Last updated on October 29, 2025
Benign prostatic hyperplasia (BPH), or an enlarged prostate, is a condition that affects a large number of ageing men, yet it’s often underdiagnosed or misunderstood. While not cancerous, BPH can lead to ongoing urinary symptoms that impact daily comfort and quality of life.
The good news is that BPH can be effectively managed. From lifestyle strategies to minimally invasive treatments, there are now more options than ever to relieve symptoms and reduce complications.
At Vein Doctors Sydney, we offer prostate artery embolisation (PAE), a non-surgical treatment option designed to shrink the prostate and reduce symptoms without the risks of traditional procedures.
In this article, we’ll walk through what BPH is, common symptoms, what causes an enlarged prostate, and how PAE may offer a safer, simpler alternative to surgery.
What Is Benign Prostatic Hyperplasia?
The prostate is a walnut-sized gland located below the bladder, surrounding the urethra. Its primary role is to produce seminal fluid, but as men grow older, the prostate often begins to enlarge.
This enlargement isn’t due to cancer, it’s a benign process, but it can cause the gland to press against the urethra, leading to a range of urinary symptoms. The process is gradual, and not all men will develop symptoms, but for those who do, early intervention can help.
Some of the common symptoms of BPH include difficulty urinating, a weak urine stream and frequent urination at night.
Common Symptoms of Benign Prostatic Hyperplasia?
Many of the symptoms caused by BPH relate to how easily urine can pass through the urethra. Some men notice a reduced stream of urine, others experience a stop-start flow. Others might feel like they can’t fully empty their bladder.
One of the earliest and most noticeable signs is frequent urination at night. This can interrupt sleep and affect daily energy levels. There might also be urgency, leaking, or a sensation of incomplete emptying, even after going to the bathroom.
The symptoms often build slowly. Over time, if the bladder has to work harder to push urine past the obstruction, it can lead to strain or even permanent damage. That’s why recognising early symptoms and seeking support is important.
Urinary Symptoms
- Difficulty starting urination
- Weak urine stream or interrupted flow
- Dribbling at the end of urination
- Frequent urination, especially at night (nocturia)
- Sudden or urgent need to urinate
- Incomplete emptying of the bladder
Complications
In more advanced cases, BPH can lead to:
- Urinary retention (inability to urinate)
- Bladder stones
- Recurrent urinary tract infections (UTIs)
What Causes an Enlarged Prostate?
While the exact cause is unknown, hormone changes associated with ageing appear to play a significant role. As men age, testosterone levels decline, and a hormone called dihydrotestosterone (DHT) can build up in the prostate, triggering its growth.
Genetics, obesity, lack of physical activity, and chronic conditions such as diabetes may also increase the risk of BPH. Some men may have a strong family history of the condition, which may also influence how early or severely it presents.
When Is Prostate Size a Problem?
A normal prostate is roughly 20 to 30 mL in volume. Once it grows beyond 40 mL, symptoms tend to become more pronounced. In some cases, the gland can grow to over 100 mL, causing severe obstruction.
But size isn’t everything. Some men with smaller prostates can have severe symptoms, while others with larger glands remain asymptomatic. For this reason, treatment decisions often depend more on symptom severity and personal impact than gland volume alone.
How Is an Enlarged Prostate Diagnosed?
Diagnosing benign prostatic hyperplasia (BPH) begins with a detailed medical history and a physical examination. Your doctor will ask about urinary symptoms, their frequency, severity, and how they affect your daily life. This initial conversation helps guide further testing.
Digital Rectal Examination (DRE)
As part of the physical exam, a digital rectal examination is performed to assess the size, shape, and consistency of the prostate. This quick procedure helps detect any abnormal enlargement or irregularities.
PSA Blood Test
A prostate-specific antigen (PSA) test measures the level of PSA in the blood, a protein produced by the prostate. While elevated levels don’t confirm prostate cancer, they can signal inflammation, enlargement, or other prostate issues that require further evaluation.
Additional Diagnostic Tests
If symptoms suggest BPH or another urinary issue, your doctor may recommend one or more of the following tests:
Urinalysis: Checks for signs of infection, blood, or other abnormalities in the urine.
