“I am 65 years old. I had an ultrasound yesterday and was told that my prostate weighs 105 grams. What should I do to treat the enlarged prostate?”
Quick Answer
A prostate measuring about 105 grams is substantially enlarged, but prostate size alone does not automatically mean that you need surgery.
The next step is to determine how much the enlargement is affecting your urine flow, bladder emptying, kidneys and quality of life.
For men with bothersome BPH symptoms and a large prostate, treatment may include a 5-alpha-reductase inhibitor such as finasteride or dutasteride, often with an alpha-blocker. If symptoms are severe, medication is ineffective, or complications are present, a procedure may be appropriate.
For a prostate around 105 g, procedures designed for large glands—particularly endoscopic enucleation such as HoLEP—are often more relevant than standard TURP.
Is a 105-Gram Prostate Very Large?
Yes. A prostate around 105 g, or approximately 105 mL in volume, is substantially enlarged.
However, the old article incorrectly suggested that this means you necessarily have a “serious problem.”
Prostate size and symptom severity do not always match.
Some men with large prostates have relatively mild symptoms, while men with smaller prostates may have severe urinary obstruction.
So the important question is not only “How large is the prostate?” but also:
- How bothersome are your urinary symptoms?
- How strong is your urine flow?
- Do you empty your bladder adequately?
- Have you had urinary retention?
- Have you developed bladder stones or repeated urinary infections?
- Is kidney function normal?
- Is there blood in the urine?
Does a 105-Gram Prostate Mean Prostate Cancer?
No.
A very large prostate can be completely benign.
BPH means benign prostatic hyperplasia. It is a noncancerous enlargement of prostate tissue.
A man can have BPH and prostate cancer at the same time because both become more common with age, but one does not turn into the other.
Whether further cancer evaluation is needed depends on factors such as PSA, prostate examination, family history, previous PSA values and other risk factors.
See my guide to understanding PSA.
Do You Automatically Need a Prostate Biopsy?
No.
The old answer recommended discussing a biopsy simply because the prostate was large. That is not how prostate biopsy should be used.
A biopsy is considered when the overall assessment raises sufficient concern for prostate cancer.
That may involve:
- PSA level and trend
- digital rectal examination
- PSA density
- prostate MRI when appropriate
- family history
- other clinical risk factors
Prostate volume by itself is not an indication for biopsy.
Can Medicine Shrink a 105-Gram Prostate?
Yes, in appropriately selected men.
The old statement that surgery is the only way to reduce prostate size is incorrect.
Two medicines called 5-alpha-reductase inhibitors are used for enlarged prostates:
- finasteride
- dutasteride
These medicines reduce the conversion of testosterone to dihydrotestosterone, or DHT, within the prostate.
Over time, they can reduce prostate volume by roughly 18–28% on average.
The effect develops gradually, usually over months rather than days.
Why Are 5-Alpha-Reductase Inhibitors Particularly Relevant With a Large Prostate?
These medicines are most useful in men who have an enlarged gland and an increased risk of BPH progression.
A prostate volume above approximately 40 mL is one commonly used marker of increased progression risk.
At approximately 105 mL, the prostate is well above that threshold.
5-alpha-reductase inhibitors can:
- gradually improve urinary symptoms
- reduce prostate volume
- improve urine flow modestly
- reduce the long-term risk of acute urinary retention
- reduce the likelihood of needing BPH surgery
However, side effects can occur and the medicine must be selected in discussion with the treating doctor.
What About Alpha-Blockers?
Alpha-blockers such as tamsulosin, alfuzosin, doxazosin and others can improve urinary symptoms relatively quickly by relaxing smooth muscle around the prostate and bladder neck.
They may improve:
- weak stream
- hesitancy
- straining
- frequency
- some symptoms of incomplete emptying
But alpha-blockers do not meaningfully shrink the prostate.
For a man with a substantially enlarged gland and bothersome symptoms, an alpha-blocker and 5-alpha-reductase inhibitor may sometimes be used together.
See my BPH medication guide.
Do BPH Medicines Affect the Heart?
The old article suggested that these drugs generally affect the cardiovascular system and therefore may be unsuitable for people with heart or blood-pressure problems.
That is too broad.
Some alpha-blockers can lower blood pressure and may cause:
- dizziness
- lightheadedness
- orthostatic hypotension
The risk differs between medicines and patients.
Finasteride and dutasteride work differently and are not primarily blood-pressure medicines.
Your doctor should consider your blood pressure, heart conditions and other medicines when selecting treatment.
Does Finasteride or Dutasteride Affect PSA?
Yes.
These medicines can reduce PSA by approximately 50% after about six to twelve months.
Doctors therefore need to know if you take one when interpreting your PSA result.
A new PSA baseline or nadir is usually established during treatment, and a confirmed rise afterward may require further assessment.
When Should Surgery Be Considered?
Surgery is not automatically required just because the gland measures 105 g.
But it becomes much more relevant if:
- urinary symptoms remain severe despite medication
- you repeatedly develop urinary retention
- the bladder does not empty adequately
- you develop recurrent urinary infections
- bladder stones occur
- there is persistent BPH-related bleeding
- obstruction begins affecting the kidneys or upper urinary tract
NIDDK likewise notes that surgery may be recommended when medicines do not help, symptoms are severe or complications develop.
Does Prostate Size Affect Which Operation Is Best?
Very much so.
