I have intermittent urinary discomfort at the end of urination, felt near the tip of the penis, along with an occasional tingling sensation in the scrotum. An enlarged prostate was diagnosed previously.
I used saw palmetto for a period and my symptoms improved, so I stopped it for about a year. I prefer noninvasive treatment.
Can I restart saw palmetto, and is an enlarged prostate common at my age? Also, can benign prostatic hyperplasia occur in a man who has been castrated?
Quick Answer
Yes, BPH is very common at age 69. Benign prostatic hyperplasia becomes increasingly common with age and is one of the most common prostate conditions in men over 50.
However, pain or burning at the end of urination and tingling in the penis or scrotum should not automatically be blamed on BPH. These symptoms can also occur with urinary infection, prostatitis, urethral irritation, pelvic-floor problems, stones and other urinary conditions.
Stopping saw palmetto for a year does not mean that you have permanently lost the ability to take it again. The more important question is whether it is likely to help. High-quality studies have generally found that saw palmetto is not more effective than placebo for typical BPH urinary symptoms, and it has not been shown reliably to shrink the prostate or prevent BPH progression.
Regarding castration, BPH is strongly dependent on androgen signaling. Men castrated before puberty historically did not develop the usual age-related prostate enlargement. The situation is more complex if androgen deprivation occurs after an adult prostate and BPH have already developed.
Can BPH Develop at Age 69?
Absolutely.
Age is one of the strongest risk factors for benign prostatic hyperplasia. BPH becomes increasingly common after age 50, and histologic prostate hyperplasia is found in a large proportion of elderly men.
This does not mean that every older man will have bothersome urinary symptoms. Some men have a visibly enlarged prostate but only mild symptoms, while others with a smaller gland can have significant urinary obstruction.
That is why doctors do not diagnose the seriousness of BPH from age or prostate size alone.
For a broader explanation, see my guide to benign prostatic hyperplasia .
What Symptoms Can an Enlarged Prostate Cause?
As the prostate enlarges, it can affect the urethra and bladder outlet. Common lower urinary tract symptoms can include:
- weak urinary stream;
- difficulty starting urination;
- intermittent or stop-and-start flow;
- straining;
- a feeling that the bladder has not emptied completely;
- frequent urination;
- urgency;
- and waking repeatedly at night to urinate.
You can compare these symptoms with those described in my BPH symptoms guide .
Is Pain at the Tip of the Penis Typical of BPH?
Not necessarily.
BPH can coexist with discomfort during or after urination, but pain felt at the tip of the penis is not specific enough to diagnose BPH.
The National Institute of Diabetes and Digestive and Kidney Diseases notes that prostatitis can cause pain or discomfort involving the penis, scrotum, lower abdomen, perineum and lower back. :contentReference[oaicite:1]{index=1}
Other possible causes include:
- urinary tract infection;
- urethritis or urethral irritation;
- prostatitis or chronic pelvic pain syndrome;
- bladder or ureteric stones;
- pelvic-floor muscle dysfunction;
- sexually transmitted infection when relevant;
- and less commonly other urinary tract disorders.
Burning, pain, tingling or a new change in urinary symptoms may justify a urine test, examination and other evaluation rather than simply restarting an old supplement.
What About Tingling in the Scrotum?
Scrotal tingling is also not a classic diagnostic symptom of BPH.
Depending on the circumstances, sensations in the scrotum may originate from the prostate, pelvic floor, nerves, testicles, epididymis, urinary tract or musculoskeletal structures.
If there is a new lump, swelling, severe tenderness or persistent testicular pain, an examination is particularly important.
Can You Restart Saw Palmetto After Stopping It?
There is no known rule that stopping saw palmetto for a year permanently makes it ineffective or prevents a person from using it again.
But the more important issue is whether restarting it is worthwhile.
Saw palmetto, or Serenoa repens, has been extensively promoted for BPH. Earlier small studies suggested possible symptom benefits, but larger and better-controlled studies have generally been much less convincing.
The National Center for Complementary and Integrative Health reports that a large randomized trial and systematic reviews found saw palmetto was not more effective than placebo for urinary symptoms associated with BPH, even at doses above the usual amount. :contentReference[oaicite:2]{index=2}
Does Saw Palmetto Shrink the Prostate?
There is no good evidence that ordinary saw palmetto supplementation reliably shrinks an enlarged prostate.
A Cochrane review summarized by NCCIH found no meaningful improvement in prostate size or urinary-flow measures with saw palmetto compared with placebo. :contentReference[oaicite:3]{index=3}
Therefore, I would not tell a patient that saw palmetto will “keep the prostate from enlarging” or that stopping it necessarily causes rebound enlargement. Those claims are not supported by good evidence.
For a broader discussion of supplements, see: natural remedies for enlarged prostate .
Urinary symptoms naturally fluctuate. A patient may feel better for weeks or months even if prostate volume has changed little. This makes it difficult to judge a supplement from symptoms alone.
Is BPH a Permanent Condition?
BPH is a chronic age-associated condition, but it is not accurate to say that the prostate can never become smaller.
Some treatments can reduce prostate volume.
For example, 5-alpha-reductase inhibitors such as finasteride and dutasteride reduce conversion of testosterone to dihydrotestosterone, or DHT, and can gradually shrink the prostate in appropriately selected men.
