Enlarged prostate? Don’t panic. Why the King is getting treatment

The King announced he was undergoing treatment on Thursday.

The King announced he was undergoing treatment on Thursday. Photo: Getty

God save the King! The fact that Charles has made public that he’s suffering from an enlarged prostate could be his finest moment.

He may have done many men a great service in encouraging them to get checked out.

Relax. King Charles doesn’t have cancer. And the benign enlargement of this tricky little organ does not increase his chances of getting prostate cancer.

The worst it’s probably doing is causing him multiple trips to the throne at night.

The greatest indignity, for most patients, is that damn gloved finger everyone jokes about.

Not you? Sorry to say, yes you. Live long enough, you’re likely to eventually develop this problem.

The best thing you can do, when you develop symptoms, is pull your finger out and see your doctor.

So … the prostate gland. Please explain

The prostate is a gland about the size of a chestnut and weighs about 30 grams.

As part of the male reproductive system, it produces seminal fluid, which mixes with sperm cells from the testicles and fluids from other glands, to make up semen.

The muscles of the prostate press semen into the urethra and expel it outwards during ejaculation, rather than back into the bladder.

The prostate surrounds the urethra, the tube from the bladder. So when the prostate becomes enlarged, it constricts the urethra, affecting the flow of urine.

A change in flow is the first indication you have an enlarged prostate. This enlargement is called benign prostatic hyperplasia (BPH).

An enlarged prostate, on the right, constricts the urethra. Image: Creative Commons

Hang on to that word ‘benign’. It translates to ‘won’t kill you’. As said above: it is not cancer, and will not transition into cancer.

The cause of this enlargement

The cause of prostate enlargement is unknown, but it’s linked to ageing.

It’s thought that changes in the cells of the testicles may have a role, as might testosterone levels.

Men who have had their testicles removed at a young age, because of testicular cancer, don’t develop this enlargement.

And, if the testicles are removed after a man develops BPH, the prostate shrinks in size.

Take a deep breath: Removing the testicles is not a standard treatment for an enlarged prostate.

The likelihood of developing an enlarged prostate increases with age. BPH is so common that it has been said all men will have an enlarged prostate if they live long enough.

A small amount of prostate enlargement is present in many men over the age of 40. Then it becomes much more common.

According to the Department of Health and Aged Care about five in 10 males aged over 50 and more than eight in 10 males aged over 80 have some symptoms of BPH.

If you are over 60, symptoms are more likely than not.

Risk factors

Your risk of BPH is higher if you:

  • Are living with obesity
  • Have been diagnosed with metabolic syndrome, diabetes or high blood pressure
  • Don’t eat enough fruit and vegetables
  • Have a family history of BPH.

When to see your doctor

If you are having persistent trouble with urination, it’s time to visit your GP.

According to Johns Hopkins Medicine, typical symptoms include:

  • Difficulty starting to urinate despite pushing and straining
  • A weak stream of urine; several interruptions in the stream
  • Dribbling at the end of urination
  • A sudden strong desire to urinate
  • Frequent urination
  • The sensation that the bladder is not empty after urination is completed
  • Frequent awakening at night to urinate (nocturia).

As the bladder becomes more sensitive to retained urine, you may develop incontinence. This can result in a damp patch or soaked trousers. It’s not subtle.

Burning or pain during urination can occur if a bladder tumour, infection or stone is present. Blood in the urine (called hematuria) may indicate BPH, but most men with BPH do not have hematuria.

Women go through a lot worse, and often for much longer. Photo: Getty

Your doctor will talk to you about your symptoms and examine you. This may involve:

  • A digital rectal examination to assess the size of your prostate
  • Having blood tests or urine tests
  • Being referred for an ultrasound of your urinary tract.

 How is BPH treated?

Depending on your symptoms, and how much you’re bothered by them, treatment can include ‘watchful waiting’ (see how it goes), lifestyle changes, medications or surgery.

Medications work by reducing the size of the prostate and relaxing your bladder. It tends to be recommended to treat moderate to severe symptoms of an enlarged prostate.

However, many men with an enlarged prostate have only minor symptoms. In these case self-care is often sufficient.

Penn Medicine suggests, for mild symptoms:

  • Urinate when you first get the urge. Also, go to the bathroom on a timed schedule, even if you don’t feel a need to urinate
  • Avoid alcohol and caffeine, especially after dinner
  • Do not drink a lot of fluid all at once. Spread out fluids during the day. Avoid drinking fluids within two hours of bedtime
  • Try not to take over-the-counter cold and sinus medicines that contain decongestants or antihistamines. These medicines can increase BPH symptoms
  • Keep warm and exercise regularly. Cold weather and lack of physical activity may worsen symptoms
  • Reduce stress. Nervousness and tension can lead to more frequent urination.


When medication fails, and symptoms have become moderate to severe, surgery becomes an option.

The most common and most proven procedure is ‘transurethral resection of the prostate’ (TURP).

TURP is carried out using a device called a resectoscope, which is a thin metal tube containing a light, camera and loop of wire.

This is passed along your urethra until it reaches your prostate, which means no incisions need to be made in your skin.

The loop of wire is then heated with an electric current and used to cut away the section of your prostate causing your symptoms.

A catheter is then inserted into your urethra to pump fluid into the bladder and flush away pieces of prostate that have been removed.

This is likely what King Charles is undergoing.

Side effects

TURP is a safe procedure and the risk of serious complications is very small.

However, many men who have a TURP lose the ability to ejaculate semen, although they still have physical pleasure from ejaculation (orgasm). This is known as retrograde ejaculation.

Some men also lose the ability to control their bladder (urinary incontinence), although this usually passes in a few weeks. In rare cases, it may be persistent and need further treatment.

There’s also a small risk of problems such as erectile dysfunction, difficulties passing urine and urinary tract infections (UTIs).

Alternative procedures

For men who have very large prostates, a simple prostatectomy removes the inside part of the prostate gland. It is done through a surgical cut in your lower belly.

Other less-invasive procedures use heat or a laser to destroy prostate tissue. None have been proven to be better than TURP.

Also, people who receive these procedures are more likely to need surgery again after five or 10 years.

These procedures tend to be chosen by younger men because the less-invasive procedures carry a lower risk for impotence and incontinence. Although the risks with TURP are very low.

It’s this fear of losing sexual function that causes many men to put off treatment. It’s foolish. And certainly unbecoming of a king.

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