Typical symptoms include:

  • difficulty starting to urinate
  • a poor urinary flow (stopping and starting during urination)
  • dribbling
  • an ‘irritable’ bladder leading to passing urine more frequently
  • a feeling of urgency or even incontinence

Many of these symptoms may be present even if the prostate is not enlarged.

Assessment & Diagnosis

Examination of the prostate is done by Digital Rectal Examination, in conjunction with urine testing, assessment of urinary flow, bladder scanning and PSA testing. This can be arranged in one visit for patients’ convenience. Further tests may be needed if prostate cancer is suspected.


Each patient’s treatment will be tailored according to the severity of their symptoms, their test findings, the size of the prostate and their treatment preference. Treatment options include conservative, medical (drug) treatment or prostate surgery.

Conservative measures include reducing caffeine intake and restricting fluid intake in the evening.

Drug treatment includes medication to relax the muscle in the prostate, or drugs to inhibit testosterone metabolism in the prostate causing it to shrink over several months. Commonly patients with mild symptoms may have combination treatment.

Prostatic surgery is almost always telescopic. The commonest established technique is TURP (trans-urethral resection of the prostate). This involves the surgeon cutting away the inner central part of the prostate using a telescope passed through the urethra (water-pipe). This removes the obstruction to urine flow, resulting in an improved urine flow rate and bladder emptying. It has a low rate of complications, and only 10 % of patients require any further intervention. Surgery normally entails 1 or 2 nights’ post-operative stay. It has the major advantage over other techniques in that it cleanly cuts the tissue away, which can be examined for unsuspected cancer.

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Peter Cooke

Mr Peter Cooke MB ChB MD FRCS England FRCS Ireland FRCS (Urology) is a leading urological surgeon and cancer specialist.

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