After 40, the prostate slowly grows, and many men notice changes in how they urinate. Most of these changes come from a non-cancerous enlargement called benign prostatic hyperplasia (BPH). It is common and often manageable. Some symptoms, though, need prompt care. This guide explains what is normal, what is not, and how to talk with your doctor about screening.
What the prostate does
The prostate is a small gland in the male reproductive system. It helps make semen, the fluid that carries sperm. Its muscles also help push semen out during ejaculation, according to the National Cancer Institute (NCI).
The gland sits just below the bladder and in front of the rectum. It wraps around the urethra, the tube that carries urine out of the body. That location explains why prostate changes so often affect urination.
How the prostate changes with age
The prostate keeps growing for much of adult life. NCI notes that it is about the size of a walnut in a man's 20s. By age 60, it is often closer to the size of a lemon.
As it grows, it can press on the urethra. This is BPH. NCI explains that BPH is not cancer and does not raise the risk of prostate cancer.
BPH becomes more common with age. The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) reports these figures:
- About 5% to 6% of men ages 40 to 64 have BPH.
- About 29% to 33% of men 65 and older have BPH.
- BPH is the most common prostate problem in men over 50.
The Mayo Clinic lists other risk factors besides age. These include a family history of prostate problems, diabetes, heart disease and obesity. Mayo also notes that exercise may help lower the risk.
Urinary symptoms to notice
Changes often come on slowly, so they are easy to dismiss. NIDDK and Mayo Clinic describe these common signs:
- Needing to urinate more often, or feeling a sudden urge
- Waking up at night to urinate
- Trouble getting started
- A weak stream, or one that stops and starts
- Dribbling at the end
- Feeling that your bladder is not fully empty
Mayo Clinic advises talking with your provider about urinary symptoms even if they do not bother you much. Some causes are easy to treat, and other conditions can look like BPH.
Red-flag symptoms that need prompt care
Some symptoms should not wait for a routine visit. NIDDK says to seek care right away if you have any of the following:
- You cannot urinate at all.
- Painful, frequent and urgent urination with fever and chills.
- Blood in your urine.
- Significant pain in your lower belly or urinary tract.
NCI adds a few more reasons to see a doctor. These include blood in your semen, painful ejaculation, and back, hip or pelvic pain that does not go away. Fever with sudden urinary trouble can signal a prostate infection called acute bacterial prostatitis.
Talking with your doctor about PSA screening
The PSA test is a blood test for prostate-specific antigen. NCI explains that a high PSA level has many possible causes. These include BPH, infection, recent irritation and cancer. A high number alone does not mean cancer.
The U.S. Preventive Services Task Force (USPSTF) recommends that men ages 55 to 69 make an individual choice about screening. That choice should come from a conversation with a clinician about benefits, harms and personal values. The Task Force recommends against routine PSA screening for men 70 and older.
The USPSTF describes the tradeoffs this way:
- Possible benefit: screening may prevent about 1.3 prostate cancer deaths per 1,000 men screened over about 13 years.
- Possible harms: false positives, biopsies with complications, and overdiagnosis of cancers that would never cause problems.
- Treatment effects: some men have urinary leakage, erection problems or bowel symptoms after treatment.
The Task Force suggests clinicians tell Black men and men with a family history about their higher risk. If either applies to you, you may want to start this conversation earlier. The USPSTF page notes that an update to this recommendation is in progress, so ask your doctor about current guidance.
Everyday habits that can help
Small changes can make urinary symptoms easier to live with. NIDDK suggests the following:
- Time your fluids. Drink less before bed or before going out, but stay well hydrated during the day.
- Limit caffeine and alcohol. Both can make you need to urinate more often.
- Stay active. Regular movement supports overall health.
- Empty your bladder fully. Try not to hold urine for long periods.
- Review your medicines. Decongestants, antihistamines, some antidepressants and diuretics can worsen symptoms. Ask before changing anything.
Keeping a healthy weight is also worth the effort. Mayo Clinic notes that obesity raises BPH risk.
What research says about saw palmetto
Saw palmetto is one of the best-known herbs for men's health. The research is worth knowing before you buy. The National Center for Complementary and Integrative Health (NCCIH) reviewed the evidence.
A 2023 review of 27 studies found that saw palmetto alone provides little or no benefit for BPH symptoms. Two NIH-funded trials tested standard and higher doses. Neither improved symptoms. NCCIH says saw palmetto is well tolerated, with mild side effects such as stomach upset or headache. It also does not appear to affect PSA results.
The review could not draw conclusions about combination products. If you choose a supplement as part of your routine, see it as one small piece of overall wellness. Some men take Prostacet, an optional daily supplement to support prostate health and normal urinary flow. It combines saw palmetto, nettle leaf, zinc and beta carotene. It is not a treatment for BPH, prostatitis or cancer, and it does not replace care from your doctor. Check with your provider first if you take any medicines. You can browse more options in our men's health collection.
Frequently asked questions
Is an enlarged prostate a sign of cancer?
No. BPH is a non-cancerous enlargement, and NCI says it does not raise prostate cancer risk. Both conditions can occur at the same time, so new symptoms still deserve a checkup.
At what age should I talk to my doctor about PSA testing?
The USPSTF advises men ages 55 to 69 to make an individual decision with their clinician. Men with a family history or Black men may want to talk sooner, since their risk is higher.
Why do I wake up at night to urinate?
Waking at night to urinate is a common sign of BPH, according to NIDDK. Other causes are possible too. Cutting back on fluids before bed may help, but mention it to your doctor.
When is a urinary problem an emergency?
Get help right away if you cannot urinate at all. Also seek prompt care for blood in your urine, or painful urination with fever and chills.
Does saw palmetto shrink the prostate?
Research does not support that. NCCIH reports that large studies found saw palmetto alone gave little or no benefit for BPH symptoms. Talk with your doctor about proven options.
Sources
- NIDDK: Prostate Enlargement (Benign Prostatic Hyperplasia)
- National Cancer Institute: Understanding Prostate Changes
- Mayo Clinic: Benign Prostatic Hyperplasia (BPH) Symptoms and Causes
- USPSTF: Prostate Cancer Screening Recommendation
- NCCIH: Saw Palmetto
This article is for general information and is not medical advice. Statements about dietary supplements have not been evaluated by the Food and Drug Administration. Our products are not intended to diagnose, treat, cure or prevent any disease.