Is Prostate Surgery Necessary?

I have an enlarged prostate gland. It does not look like cancer. Is surgery necessary?

Noncancerous enlargement of the prostate, usually referred to as benign prostatic hypertrophy (BPH), is extremely common in men as they age.

The prostate gland is a walnut-sized organ which surrounds the male urethra at the point where the urethra leaves the bladder. Its normal function is to produce fluids and chemicals which make up much of the semen that a man ejaculates.

The prostate gland undergoes two growth spurts: one during puberty, when a boy is developing sexual characteristics under the influence of testosterone, the male sex hormone; and a second after age 45 or 50. By age 80, 90 percent of men have BPH. Since the gland surrounds the urethra, its enlargement can interfere with the passage of urine, causing the following symptoms: decrease in the force of the urinary stream; failure to fully empty the bladder, which results in frequent urination, especially at night; thickening of the bladder muscle, since it must work harder to expel the urine; and occasionally bladder infection or kidney damage.

An enlarged prostate gland can be easily felt by a physician during a rectal exam. Some men, however, can have symptoms even with a normal gland on examination; occasionally, only the tissue around the urethra becomes enlarged, and this tissue cannot be felt during a rectal exam. The enlarged gland of BPH has a kind of spongy feel, unlike the hard nodules in the gland that can indicate prostate cancer. Having BPH does not predispose a man to prostate cancer, but it can make the diagnosis more difficult. Feeling those hard nodules in an enlarged gland may not be easy, and BPH by itself can cause the level of the prostatic specific antigen (PSA) test to rise (see my archives). Doctors are now frequently adjusting the normal values of the PSA test for the person’s age and prostate size.

Whether the BPH needs to be treated depends entirely on the presence of symptoms or signs of damage to the bladder or kidneys. If there are no symptoms or signs of damage, the BPH can simply be watched, perhaps for years, without treatment. There are now several medical treatments which are quite effective and can be tried before resorting to surgery. The surgical procedures have also been undergoing changes, with new laser techniques that destroy part of the gland by heating it.

The information provided on Health Search Online is for educational purposes only and is not a substitute for medical advice, diagnosis or treatment.