Ultrasound or MRI: Imaging studies help measure the prostate’s size and detect any structural changes or abnormalities.
Bladder Scan (Post-Void Residual): Measures how much urine remains in the bladder after urination, indicating whether the bladder is emptying properly.
Uroflowmetry: Evaluates the strength and speed of your urine stream to assess potential obstruction or poor bladder function.
Treatment options for an enlarged prostate include lifestyle strategies, medications, PAE and other surgical options.
Treatment Options for an Enlarged Prostate
Management of BPH depends on how severe the symptoms are and how much they affect your daily life. Some men may only need simple lifestyle changes, while others benefit from medication or procedures like Prostate Artery Embolisation (PAE). Here’s an overview of the available treatments:
Lifestyle Strategies
For mild symptoms, lifestyle changes may be enough. This includes reducing fluid intake before bedtime, limiting caffeine and alcohol (which irritate the bladder), and maintaining a healthy weight. Exercise and a balanced diet may also help reduce inflammation and support urinary health.
Medications
When symptoms persist, medications are often the first treatment step:
Alpha-blockers (e.g. tamsulosin) relax the muscles around the bladder and prostate, improving urine flow.
5-alpha-reductase inhibitors (e.g. finasteride) shrink the prostate over time by blocking the hormone DHT.
Some men may experience side effects such as dizziness, fatigue, or sexual dysfunction, but many find relief with medication alone.
Prostate Artery Embolisation (PAE)
PAE is a minimally invasive treatment performed by an interventional radiologist, such as Dr Ryan McConnell. A small catheter is inserted into an artery in the wrist or groin and guided to the arteries supplying the prostate. Tiny particles are then injected to block blood flow, causing the prostate to shrink over time.
Because PAE avoids cutting or removing tissue, there’s no need for general anaesthesia, and most patients go home the same day. Recovery is faster and the risk of complications is lower than with traditional surgery.
Surgical Options
Surgery may be recommended for men with severe symptoms, complications like bladder stones, or when other treatments don’t provide relief. Common surgical procedures include:
TURP (Transurethral Resection of the Prostate): Removes excess prostate tissue through the urethra.
Laser surgery: Vaporises tissue with precision, often with less bleeding.
UroLift® system: Lifts and holds the prostate tissue away from the urethra without removing any tissue.
Surgical treatments are effective but may come with longer recovery times and a higher risk of side effects such as bleeding or retrograde ejaculation.
How to Book an Appointment
At Vein Doctors Sydney, we are committed to providing personalised and compassionate care for patients seeking treatment for an enlarged prostate. For more information on our services or to schedule a consultation at our clinic, please contact our friendly staff by either calling us on (02) 9023 9970, via our online form or by sending us an email.
Frequently Asked Questions
Is an enlarged prostate serious?
Not usually, but it can lead to disruptive urinary symptoms such as frequent urination, weak urine flow, or incomplete bladder emptying. If left untreated, BPH may progress and cause complications like urinary tract infections, bladder stones, or in rare cases, kidney damage due to long-term retention.
Is benign prostatic hyperplasia the same as prostate cancer?
No. BPH is a non-cancerous enlargement of the prostate and does not increase your risk of prostate cancer. However, because some symptoms can overlap, your doctor may order a PSA test or other imaging to rule out malignancy.
Can BPH affect sexual function?
Yes, in some men. BPH itself, as well as treatments like medications or surgery, can lead to issues such as reduced libido, difficulty with ejaculation, or erectile dysfunction. These effects vary based on individual response and treatment type.
Does PAE improve urinary symptoms?
Yes. PAE has been shown to significantly reduce symptoms such as frequent urination, urgency, and weak stream. Many men see gradual improvement within a few weeks to a few months post-procedure, with fewer sexual side effects compared to surgery.
Is surgery always necessary for an enlarged prostate?
Can BPH be prevented?
There’s no guaranteed way to prevent BPH, but maintaining a healthy lifestyle may help reduce your risk. Staying active, managing weight, limiting alcohol and caffeine, and regularly emptying your bladder can contribute to prostate health.
This information is not intended to be used for diagnosis or treatment. It is aimed at presenting a perspective only and is not a substitute for a prescription. Anyone experiencing a medical condition should consult their doctor.
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