Most glands have an early growth phase and then settle. The prostate behaves differently: it starts enlarging again from around the mid-twenties and can continue growing throughout a man’s life.
By the sixties, approximately 50% to 60% of men have the tissue changes of benign prostatic hyperplasia. By age 70, estimates reach 80% to 90%.
This guide explains what BPH is, which urinary symptoms it can cause, how it is diagnosed and where prostate and bladder ultrasound fits into the pathway.
What does BPH stand for?
You may also see benign prostatic hypertrophy, benign prostate enlargement or prostatomegaly. These terms are often used for the same condition, although hyperplasia is technically more accurate because the gland grows by adding cells.
The prostate lies just below the bladder and surrounds the urethra, the tube carrying urine out of the body. As the gland enlarges, it can narrow this tube and alter how the bladder empties.
What are the symptoms of an enlarged prostate?
Symptoms fall into two groups: problems passing urine and problems storing urine.
Problems passing urine
- A weak or slow stream that may stop and start
- Difficulty getting started
- Straining to pass urine
- Dribbling afterwards
- A feeling that the bladder has not emptied
Problems storing urine
- Passing urine more often during the day
- Waking at night to urinate, known as nocturia
- Sudden urgency that is difficult to postpone
Clinicians commonly assess severity using the seven-question International Prostate Symptom Score. It ranges from 0 to 35. One widely used interpretation classifies 0–9 as mild, 10–19 as moderate and 20–35 as severe. Treatment is often considered from a score of around 10, depending on how much symptoms affect daily life.
Symptoms alone cannot establish the cause. Prostatitis, urinary infection, overactive bladder and diabetes may create a similar pattern, so assessment can include imaging, laboratory tests and GP or urology review.
What causes the prostate to enlarge?
Age and hormones are the principal drivers. Testosterone is converted within the prostate into dihydrotestosterone, a more potent hormone that stimulates ongoing cell growth.
Family history also increases the likelihood, and BPH often runs in families.
Common misconceptions
Prostate enlargement is not caused by sexual activity, vasectomy or cycling. BPH is also separate from prostate cancer: an enlarged prostate does not turn into cancer or, by itself, mean that cancer is more likely.
How is BPH diagnosed?
BPH is diagnosed by combining the symptom score with a physical examination, urine and blood tests, and ultrasound assessment of the prostate and bladder.
A typical evaluation includes:
- A symptom questionnaire
- A urine test for infection or blood
- A digital rectal examination to assess gland size and texture
- Urine-flow measurement
- A PSA blood test in appropriate patients
PSA measures a protein produced by the prostate. It can rise with age, prostate size, infection, inflammation and prostate cancer. Results therefore need clinical interpretation and help determine whether specialist assessment is required.
What does a prostate ultrasound show?
A prostate ultrasound measures the gland and, in a combined examination, shows how the bladder and urinary tract are coping. The scan is performed through the abdomen with a full bladder.
Prostate volume
Volume is calculated from three dimensions. Size affects treatment decisions because 5-alpha reductase inhibitors are generally most useful when the prostate is above about 30 grams.
Post-void residual urine
This measures urine left after emptying. Under 100–150 ml is commonly considered acceptable, while more than 200 ml usually prompts further assessment.
Median lobe enlargement
Ultrasound may show prostate tissue growing upwards into the bladder, which can affect procedure selection.
Bladder-wall thickening
The bladder wall can thicken after pushing against resistance over a long period.
Stones and diverticula
Bladder stones and pouches may develop as a consequence of incomplete emptying.
Kidney back pressure
The urinary tract and kidneys can be checked for changes caused by longstanding obstruction.
Combine imaging with the wider clinical picture
A prostate and bladder ultrasound provides the imaging component. The Prostate Health Check combines the scan with PSA, urine analysis, a blood profile and a 30-minute GP review.
Prostate Health CheckWhat happens if an enlarged prostate is left untreated?
Many men with mild symptoms live with BPH for years without harm. Problems can develop when the bladder works against obstruction for a prolonged period.
Possible complications include acute urinary retention, bladder stones and recurrent urinary infections. Longstanding back pressure can eventually affect kidney function.
At this stage, patients often require a kidney, bladder and urinary tract ultrasound scan, sometimes with blood testing to assess renal function.
What are the treatment options for an enlarged prostate?
Treatment ranges from lifestyle changes to surgery and depends on symptom score, prostate size, bladder emptying and how much the problem affects quality of life.
Lifestyle measures
For mild symptoms, NHS advice includes reducing alcohol, caffeine and fizzy drinks, limiting fluids before bed and using bladder-training exercises.
