Prostate Health Over 50: From BPH to Cancer - What Every Man Should Know

Many men over 50 years old notice changes in their urinary habits, such as a weak stream, frequent nighttime trips to the bathroom, or a sense of incomplete emptying. While these may seem like normal signs of ageing, they often point to treatable prostate conditions that can restore quality of life. This article explains two common prostate conditions: Benign Prostatic Hyperplasia (BPH) and prostate cancer.

Benign P​rostatic Hyperplasia (BPH)

BPH is a non-cancerous enlargement of the prostate gland that affects many men as they age. The prostate sits just below the bladder and surrounds the urethra. As it enlarges, it can press against the bladder outlet and urethra, causing lower urinary tract symptoms (LUTS).

Common symptoms

• Slow or weak urine flow
• ​​Frequent urination, especially at night (nocturia)
• Urgency or difficulty starting and stopping
• Feeling of incomplete emptying

Why it matters

Left untreated, BPH can lead to urinary tract infections, bladder stones and acute urinary retention. Early intervention has been shown to be better for men's overall health, bladder, and prostate health.

When to seek help

See a healthcare professional if you develop or have any urinary symptoms. Early evaluation can determine the cause and help you avoid unnecessary complications. There are many treatment options available today that prioritise recovery, convenience, and quality of life.

Treatment options

Treatment is personalised based on each patient's prostate size, preferences and overall health. Options may include:

1. Medical Therapy

• ​Alpha‑blockers and 5α‑reductase inhibitors
• Lifestyle guidance, including fluid management and bladder training
  

2. Minimally Invasive Surgical Treatments (MISTs)​​​
   

• Includes Rezūm steam therapy, UroLift®, and iTIND
• Usually recommended to younger, sexually active patients who may not want to be on lifetime medications, are experiencing side effects from medications or find that medical therapy does not relieve their symptoms adequately.

3. Endoscopic & Laser Procedures

• Transurethral Resection of the Prostate (TURP): A well-established treatment for moderate to severe BPH
• Photoselective Vaporisation of the Prostate(PVP/GreenLight laser): Offers reduced bleeding and shorter hospital stays
• Endoscopic Laser Enucleation of the Prostate (commonly known as HoLEP): A gold standard for treatment of very large prostates.

These procedures are generally associated with greater symptom improvement and lower rates of retreatment than MISTs, but may not be suitable for men wishing to preserve ejaculation. Depending on recovery, some patients may be discharged on the same day or after an overnight stay.

Prostate Cancer

Unlike BPH, prostate cancers often have no symptoms in the early stages. That’s why prostate cancer screening plays a crucial role in detecting cancer before it is too late.

Why Screen for Prostate Cancer?

• Most early prostate cancers are silent, i.e. men have no symptoms at all.
  
• Early detection allows for more treatment choices and better outcomes

When to Start Screening for Prostate Cancer

• Men experiencing urinary symptoms or other potential signs of prostate problems should consult a doctor for screening, regardless of age
• Men with a family history* of breast cancer should start prostate cancer screening at age 40
• Men with a family history* of prostate cancer should start at age 45
• All other men should start at age 50

Note: *family history generally refers to first-degree relative (father, brother, sister, or mother). Breast cancer is related to prostate cancer due to the common gene implicated in both conditions (BRCA2 gene).

How Screening Works

1. Prostate-Specific Antigen (PSA) blood test to measure PSA level
2. A digital rectal examination (DRE) to assess the prostate texture and size (Optional)
3. Prostate Magnetic Resonance Imaging (MRI)

Our multidisciplinary team of urologists and radiologists uses advanced MRI prostate protocols, benchmarked against international best practices, to support accurate diagnosis. If the MRI prostate is normal, a biopsy may not be required. However, if the MRI prostate is abnormal, a prostate biopsy may be recommended to exclude prostate cancer.​

Treatment Options

If prostate cancer is diagnosed, treatment options depend on stage, grade and your overall health:

• Active surveillance for low‑risk, slow‑growing cancers, with regular PSA tests, MRI prostate imaging, physical exams and occasional prostate biopsies
• ​Radical prostatectomy, often robot‑assisted for precise removal of the prostate gland, seminal vesicles, and quick recovery. Majority of our patients are discharged on Post-O​perative Day 1, with selected patients chosen for Day Surgery.
• Radiotherapy, including external beam radiotherapy (EBRT) and brachytherapy
• Hormone therapy alone or combined with radiotherapy for higher‑risk cases

Care decisions are made by a multidisciplinary team, taking into account cancer stage, overall health and patient preferences. The care team may include urologists, radiologists, nurse clinicians, continence physiotherapists and sexual wellness counsellors to provide holistic support.​​

The Ball is in Your Court

Prostate health is an important part of ageing well. Whether it is BPH or screening for prostate cancer, early evaluation empowers you to make informed choices and maintain your quality of life. Speak with our Urology team and take the first step towards better prostate health. From diagnosis to treatment, we are here to support you.