Prostate size: walnut or orange?

A normal prostate is the size of a walnut (about 20–25 grams). After age 40, benign prostatic hyperplasia becomes more common; the prostate can reach the size of a tangerine, an orange or even a grapefruit. What determines treatment is the severity of the symptoms rather than the size.

Why does the prostate grow?

Benign prostatic hyperplasia (BPH) develops with age due to hormonal changes and is not cancer. It is seen in a significant proportion of men over 50. The enlarged prostate can compress the urethra, leading to frequent urination, waking at night to urinate, a weak urinary stream and a feeling of incomplete emptying.

How is prostate size measured?

Prostate volume is measured by ultrasonography (abdominal or transrectal) or MRI and is reported in grams or milliliters (cc). 1 cc is considered approximately 1 gram. A rectal examination also gives an idea about the enlargement.

Treatment options by size

• No symptoms: even if the size is large, treatment may not be needed; regular check-ups are sufficient.
• Mild to moderate symptoms: lifestyle advice and medication (alpha blockers, 5-alpha reductase inhibitors).
• Symptoms persisting despite medication, or complications: transurethral resection of the prostate (TURP) or laser prostate surgery.
• Large prostate: because laser prostate surgery (HoLEP/ThuFLEP) can be performed regardless of size, it offers an alternative to open surgery.

When should you see a doctor?

If you wake up more than twice a night to urinate, your urinary stream has weakened, you see blood in your urine or you cannot urinate, a urological evaluation is needed. You can measure the severity of your symptoms in 2 minutes with the IPSS test.