Prostate Health: Symptoms, Screening & Modern Treatment Options

Early symptoms of enlarged prostate (BPH) you should never ignore

The prostate is a walnut-sized gland that sits just below the bladder and surrounds the urethra. As men age, it naturally grows — a condition known as Benign Prostatic Hyperplasia (BPH). By age 60, over 50% of men have some degree of BPH; by age 80, this rises to nearly 90%. While BPH is not cancer, the symptoms it causes can significantly impair quality of life, sleep, and — if left untreated — kidney function.

In Dr. Utture's clinical experience treating patients across Mumbai, many men dismiss early urinary symptoms as a normal part of ageing. Recognising these warning signs early allows for timely, often medication-based, management before surgical intervention becomes necessary.

• Weak or slow urine stream — Prostate enlargement compresses the urethra, reducing flow rate. Many men notice they need to strain or wait before urine begins to flow.
• Frequent urination, especially at night (nocturia) — Waking two or more times per night to urinate is one of the most common and disruptive BPH symptoms, often the first sign patients report.
• Difficulty starting urination (hesitancy) — A delay between attempting to urinate and flow beginning is caused by the increased resistance the enlarged prostate creates at the bladder outlet.
• Incomplete bladder emptying — A persistent sensation that the bladder has not fully emptied after urination. Residual urine left behind can predispose to urinary tract infections.
• Intermittent urine stream — Urine flow that starts and stops during voiding is a sign of significant outflow obstruction and warrants formal urological evaluation.
• Sudden, urgent need to urinate — Urgency that is difficult to defer is caused by bladder overactivity secondary to outlet obstruction, and can lead to urge incontinence in severe cases.
• Dribbling after urination — Post-void dribbling occurs when urine remaining in the urethra leaks out after voiding has finished, a particularly bothersome symptom for many patients.
• Complete inability to urinate (acute urinary retention) — A urological emergency. If you are suddenly unable to pass urine and experience lower abdominal pain and distension, seek immediate medical attention. Do not wait.

When should men get a prostate check-up?

Prostate disease — whether BPH or prostate cancer — is predominantly a condition of ageing men, and screening at the right time is critical. Unlike many cancers, prostate cancer caught early is highly treatable; the five-year survival rate for localised prostate cancer exceeds 98%.

Understanding PSA tests and prostate screening

Prostate-Specific Antigen (PSA) is a protein produced by prostate cells. A small amount normally enters the bloodstream and can be measured with a routine blood test. An elevated PSA does not automatically mean cancer — it simply signals that further evaluation may be needed. Interpreting PSA correctly requires clinical context, age adjustment, and often a trend over time.

Beyond the absolute PSA value, Dr. Anand Utture evaluates PSA density (PSA relative to prostate volume on ultrasound), free-to-total PSA ratio (a low ratio increases cancer suspicion), and PSA velocity (rate of rise over time). A multiparametric MRI (mpMRI) of the prostate is now standard before biopsy, significantly improving cancer detection accuracy while reducing unnecessary biopsies.

Common non-cancerous causes of elevated PSA include BPH, prostatitis (prostate infection), urinary tract infection, recent ejaculation (within 48 hours), vigorous cycling, and recent urological procedures. Patients are advised to avoid ejaculation for 48 hours and vigorous exercise for 24 hours before a PSA test for accurate results.

Laser prostate surgery: HoLEP vs TURP — what's right for you?

When medication fails to adequately control BPH symptoms, or when complications such as urinary retention, bladder stones, or kidney impairment develop, surgical treatment is indicated. The two most widely performed procedures in modern urology are HoLEP (Holmium Laser Enucleation of the Prostate) and TURP (Transurethral Resection of the Prostate). The right choice depends on prostate size, patient fitness, current medications, and surgeon experience.

Dr. Anand Utture is highly experienced in both HoLEP and TURP, and has performed these procedures for patients across Mumbai and Maharashtra. HoLEP has emerged as the procedure of choice for larger prostates (over 80 mL) and for men on anticoagulant medications — the laser's precise energy delivery seals blood vessels as it cuts, dramatically reducing intraoperative bleeding and making transfusion virtually unnecessary.

For patients with moderately enlarged prostates and no contraindications, bipolar TURP remains an excellent option with decades of evidence supporting its efficacy. Dr. Utture's pre-operative evaluation includes uroflowmetry, post-void residual ultrasound, PSA, urine culture, and where indicated, urodynamic studies — ensuring the most appropriate procedure is selected for each individual patient.

Can an enlarged prostate be treated without surgery?

Yes — the majority of men with BPH do not require surgery, particularly when symptoms are mild to moderate and complications such as urinary retention or kidney impairment are absent. Treatment is matched to symptom severity, and many men achieve excellent relief with a combination of lifestyle modification and medication.

1. Lifestyle and bladder training

   Reducing evening fluid intake, limiting caffeine and alcohol (both irritate the bladder), timed voiding, and pelvic floor exercises can meaningfully reduce urinary frequency and urgency without any medication. These measures are recommended as first-line for mild symptoms.

2. Alpha-blockers (e.g. tamsulosin, alfuzosin)

   These medications relax the smooth muscle in the prostate and bladder neck, improving urine flow within days to weeks. They are the most commonly prescribed first-line drugs for BPH. Side effects include dizziness and retrograde ejaculation in some patients.

3. 5-alpha reductase inhibitors (e.g. finasteride, dutasteride)

   These medications work by shrinking the prostate over 3–6 months by blocking the hormone DHT. They are most effective for larger prostates (above 40 mL) and also lower PSA levels, which must be accounted for during cancer screening. They are often combined with alpha-blockers.

4. Anticholinergic or beta-3 agonist medications

   When urgency and frequency (overactive bladder symptoms) dominate the picture, medications such as solifenacin or mirabegron can be added to reduce bladder hypersensitivity. These are prescribed in addition to — not instead of — BPH-specific drugs.

5. PDE-5 inhibitors (e.g. tadalafil)

   Tadalafil, originally developed for erectile dysfunction, is now approved for BPH symptom relief. It is particularly useful in men who have both BPH and erectile dysfunction, offering dual benefit with once-daily dosing.

6. Minimally invasive office procedures

   For men who wish to avoid surgery and have not responded to medication, newer in-office options such as Urolift (prostatic urethral lift) and Rezūm (steam therapy) can provide significant relief without general anaesthesia, hospital admission, or risk to ejaculatory function.

Surgery is recommended when: symptoms are severe and medication has failed; acute urinary retention has occurred; recurrent UTIs or bladder stones develop secondary to obstruction; or there is evidence of kidney impairment from chronic retention. In these settings, early surgical intervention protects long-term bladder and kidney function.

Prostate-friendly diet and lifestyle habits

Dietary choices cannot reverse an enlarged prostate, but emerging evidence supports their role in slowing progression, reducing inflammation, and maintaining prostate health. Dr. Utture recommends these evidence-informed modifications as part of a comprehensive approach.