?
Often, yes. Many men do well on medication for years. Surgery is advised when medication stops working or when complications like retention, stones or kidney back-pressure appear.
Is prostate surgery safe at 75 or 80?
Age alone is not a barrier. Fitness for anaesthesia matters more, and endoscopic techniques such as HoLEP are well tolerated even in older men and in those on blood thinners.
Will prostate surgery affect my sex life?
Erections are usually unaffected. Most men do experience retrograde ejaculation, where semen passes back into the bladder — it is harmless but does affect fertility, so it matters if you plan to have children.
Reviewed by Dr. Kinjal Banerjee, MBBS, MS (General Surgery), DNB (Urology) — Urologist, Renal Transplant & Robotic Surgeon, Faridabad. This page explains prostate enlargement (bph) treatment in general terms; your own treatment plan depends on your reports and examination.