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Your prostate after 65: What’s normal (and what’s not)

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Age increases the risk of prostate problems. Here’s what to know about prevention, treatment and early detection. 

Lately you’ve been peeing more often, day and night. Or maybe you notice you have a weak flow. Or you’re having trouble getting started when you need to go.  

You may have heard that these issues can be related to your prostate. But what’s the connection?  

The prostate is a gland that most men rarely think about until they’re in their 50s or 60s.1  Here’s what you need to know about how your prostate works, why it can cause problems as you get older, and how your doctor can help. 

What exactly is the prostate? 

The prostate is a gland that rests below the bladder.1  It serves a relatively simple purpose. “The main function is to produce fluid that contributes to semen,” says Steven Tillem, MD, a urologist at Optum in Long Island, New York.  

While sperm comes from the testicles, “much of the fluid in the ejaculate comes from the prostate,” says Dr. Tillem. This fluid nourishes the sperm. Meanwhile, muscles in the prostate help push semen through your urethra.2 (That’s the tube that lets urine or semen leave your body.) 

That makes the prostate an important part of fertility. So, why does this little gland become so significant later in life? A couple of reasons:  

  • Your prostate grows with age. The prostate is about the size of a walnut in a young man, but it gets larger over time. This usually begins after the age of 40, and it is a normal part of aging, says Dr. Tillem. It’s called benign prostatic hyperplasia (BPH), also known as an enlarged prostate.1 An enlarged prostate is treatable. 
  • Your prostate can develop cancer. In men, prostate cancer is the second most-common cancer. Only nonmelanoma skin cancer affects more men in the United States.3 The good news? Unless it’s caught at a late stage, prostate cancer is highly treatable.4 

Read on to find the answers to your other questions about prostate health. 

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What should I know about benign prostatic hyperplasia?  

The most notable sign of an enlarged prostate is urinary trouble. When the prostate grows, it can push against the bladder and close in on the urethra.1 “This affects bladder function, and it can cause symptoms such as frequent urination and incomplete bladder emptying,” says Dr. Tillem.  

Men with enlarged prostates may notice a weak urine stream, dribbling after urination, and even an unusual smell or color to their urine.5, 6 

You might wonder why you get an enlarged prostate. Unfortunately, there’s no simple answer. “The actual cause is unknown, but it’s believed to be related to hormonal factors,” says Dr. Tillem.  

That said, there may also be a genetic component. You’re more likely to have BPH if your dad did.5 The risk of an enlarged prostate is also higher if you are:5, 6 

  • Over the age of 50  
  • Overweight or obese  
  • Inactive (you don’t exercise)  
  • Have heart disease or type 2 diabetes 
  • Have erectile dysfunction  

How do doctors diagnose an enlarged prostate?  

There are several steps to diagnosing BPH. A doctor will usually start by asking about your bladder habits. Or you’ll fill out a questionnaire. Either way, you’ll describe any bladder changes, including whether you have to pee more often, especially at night, or often feel as if you haven’t emptied your bladder all the way.5  

The next step is often a digital rectal exam. This is a 10- to 15-second procedure where a doctor inserts a gloved, lubricated finger into your rectum to look for signs that your prostate is larger.5  

From there, you may have a urine test that measures your urine flow or pressure, or how much is left in your bladder when you’re done.5  Your doctor might order other urine tests or scans too. 

Finally, the doctor will check how much prostate-specific antigen (PSA) is in your blood. That’s a protein produced by the prostate. PSA tests can help providers detect a variety of prostate issues, including cancer.5 

Your Optum doctor can help you figure out what’s causing your bladder problems and refer you to specialist if needed. Find an Optum doctor

How do doctors treat BPH?  

There are several ways that providers can treat BPH, depending on how severe the problem is.1, 5  

  • Lifestyle changes: For mild BPH, your provider may want to wait on medical treatment. Instead, they’ll advise you to follow healthier habits such as drinking less caffeine and alcohol, and exercising for 30 minutes a day. They’ll also watch for signs of change. 
  • Prescription medication: “After lifestyle changes, we consider medical therapy,” says Dr. Tillem. This is usually a pill. Alpha-blockers, which help relax muscles in the prostate and urethra, are common. So are 5-alpha-reductase inhibitors, which may help shrink the prostate. 
  • Surgery: If your symptoms are severe and medications can’t help, there are several types of procedures. Some can be done as an outpatient, which means you do not have to stay overnight at the hospital. “These procedures work by opening the channel that the urine flows through,” says Dr. Tillem. Your doctor may recommend a procedure based on your situation. 