Medication
Alpha-blockers such as tamsulosin relax muscle around the prostate and can work within days. 5-alpha reductase inhibitors such as finasteride shrink the gland over months and are usually considered when the prostate is above approximately 30 grams. The two classes may be combined.
Minimally invasive procedures
Water-vapour therapy, marketed as Rezūm, uses steam to remove a small amount of prostate tissue. Prostate artery embolisation and urethral implants are other options between medication and surgery.
Surgery
For severe symptoms, surgery remains the most effective option. Transurethral resection of the prostate and laser procedures remove obstructing tissue directly.
London Private Ultrasound diagnoses, measures and monitors BPH and arranges onward referral when treatment is required. The private GP clinic can review results, start appropriate first-line medication and refer to a consultant urologist.
Does an enlarged prostate mean prostate cancer?
No. BPH and prostate cancer are different conditions, although both become more common with age and can occur at the same time.
Early prostate cancer often causes no symptoms. Urinary symptoms therefore cannot confirm or exclude cancer.
Abdominal ultrasound measures the prostate and assesses the bladder. A cancer-risk pathway may also require PSA testing, specialist examination, MRI and biopsy where indicated.
If cancer risk is the principal concern, the Men’s Cancer Screening Package includes relevant tests, with urology consultation arranged when findings require it.
Book a prostate and bladder ultrasound in London
If you have difficulty passing urine, urgency or suspected incomplete emptying, a prostate and bladder ultrasound provides objective measurements in one appointment.
Established diagnostic service
London Private Ultrasound has scanned patients since 2012 and operates within a CQC-registered pathway.
External abdominal scan
The examination is performed over the lower abdomen. Nothing is inserted.
Prostate and bladder measurements
The scan records prostate volume, bladder changes and urine remaining after emptying.
Connected clinical care
GP review, blood tests and onward urology referral can be arranged when necessary.
Convenient appointments
Same-day and next-day appointments are available seven days a week, 9am to 7pm, at 27 Welbeck Street near Bond Street and Oxford Circus and at 54–56 Victoria Street in St Albans.
This service is for adults aged 18 and over. No GP referral is required. Call 020 7101 3377 or contact the clinic through WhatsApp.
Book Prostate & Bladder UltrasoundRelated prostate and urinary services
Prostate and bladder ultrasound
External measurement of prostate volume, bladder wall and post-void residual urine.
Prostate & Bladder UltrasoundProstate Health Check
Ultrasound combined with PSA, urine analysis, blood testing and a GP review.
Prostate Health CheckKidney and urinary tract ultrasound
Assessment of the kidneys, bladder and urinary tract when obstruction or back pressure is a concern.
Urinary Tract UltrasoundPrivate GP clinic
Clinical interpretation, medication review, examination and onward urology referral.
Private GP ClinicMen’s Cancer Screening
A wider assessment when prostate-cancer risk is the main concern.
Men’s Cancer ScreeningFrequently asked questions
What is the best treatment for an enlarged prostate?
It depends on symptom severity and prostate size. Lifestyle changes suit mild symptoms, alpha-blockers can work quickly for moderate symptoms, and surgery is most effective for severe obstruction or when medication no longer works.
Will an enlarged prostate get better on its own?
Symptoms can fluctuate, but the gland rarely becomes smaller without treatment. Monitoring can be reasonable for mild symptoms, with imaging to ensure the bladder is coping.
Does ejaculation help BPH?
There is no evidence that ejaculation shrinks the prostate or improves urinary flow. It does not cause harm, but it is not a treatment.
Who is the best prostate consultant in the UK?
No single urologist is right for everyone. Look for someone on the GMC specialist register with a BPH subspecialty interest and experience in the procedure being considered. A recent scan and symptom score make the consultation more useful.
Is an enlarged prostate treated on the NHS?
Yes. NHS care usually begins with GP assessment, lifestyle advice and medication, followed by urology referral if symptoms persist. Waiting times vary.
Does a prostate ultrasound hurt, and do I need a referral?
The scan is painless, uses no radiation and is performed externally over the abdomen. No GP referral is required for a private appointment.
What is the difference between BPH and prostatitis?
BPH is gradual non-cancerous enlargement. Prostatitis is inflammation or infection and often develops more quickly with pelvic or perineal pain, painful urination and sometimes fever.
Can BPH turn into prostate cancer?
No. BPH does not transform into prostate cancer, although both conditions can exist at the same time.
Clinical guidance and review
This information reflects NHS and NICE principles for lower urinary tract symptoms and ultrasound practice aligned with professional BMUS standards. Individual decisions should be made after clinical assessment and appropriate testing.