The prostate is a walnut-sized gland that is part of the male reproductive system. It surrounds the urethra just below the bladder and produces fluid that nourishes and protects sperm. As men age, the prostate often enlarges, a condition called benign prostatic hyperplasia (BPH). An enlarged prostate can cause urinary symptoms such as frequent or urgent urination, weak stream, and inability to fully empty the bladder.
Normal Prostate Size at Age 65
There is no single “normal” size for the prostate, as there is natural variation among men. However, some general guidelines are:
- Average prostate size for men in their 60s: 30-40 grams
- Average prostate size for men in their 40s for comparison: 20-30 grams
Prostate size also varies depending on race. For example, African-American men tend to have larger prostates than Caucasian men.
In addition to weight, prostate size is often measured in terms of volume. Some normal prostate volumes for men aged 60-69 years include:
- Total prostate volume: 20-40 mL
- Transition zone volume: 5-20 mL
The transition zone is the inner part of the prostate that surrounds the urethra and is most likely to enlarge. A transition zone volume greater than 20-25 mL is considered enlarged.
Diagnosing Prostate Enlargement
There are several ways to evaluate prostate size:
- Digital Rectal Exam (DRE): The doctor inserts a gloved, lubricated finger into the rectum to estimate prostate size.
- Prostate Specific Antigen (PSA) Test: Measures PSA levels in the blood. Higher levels may indicate prostate enlargement.
- Transrectal Ultrasound: Uses sound waves to create an image of the prostate and measure its volume.
- Uroflowmetry: Measures urine flow rate, which may be reduced with prostate enlargement.
- Post-Void Residual Volume: Measures amount of urine left in bladder after urination via ultrasound.
These tools help doctors evaluate symptoms and determine optimal treatment options for enlarged prostates.
Risk Factors for Prostate Enlargement
Some factors that increase the risk of an enlarged prostate include:
- Age: Risk increases significantly after age 50.
- Family history: Having a father or brother with an enlarged prostate increases risk.
- Obesity
- Lack of physical activity
- Diabetes
- Heart disease
- Erectile dysfunction
- Use of certain medications like antihistamines, antidepressants, and diuretics
African-American men also have an increased risk compared to Caucasians. Lifestyle factors like diet, exercise, and managing other health conditions may help reduce the risk.
Symptoms of an Enlarged Prostate
In many cases, an enlarged prostate causes no signs or symptoms initially. As the prostate grows larger, it can press on the urethra and cause troublesome lower urinary tract symptoms (LUTS) such as:
- Frequent urination, especially at night
- Urgency to urinate
- Difficulty starting a urine stream
- Weak urine stream
- Straining or pushing to empty the bladder
- Dribbling after urination ends
- Unable to fully empty the bladder
- Frequent urinary tract infections
- Blood in the urine (hematuria)
Severe BPH can cause complete urinary retention, inability to urinate at all. This requires immediate medical treatment.
Treatments for an Enlarged Prostate
Treatment options for an enlarged prostate depend on symptom severity. They include:
- Watchful Waiting: No treatment, but doctor monitors symptoms periodically.
- Medications: Alpha blockers and 5-alpha-reductase inhibitors relax muscle tension and shrink the prostate.
- Minimally Invasive Therapies: Transurethral microwave thermotherapy and transurethral needle ablation use heat or radio waves to shrink enlarged prostate tissue.
- Surgery: Transurethral resection of the prostate (TURP) trims excess tissue. Laser surgery vaporizes tissue.
In severe cases, surgery to remove the entire prostate may be needed. The choice of treatment depends on the extent of symptoms and how bothersome they are to the patient.
Medications for Enlarged Prostate Treatment
Medications are often the first-line treatment for mild to moderate enlarged prostate symptoms. Two main drug classes used are:
- Alpha-1-adrenergic blockers: These relax the smooth muscle of the prostate and neck of the bladder, improving urine flow. Examples include tamsulosin (Flomax), terazosin (Hytrin), doxazosin (Cardura).
- 5-Alpha-reductase inhibitors: These shrink the overall size of the prostate by preventing the conversion of testosterone to dihydrotestosterone (DHT), which stimulates prostate growth. Examples are finasteride (Proscar) and dutasteride (Avodart).
Combining the two types of medications may provide better symptom relief than either alone. Side effects are generally mild but can include dizziness, headache, sexual dysfunction, and gastrointestinal issues.
Surgical Procedures for BPH
If medications are ineffective, surgical options for enlarged prostates may include:
- Transurethral resection of the prostate (TURP): Removal of excess prostate tissue through the urethra. Most common and effective surgery for BPH.
- Laser procedures: Use lasers to vaporize obstructing prostate tissue.
- Open prostatectomy: Removal of the entire prostate gland via abdominal incision. Rarely done today.
- Prostate stents: Small wire tubes placed temporarily in the urethra to improve urine flow.
Though effective, surgical procedures carry risks like bleeding, infection, retrograde ejaculation (semen flowing backward into the bladder), and erectile dysfunction. Newer laser techniques have helped minimize these risks compared to traditional TURP surgery.
Preventing Prostate Enlargement
Though the exact causes of prostate enlargement are unknown, some practices may help reduce risk:
- Maintain a healthy weight
- Eat a nutritious diet high in fruits, vegetables, and healthy fats (Mediterranean diet)
- Stay physically active with regular exercise
- Manage chronic conditions like diabetes, high blood pressure, and high cholesterol
- Avoid medications that aggravate LUTS when possible (decongestants, antihistamines, tricyclic antidepressants)
- Limit alcohol consumption
- Quit smoking
- Reduce stress levels through relaxation techniques
Though BPH is common with aging, living an overall healthy lifestyle may help slow prostate growth and minimize symptoms.
Conclusion
The normal size of the prostate in 65-year-old men ranges from 30-40 grams in weight or 20-40 mL in volume. The transition zone, which is prone to enlarge with age, is typically less than 20-25 mL. An enlarged prostate is diagnosed through a combination of physical exam, imaging, and lab tests. Mild to moderate symptoms can often be treated with medications like alpha blockers and 5-ARIs. For severe BPH, surgical procedures like TURP may be warranted. Lifestyle measures and managing other health conditions may help reduce risk. Staying active and getting regular checkups ensures proper monitoring and treatment of prostate health.