Your prostate gland is in your pelvis, just below your bladder. It makes part of the fluid that becomes semen. When you're young, your prostate is close to the size of a walnut. As you age, it can grow to the size of a lemon.

If the prostate gets too large, it can start to push on your urethra. This can cause problems with urination. It might mean you pee more than usual and you might have trouble controlling urine the way you used to.

There are a few reasons why your prostate may become enlarged. The most common reason is benign prostatic hyperplasia (BPH). BPH means that your prostate is larger than normal, but the growth is benign, meaning it's not cancer. 

BPH:

• Is the most common prostate problem in men over 50
• Affects at least half of men older than 65
• Is more common if you have a family history of BPH

The most common symptoms of BPH are: 

• Having to pee more than normal, especially at night
• Trouble starting a urine stream or feeling like you can't fully empty your bladder
• Pain when you pee
• Having a urine stream that's weak or starts and stops

Inflammation of the prostate, called prostatitis, can also cause your prostate to swell. Prostatitis is the most common prostate problem in men under the age of 50.

Does an enlarged prostate mean cancer?

Some men with prostate cancer may have an enlarged prostate. 

Prostate cancer symptoms can also overlap with BPH symptoms. For example, prostate cancer can cause frequent urination and a weak urine stream.

But, prostate cancer is separate from BPH. It's important to understand that BPH:

• Is not cancerous
• Doesn't turn into cancer
• Doesn't raise your risk for prostate cancer

If you’re having urinary issues, talk to your primary care doctor. To help diagnose your prostate issue, they may order:

• Urine tests
• Blood tests, including the prostate-specific antigen test
• Bladder function tests
• Noninvasive imaging tests, such as ultrasound
• Image-guided prostate biopsy (most men with BPH do not need a biopsy)

The test results and your symptoms tell us what treatment might work best. 

For BPH, the main treatments are:

• Watchful waiting: You'll see us yearly, and we'll continue to monitor you. If your symptoms are manageable, we usually start with this.
• Medicine: If symptoms bother you, we may prescribe medicine to relax muscles and shrink the prostate. 

For prostatitis caused by bacteria, we prescribe medicine. If your prostatitis is chronic (keeps returning) or the cause isn't clear, we'll work with you to create a treatment plan. This can include lifestyle changes and medicine. 

If your enlarged prostate isn’t improving with these treatments, your primary care team may refer you to a urologist. Carilion urologists can offer additional treatment options, including surgery.

Urology surgery is an option if your BPH worsens, you're having side effects to medications, or your symptoms become unmanageable.

• Transurethral resection of the prostate: Treats BPH by cutting away excess prostate tissue that is blocking urine flow. The surgeon uses a thin tube with a camera and an electrical loop to cut away and cauterize the overgrown prostate tissue.
• Ablations: Uses heat to destroy excess prostate tissue and have it shrink over time instead of cutting it away.
• Aquablation: A minimally invasive procedure that uses a heat-free, high-pressure water jet to precisely remove excess prostate tissue. The treatment is guided by real-time imaging, allowing for accurate removal while helping preserve surrounding structures.
• Enucleation: A laser surgery to remove the part of the prostate that’s blocking urine flow. This approach preserves the capsule and improves urine flow.
• Simple prostatectomy: Removes the inner portion of the prostate. The term simple means that the capsule of the prostate is left in place and only the inner portion of the prostate obstructing the flow of urine is removed. This is an option for significantly enlarged prostates for which less invasive methods are not a good option. Simple prostatectomies can be performed with traditional open surgery or less invasive ways, like robot-assisted surgery.

In some cases, a temporary or permanent urinary catheter may be an effective option for BPH. The tube drains urine from your bladder. It can help treat men with severe incontinence. Learn more about catheter care.