Groin Pain and a 26 cc Prostate: Is BPH the Cause and Does It Need Treatment?

Question 1: How Do You Treat “Prostate” Groin Pain?

Hello,

The first step is to identify what is actually causing the pain. Groin pain is a symptom, not a diagnosis, and many conditions outside the prostate can cause it.

Can Prostatitis Cause Groin Pain?

Yes.

The National Institute of Diabetes and Digestive and Kidney Diseases lists pain in the genital area, groin, lower abdomen and lower back among possible symptoms of bacterial prostatitis. Chronic prostatitis/chronic pelvic pain syndrome can also cause pain in the penis, scrotum, perineum and lower abdomen.

Other symptoms that may accompany prostatitis include:

• burning or pain during urination;
• urinary frequency or urgency;
• weak or interrupted flow;
• pain during or after ejaculation;
• difficulty emptying the bladder; and
• fever or chills in acute bacterial prostatitis.

See our prostate and pelvic pain guide.

What Else Can Cause Groin Pain?

Important alternatives include:

• inguinal hernia;
• epididymitis or epididymo-orchitis;
• testicular torsion;
• urinary or ureteric stones;
• urinary infection;
• hip, tendon or muscle injury;
• pelvic-floor muscle pain;
• nerve irritation;
• sexually transmitted infection when relevant; and
• pain following urinary or prostate procedures.

A clinician may need to examine the abdomen, groin, penis, scrotum and testicles and perform urinary testing depending on the history.

What If the Groin Pain Started After a Prostate Biopsy?

Mild perineal or pelvic discomfort can occur after a prostate biopsy, particularly after a transperineal procedure.

However, the original article’s instruction to take aspirin twice daily after biopsy should be removed.

Do Not Start Aspirin Just for Post-Biopsy Pain

Aspirin affects platelet function and can increase bleeding. Different biopsy centers use different protocols:

• some allow patients who already take low-dose aspirin for a cardiovascular indication to continue it;
• some advise avoiding aspirin-containing painkillers for a short period after biopsy; and
• higher aspirin doses and other anticoagulant/antiplatelet medicines require individualized instructions.

Recent NHS biopsy aftercare guidance commonly recommends ordinary pain relief such as paracetamol/acetaminophen when appropriate and instructs patients to follow their own team’s directions regarding aspirin and blood-thinning medicines.

If you already take aspirin because of heart disease, stroke or another medical indication, do not stop or restart it without following the clinician’s instructions.

When Should Post-Biopsy Pain Be Reassessed?

Contact the biopsy/urology team if pain is severe, persistent or worsening, particularly if it is accompanied by:

• fever or chills;
• difficulty urinating or complete retention;
• heavy or increasing bleeding;
• large blood clots;
• marked scrotal swelling; or
• feeling systemically unwell.

Question 2: What Is the Best Treatment for a 26 cc Prostate?

Hello Venkat,

The first thing I would clarify is the ultrasound interpretation itself.

A 26 cc Prostate Is Not Clearly Enlarged

Your dimensions—44 × 30 × 37 mm—correspond to an ellipsoid volume of approximately 25.6 cc, which agrees with the reported 26 cc.

That is a relatively modest prostate volume.

The AUA describes prostates below 30 g/cc as small when planning BPH procedures. In medical treatment guidance, 5-alpha-reductase inhibitors such as finasteride or dutasteride are generally reserved for men with demonstrable enlargement, commonly >30 cc in AUA guidance, while the 2026 EAU guideline uses >40 mL as an example of increased progression risk.

Why Might the Ultrasound Still Say “Prostatomegaly”?

Ultrasound reports sometimes use local or laboratory-specific reference ranges, and measurements vary depending on technique and bladder filling.

Prostate size also increases gradually with age.

More importantly, modern urology does not treat the ultrasound number alone. Current EAU guidance emphasizes that male lower urinary tract symptoms can have multiple causes and that treatment should focus on whether there is benign prostatic obstruction causing meaningful symptoms.