A prostate around 105 mL is larger than the size range for which standard TURP is usually considered the conventional surgical choice.
| Treatment | Role with a prostate around 105 g | Main point |
|---|---|---|
| Medication | May still be appropriate depending on symptoms and complications. | 5-alpha-reductase inhibitors are particularly relevant in men with clearly enlarged prostates. |
| TURP | Usually better established for prostates approximately 30–80 mL. | At 105 mL, another large-gland procedure may be preferable depending on expertise and anatomy. |
| HoLEP | Well suited to large prostates when expertise is available. | Endoscopically enucleates obstructing prostate tissue through the urethra. |
| Bipolar enucleation | Another endoscopic option for larger glands. | Uses bipolar energy to enucleate the adenoma. |
| Simple prostatectomy | Can be considered for very large glands, particularly where endoscopic enucleation is unavailable or unsuitable. | May be open, laparoscopic or robotic depending on the center. |
What Is HoLEP?
HoLEP stands for holmium laser enucleation of the prostate.
Instead of shaving small pieces from the prostate in the way traditional TURP does, the surgeon separates the obstructing adenoma from the prostate capsule and removes that tissue through the urethra.
HoLEP can be used for large prostates and has durable results.
For glands above 80 mL, current European guidance considers endoscopic enucleation an important alternative to open surgery.
Would TURP Still Be Possible?
Possibly in some centers and selected patients, particularly with experienced surgeons and modern bipolar techniques.
However, European guidance identifies TURP primarily as the standard procedure for prostates in the approximately 30–80 mL range.
As prostate size increases, operating time and complication risk may increase.
With a 105 g gland, I would specifically ask whether an enucleation procedure would be more suitable.
What About Simple Prostatectomy?
A simple prostatectomy removes the internal obstructing adenoma while leaving the prostate capsule behind.
This is different from a radical prostatectomy used to treat prostate cancer.
Simple prostatectomy may be performed:
- open
- laparoscopically
- robotically
It can provide substantial and durable relief for very large prostates.
Open simple prostatectomy is more invasive than endoscopic enucleation, so when HoLEP or another suitable enucleation technique is available, those options may offer advantages in selected patients.
Is TUNA a Good Option for a 105-Gram Prostate?
I would remove TUNA from the recommendations on this page.
Transurethral needle ablation is an older minimally invasive technique and is not a principal contemporary treatment for a gland of this size.
The procedure landscape has changed considerably since the original article was written.
What Tests Should Be Done Before Deciding?
A urologist may consider:
- urinary symptom score
- urinalysis
- PSA when appropriate
- digital rectal examination
- confirmation of prostate volume
- uroflowmetry
- post-void residual measurement
- kidney-function tests when indicated
- ultrasound of the urinary tract when appropriate
- cystoscopy in selected patients
- urodynamic testing if the diagnosis is uncertain
See my guide to prostate and urinary tests.
Why Is Post-Void Residual Important?
The post-void residual tells us how much urine remains in the bladder after urination.
A man can have a very large prostate yet still empty reasonably well, while another man may have significant retention.
This information helps determine how much functional obstruction is actually occurring.
Can Drinking Less Water Shrink a Large Prostate?
No.
Changing fluid timing can sometimes reduce urinary frequency and nighttime urination, but it does not shrink the prostate.
Avoiding excessive fluid intake shortly before bedtime may help nocturia.
Caffeine and alcohol can also worsen urgency or frequency in some men.
However, patients should not intentionally dehydrate themselves.
Do Kegel Exercises Reduce a 105-Gram Prostate?
No.
Pelvic-floor exercises do not reduce prostate volume and do not remove mechanical obstruction.
They are useful for certain forms of urinary leakage, especially after prostate surgery, but they are not a primary treatment for a 105 g obstructing prostate.
Can Zinc Shrink a Large Prostate?
No reliable evidence shows that eating large quantities of zinc-rich foods such as oysters or beef will shrink a prostate.
Zinc is an essential nutrient, but more zinc is not automatically better for prostate health.
High-dose zinc supplementation should not be used as routine BPH therapy.
What About Saw Palmetto?
Saw palmetto is widely marketed for BPH, but high-quality studies have generally not shown a reliable clinically important benefit from saw palmetto used alone.
It should not be expected to shrink a prostate from approximately 105 g to normal size.
See my natural remedies for enlarged prostate guide for a balanced review of supplements.
Does a Large Prostate Automatically Need Treatment?
No.
Treatment is generally driven by the combination of:
- symptom burden
- prostate size
- risk of progression
- urinary flow
- residual urine
- complications
- overall health
- patient preferences
A 105 g prostate increases the likelihood that treatment may eventually be necessary, but the correct treatment cannot be selected from the ultrasound number alone.
When Is Urgent Care Needed?
- you suddenly cannot urinate at all
- you develop severe lower abdominal pain with a full bladder
- you have fever or shaking chills with urinary symptoms
- you have significant blood in the urine
- you develop vomiting, marked weakness or become acutely unwell
What I Would Ask the Urologist
Tahir, I would take your ultrasound report to a urologist and ask:
- Is the 105 g measurement reliable?
- How severe are my urinary symptoms?
- What is my urinary flow rate?
- How much urine remains after I urinate?
- Would finasteride or dutasteride be appropriate?
- Would combination medical therapy be appropriate?
- Do I have complications that make surgery advisable?
- If I need surgery, am I a candidate for HoLEP or another enucleation procedure?
- How does my PSA fit with my prostate size and age?
Tahir, a prostate weighing around 105 grams is certainly enlarged, but I would not tell you that surgery is automatically required or that you need a biopsy simply because of the size. The first step is to assess your urinary symptoms, urine flow, residual urine, PSA when appropriate, and whether any complications have developed. If your symptoms are moderate or severe, medicines that include a 5-alpha-reductase inhibitor may be particularly relevant because your prostate is clearly enlarged. If medication is insufficient or complications are present, I would ask a urologist specifically about procedures designed for large prostates, especially HoLEP or another enucleation technique.