Enlarged prostate seen by chance on a scan

What the report means

The prostate is a small gland below the bladder that makes fluid for semen and sits around the tube that carries urine out of the body (the urethra). (NHS) The NCI says it tends to grow larger with age: about the size of a walnut in a man's 20s, slightly larger by 40, and often the size of a lemon by 60. (NCI)

When this growth is not cancer it is called benign prostatic hyperplasia (BPH), or benign prostate enlargement. MedlinePlus says BPH is not cancer, does not increase the risk of prostate cancer, and is the most common prostate condition in people over 50; the chance of it rises from age 40. (MedlinePlus) The NHS says it is common, not usually serious, and most common in men over 50. (NHS)

A large prostate on a scan does not need treatment just because it is large. The NHS says an enlarged prostate does not always need treatment, and that it depends on symptoms and how they affect you. (NHS)

How it relates to prostate cancer screening

Prostate size on a scan is not a screening test for cancer, and the screening decision stays the same as for anyone your age. None of the screening advice below lists prostate size as a reason to test:

USPSTF (US, 2018; update in progress): for men aged 55 to 69, PSA-based screening is an individual decision made after talking through the benefits and harms with a clinician; it recommends against PSA screening from age 70. (USPSTF)
ACS (US, 2023): men should make an informed decision with their health care provider, starting the conversation at 50 at average risk, 45 at high risk and 40 at even higher risk. (ACS)
NHS (UK): routine PSA testing is not offered unless genetic tests have shown a faulty BRCA2 gene, but men and anyone with a prostate can ask a GP about PSA testing, and the GP discusses the benefits and risks first. (NHS PSA test)

The full screening picture is on the prostate cancer screening page.

An enlarged prostate and PSA results

The USPSTF says a raised PSA can be caused by an enlarged prostate or prostate inflammation as well as by cancer, so some people without cancer get a positive result. (USPSTF) If you already have a PSA result, a known large prostate is useful for your doctor to have. How PSA numbers, age-based ranges and PSA density (PSA divided by prostate size) are read is on the PSA test results page, and MRI scoring after a raised PSA is on the prostate MRI PI-RADS results page.

Urinary symptoms to mention to a doctor

An enlarged prostate can press on the urethra and cause problems peeing. The NHS lists these as the main symptoms: (NHS)

difficulty starting to pee, or having to push or strain
a weak flow, stopping and starting, or taking longer to empty the bladder
feeling the bladder is not fully empty
dribbling after finishing
needing to pee more often or urgently, including at night

The NHS says to see a GP if you have difficulty peeing or need to pee more often, because these symptoms can sometimes be caused by more serious conditions such as prostate cancer. Ask for an urgent GP appointment or get help from NHS 111 if you have blood in your pee, pain when peeing, or cannot pee at all. (NHS) MedlinePlus says to get medical help right away if you cannot urinate at all, have fever and chills with painful, frequent and urgent urination, have blood in your urine, or have pain in the lower belly and urinary tract. (MedlinePlus)

In the UK, NICE says doctors should consider a PSA test and a rectal examination for men and other people with male reproductive organs who have any lower urinary tract symptoms, such as getting up at night to pee, frequency, hesitancy, urgency or retention, as well as erectile dysfunction or visible blood in the urine. (NICE NG12) NICE CG97 also says that men with urinary symptoms that suggest a blockage from an enlarged prostate should be offered information and time to decide whether they want a PSA test. (NICE CG97)

UK PSA thresholds when there are symptoms

For people with possible prostate cancer symptoms, NICE NG12 says to consider a suspected cancer referral when PSA is above the threshold for their age, taking their preferences and other health conditions into account. (NICE NG12) These thresholds are for people with symptoms, not for screening.

NICE NG12 table 2: age-specific PSA thresholds for people with possible symptoms of prostate cancer
Age	PSA threshold (micrograms per litre)
Below 40	Clinical judgement
40 to 49	More than 2.5
50 to 59	More than 3.5
60 to 69	More than 4.5
70 to 79	More than 6.5
Above 79	Clinical judgement

NICE notes that PSA rises naturally with age, which is one reason it uses thresholds by age. (NICE NG12)

Other things on the same report

A CT or ultrasound often notes more than one finding. See kidney stone found by chance, enlarged lymph node seen by chance and after an abnormal screening result.

Where they differ:

Who is offered PSA testing without symptoms. The USPSTF frames it as an individual decision at 55 to 69 and recommends against it from 70; the ACS starts the conversation at 50, or 45 or 40 at higher risk; the NHS does not offer routine testing but lets anyone with a prostate ask a GP. (USPSTF)(ACS)(NHS PSA test)
Urinary symptoms. NICE NG12 says to consider a PSA test for any lower urinary tract symptoms; the NHS says to have them checked by a GP because they can sometimes be caused by more serious conditions such as prostate cancer. (NICE NG12)(NHS)
PSA cut-offs. NICE uses age-specific thresholds for people with symptoms; the USPSTF notes that an enlarged prostate alone can raise PSA and cause false positives. (NICE NG12)(USPSTF)
Up-to-date status. The USPSTF recommendation dates from 2018 and its page says an update is in progress; NICE NG12 was last updated in 2026. (USPSTF)(NICE NG12)

Your doctor decides what your result means for you.

Questions people ask

Does an enlarged prostate on a scan mean cancer?

No. MedlinePlus says benign prostatic hyperplasia (BPH) is not cancer and does not raise the risk of prostate cancer. The NCI says the prostate tends to grow larger with age, from about the size of a walnut in the 20s to often the size of a lemon by 60. (MedlinePlus) (NCI)

How common is an enlarged prostate?

Very common with age. The NHS says it is most common in men over 50 and can affect anyone with a prostate. MedlinePlus calls BPH the most common prostate condition in people over 50. (NHS) (MedlinePlus)

Should I get a PSA test because of this finding?

Size on a scan alone is not a screening trigger in the guidance cited here. In the US, PSA screening at 55 to 69 is an individual decision made with a clinician (USPSTF), and the ACS says to start the conversation at 50, or 45 or 40 at higher risk. In the UK, routine PSA testing is not offered, but anyone with a prostate can ask a GP about it. Your doctor decides with you. (USPSTF) (ACS) (NHS PSA test)

Can an enlarged prostate raise my PSA?

Yes. The USPSTF says a raised PSA can come from an enlarged prostate or inflammation as well as cancer, which is one reason for false-positive results. See our PSA test results page for more. (USPSTF)

When should I see a doctor?

The NHS says to see a GP if you have difficulty peeing or need to pee more often, and to ask for an urgent GP appointment or NHS 111 if you have blood in your pee, pain when peeing or cannot pee at all. MedlinePlus says to get medical help right away if you cannot urinate at all. (NHS) (MedlinePlus)