Why Your Prostate Grows with Age—and When to Worry

“Is it normal for my prostate to keep getting larger as I age?”

My answer: “Yes! If that’s all, take care and see you next time!”

Just kidding. While it is normal for the prostate to grow as you age there’s a bit more to talk about here.

Prostates keep Urologists in business.

Benign Prostatic Hyperplasia, or BPH, is the pathologic definition for a large prostate. We know not only that BPH is common in men, but that its prevalence increases with age. I often get asked ‘why.’ Many of my male patients want to know why they have a large prostate. I can’t answer that – and unless the data has changed – I don’t think that anyone has ever answered why some men have larger prostates than others. I see it as similar to breast tissue. Women have different-sized breasts, and men have different size prostates.

Maybe this answers their question or potentially, it just distracts them because now they are thinking about breasts.

The most important question for patients: does it bother you?

I saw a gentleman with an almost 100g prostate just this morning. He has no trouble peeing, wakes up once a night, and completely empties his bladder. He has BPH, but very mild symptoms, so I don’t recommend any treatment other than seeing if Flomax/tamsulosin once a day makes his life a little better.

I have also seen men with prostates around 30g who have a slow stream and wake up 5 times a night benefit from treatment. There is a great questionnaire that Urologists use to see how your bladder and prostate might be affecting you. It’s called the International Prostate Symptom Score. You can fill this out at home.

The most important question on this form is the last one – how much does this bother you?

Other tools for prostate health your urologist might use

Besides this questionnaire, urologists have different tools to assess your prostate and the effects it may be having on you. We often use ultrasound to make sure that you are emptying your bladder.

I have seen many many men with no urinary complaints, but bladders that have over 1 liter in them, and these patients need their prostates addressed. We can measure your prostate size with ultrasound, or if you’ve had other scans such as abdominal MRI or CT scans, we can often measure it there.

We can use the tried-and-true digital rectal exam but this only captures a portion of the prostate. We can also perform a cystoscopy to look inside the bladder to see exactly what the prostate is doing. Each Urologist has their own preference for how to assess for BPH and if a patient needs treatment. There are many medication options and many surgical options.

My overall recommendation

It’s a pretty simple if/then statement: if you have urinary symptoms, then find a urologist. At the end of the day you might decide that you don’t need or want any treatment, and that’s fine. But don’t wait too long. Your bladder is at the mercy of your prostate and I believe that many of my patients with terrible bladders could have had better lives if they had addressed their prostates when the problem started!

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