What should I know about prostate cancer?  

Prostate cancer happens when prostate cells grow out of control. Many prostate cancers don’t spread outside the prostate. And they tend to be slow growing. If it’s caught early, prostate cancer is curable, says Dr. Tillem. But early-stage prostate cancer rarely causes symptoms.7 That’s why screening is so important. (Screening is getting a test before there are any symptoms.) 

As the diseases progresses, symptoms can include:7  

  • Frequent, often urgent need to urinate 
  • A weak urine flow  
  • A need to wake up to pee at night 
  • Loss of bladder or bowel control  
  • Painful ejaculation 
  • Erectile dysfunction 
  • Blood in urine or semen 
  • Pain in the lower back, hips or chest 

The average age of a man diagnosed with prostate cancer is 67, according to the American Cancer Society (ACS).8 And roughly 1 in 8 men will be diagnosed with prostate cancer at some point in their life. 

How do doctors check for prostate cancer?  

There are two screening tests to look for possible signs of prostate cancer: A PSA test and a digital rectal exam. 

All men should talk to their doctor or specialist about when to get screened for prostate cancer. For guidance, the ACS recommends the following:9 

  • Men with an average risk of prostate cancer who are expected to live at least 10 more years should have the conversation with their doctor about screening at age 50.  
  • Men with a high risk of prostate cancer should talk to their doctor about screening at age 40-45. That includes Black men and those with a father or brother who had prostate cancer at an early age. Men with a known genetic risk for cancer are also at high risk.7 

Several guidelines do not recommend that men aged 70 or over get screened.10 Given that the prostate becomes bigger with age, many older men have higher PSA readings, which result in false positives. (A false positive is when the test results say there’s a problem but there really isn’t.) Many men in their 70s are overtreated for low-risk prostate cancer and have a reduced quality of life due to harsh side effects of treatment. If you’re 70 or older, ask your doctor if you need to continue screening.10 

What can you do to help keep your prostate healthy? 

The best way is by taking the steps to boost your overall health. This includes: 2, 11 

You’ll also want to talk to your Optum doctor about whether getting screening tests is right for you. While you can’t do anything about getting older, with help from your Optum care team, you can take steps to get healthy and stay that way. That’s good for your prostate and your quality of life. 


  1. Cleveland Clinic. Benign prostatic hyperplasia. Last reviewed August 5, 2022. Accessed January 16, 2024.  
  2. Cleveland Clinic. Prostate. Last reviewed August 9, 2022. Accessed January 16, 2024. 
  3. Centers for Disease Control and Prevention. Prostate cancer statistics. Last reviewed June 8, 2023. Accessed January 16, 2024. 
  4. American Cancer Society. Survival rates for prostate cancer. Last revised March 1, 2023. Accessed January 16, 2024. 
  5. American Urological Association. Benign prostatic hyperplasia (BPH). Last updated September 2023. Accessed January 16, 2024. 
  6. National Library of Medicine: MedlinePlus. Enlarged prostate (BPH). Last updated December 15, 2023. Accessed January 16, 2024. 
  7. Cleveland Clinic. Prostate cancer. Last reviewed January 17, 2023. Accessed January 16, 2024. 
  8. American Cancer Society. Key statistics for prostate cancer. Last revised January 12, 2023. Accessed January 16, 2024. 
  9. American Cancer Society. American Cancer Society recommendations for prostate cancer early detection. Last revised February 24, 2023. Accessed January 16, 2024.  
  10. U.S. Preventive Services Task Force. Prostate Cancer: Screening. Last updated December 21, 2023. Accessed February 15, 2024. 
  11. Mayo Clinic. Prostate cancer prevention: Ways to reduce your risk. Last reviewed December 21, 2022. Accessed January 16, 2024.   

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