Do You Have Symptoms?

This is the most important missing information.

Treatment decisions depend on whether you have symptoms such as:

• weak urine stream;
• hesitancy;
• straining;
• frequency;
• urgency;
• waking repeatedly at night to urinate;
• dribbling; or
• a feeling that the bladder does not empty completely.

See our BPH symptoms guide.

If You Have No Symptoms, Do You Need Medicine?

Usually not simply because an ultrasound says “prostatomegaly.”

If you are comfortable, emptying the bladder adequately and have no urinary complications, monitoring is reasonable.

The 2026 EAU patient guidance states that men with mild or minimally bothersome benign prostate enlargement can often start with conservative management and watchful waiting rather than medicines or surgery.

Follow-up can be adjusted according to symptoms and risk rather than treating the scan number.

What If You Do Have Bothersome Urinary Symptoms?

Then treatment should be matched to the symptom pattern.

Would Finasteride or Dutasteride Be a Good Choice for 26 cc?

Usually not on prostate volume alone.

The 2026 AUA medical-management update recommends 5-alpha-reductase inhibitor therapy primarily when LUTS/BPH is accompanied by an estimated prostate volume above about 30 cc and/or PSA above 1.5 ng/mL.

The EAU uses an even more conservative practical example—prostate volume above 40 mL—for men at increased progression risk.

These drugs work slowly and can cause reduced libido, erectile dysfunction or ejaculatory effects, so there should be a clear reason to use them.

Would an Alpha Blocker Help?

If you have bothersome voiding symptoms, possibly.

Alpha blockers improve symptoms by relaxing smooth muscle around the prostate and bladder neck. Unlike 5-alpha-reductase inhibitors, their short-term effectiveness does not depend strongly on having a large prostate.

They do not shrink the gland and can cause side effects such as dizziness, low blood pressure or ejaculation changes.

See our BPH medications guide.

What Basic Evaluation Is Reasonable?

If you have urinary symptoms, a clinician may use:

• a symptom score such as IPSS;
• urinalysis;
• physical examination;
• post-void residual measurement;
• uroflowmetry;
• review of prostate size and anatomy; and
• PSA if the result would influence prostate-cancer assessment or BPH management.

PSA is not required just because the ultrasound volume is 26 cc. Its use should be discussed in the context of age, health, family history and the potential consequences of the result.

Do You Need Antibiotics or Urinary Alkalinizers?

Not unless there is a specific indication.

Antibiotics treat bacterial infection, not uncomplicated BPH. Urinary alkalinizers may alter urine pH but do not cure an infection or shrink the prostate.

If you have burning urination, fever or other infection symptoms, obtain appropriate urinary testing rather than taking antibiotics empirically.

Do Uva Ursi, Rose-Hip or Milk-Thistle Tea Shrink a 26 cc Prostate?

There is no good evidence that these teas shrink BPH.

Uva ursi should not be recommended as routine self-treatment for urinary symptoms in men, and milk thistle is not an established BPH treatment.

See our natural remedies for enlarged prostate guide for a more evidence-based review.

Do You Need to Avoid Fried, Spicy or Chili Foods?

No universal BPH diet requires this.

Some men notice that particular foods or drinks worsen urgency or bladder irritation. If you notice a consistent trigger, reducing it is reasonable. But chili, citrus, fried food or other foods do not automatically enlarge the prostate.

Useful Precautions Without Over-Treating

If urinary symptoms are mild, practical measures include:

• maintain normal hydration rather than deliberately dehydrating yourself;
• reduce large fluid intake close to bedtime if nocturia is troublesome;
• reduce caffeine or alcohol if they clearly increase urgency/frequency;
• treat constipation;
• stay physically active;
• review decongestants, antihistamines and other medicines that may worsen urination; and
• seek reassessment if the stream deteriorates, residual urine rises or new symptoms develop.