I see this often in clinic. Someone has an ultrasound scan, the report says ‘enlarged prostate’ or gives a size in grams, and they come in worried about two things: whether it could be cancer, and whether they will need an operation.
In most cases it is neither.
Does an enlarged prostate mean cancer?
No. It is very common for the prostate to grow with age, and usually this is benign prostatic hyperplasia (BPH): growth that is not cancer and does not turn into cancer over time.
That said, a large prostate does not protect you from cancer. It can appear in a large prostate just as in a small one, which is why it is checked for separately, with a PSA blood test, an examination and, if needed, an MRI scan.
Bear in mind, too, that a large prostate produces more PSA, so a slightly raised result is not interpreted in the same way as in a small prostate. I go into this in more detail in my article on PSA.
Does an enlarged prostate need surgery?
Not just because it is large. Size and symptoms do not always go hand in hand: some very large prostates cause hardly any symptoms, while some smaller ones make passing urine very difficult.
When deciding whether to suggest an operation, I look at two things. First, whether your symptoms limit you and do not improve with medication: a weak stream, getting up several times at night, urgency or a feeling of not emptying completely. Second, whether the blockage is already causing problems, such as urinary retention, repeated infections, bleeding, bladder stones or damage to the bladder or kidneys.
If none of this applies, the usual approach is regular check-ups and, if the symptoms get worse, medication.
And if an operation is needed?
Size is no longer an obstacle. Today a prostate of any size can be operated on through the urethra, with no cuts in the skin.
When the prostate is large I use HoLEP (holmium laser enucleation of the prostate), which I consider from about 30 grams and which has no upper size limit. For other cases there are TURP, green laser and Rezum. The choice between them depends on the size of the prostate, whether you take blood thinners and whether preserving ejaculation matters to you.
Because I perform all four techniques, I can choose the one that best suits your case.
What to do with your report
The sensible next step is to have it assessed. At the appointment your symptoms, PSA and examination are reviewed and, depending on the case, a urine flow test and an ultrasound scan are done to see how well your bladder empties. Please bring your report and any blood test results you have, even old ones.
You can book an appointment at Quirónsalud Palmaplanas (Palma) or at my clinic in Manacor. Consultations are in English or Spanish, and you can call in English.
This article is general information and does not replace a medical consultation.