Procedures and surgery can also remove or ablate obstructing prostate tissue.
So the goal is not merely to “minimize enlargement.” Treatment depends on symptoms, prostate size, urinary obstruction, risk of progression and the patient’s preferences.
Can BPH Turn Into Prostate Cancer?
No. BPH does not transform into prostate cancer.
Benign prostatic hyperplasia and prostate cancer are different diseases. Having BPH does not mean benign cells gradually become malignant because the prostate has remained enlarged.
The two conditions can occur in the same man because both become more common with age, and some urinary symptoms may overlap.
This is why an older man with urinary symptoms may still undergo PSA assessment and other evaluation when clinically appropriate—not because BPH itself is turning into cancer.
Should a 69-Year-Old Man Have a PSA Test?
PSA testing should be individualized rather than performed automatically at a fixed frequency for every man.
A clinician considers age, previous PSA values, family history, prostate examination, overall health, life expectancy, symptoms and personal preferences.
If you have not been evaluated for many years and now have new urinary symptoms, it is reasonable to discuss whether PSA testing and a broader prostate assessment are appropriate.
But PSA does not diagnose BPH, and an elevated PSA does not automatically mean cancer.
Do You Need to See a Urologist Three or Four Times a Year?
Not necessarily.
There is no general rule that every man with stable BPH must see a urologist three or four times each year.
Follow-up frequency depends on:
- severity of symptoms;
- medications being used;
- prostate size;
- post-void residual urine;
- urinary-flow measurements when needed;
- PSA monitoring;
- history of retention or infection;
- kidney or bladder complications;
- and whether symptoms are stable or changing.
Some men with mild stable symptoms may need only periodic review, while others require closer follow-up.
Can BPH Occur in a Castrated Man?
This question requires more nuance than the old answer provided.
The prostate is an androgen-dependent organ. Testosterone and especially its metabolite dihydrotestosterone, or DHT, play important roles in prostate development and maintenance.
Historical observations and modern reviews consistently show that men who were castrated before puberty generally did not develop the usual age-related prostate enlargement. :contentReference[oaicite:4]{index=4}
| Situation | What We Know About BPH |
|---|---|
| Castration before puberty | The prostate remains very small because normal androgen-driven prostate development does not occur. Classical age-related BPH is generally not seen. |
| Castration after adulthood | A fully developed prostate is already present. Androgen withdrawal can cause prostate regression, but any pre-existing urinary symptoms still need proper evaluation. |
| Medical androgen deprivation | Strong suppression of testicular androgen signaling can reduce prostate volume, although these treatments have important systemic effects and are not standard BPH therapy. |
Why Is DHT Important?
Testosterone entering prostate cells can be converted into the more potent androgen dihydrotestosterone (DHT) by the enzyme 5-alpha-reductase.
DHT binds to androgen receptors in prostate tissue and helps maintain prostate growth and function.
This biological pathway is the reason why finasteride and dutasteride can reduce prostate volume: they inhibit 5-alpha-reductase and therefore reduce DHT exposure within the prostate.
Reviews of BPH biology describe androgen-receptor signaling as essential to normal prostate development and strongly involved in age-related prostate enlargement. :contentReference[oaicite:5]{index=5}
Does Estrogen Cause BPH After Castration?
The old answer suggested that after castration the adrenal glands increase estrogen production and that the resulting estrogen causes BPH. That is not an accurate explanation.
BPH biology is complex, and interactions between androgens, estrogens, inflammation, stromal cells and aging continue to be studied.
Estrogen signaling may influence prostate biology, but the established clinical observation is that adequate androgen signaling is important for normal prostate growth and the development and maintenance of typical BPH.
It is therefore misleading to say that loss of testicular testosterone causes the body to compensate by producing enough estrogen to create BPH.
Dr. Albana’s Perspective
For Fabian’s specific symptoms, I would focus less on whether saw palmetto can be restarted and more on why the discomfort has returned.
At age 69, an enlarged prostate is certainly common. But discomfort at the end of urination and scrotal tingling are not specific enough for me to assume that BPH is responsible.
I would want to know whether there is burning, urgency, urinary frequency, weak flow, discharge, fever, pelvic pain, blood in the urine, testicular swelling or difficulty emptying the bladder.
Depending on the answers, a clinician might consider urinalysis, urine culture, prostate examination, PSA when appropriate, post-void residual measurement, urinary-flow testing or other investigations.
If your symptoms previously improved while taking saw palmetto, that experience is relevant, but it does not prove that saw palmetto shrank your prostate. Current evidence is not strong enough for me to recommend it as a reliable substitute for established BPH treatment when treatment is actually needed.
— Dr. Albana Greca, MD, MMedSc
Family Physician / General Practitioner
What Are the Least Invasive BPH Options?
Preferring a noninvasive approach is completely reasonable, particularly when symptoms are mild and there are no complications.
Management may begin with conservative measures such as:
- reducing excessive evening fluids;
- limiting caffeine and alcohol if they worsen symptoms;
- avoiding constipation;
- reviewing medicines that may worsen urinary symptoms;
- double voiding when advised;
- monitoring symptoms over time;
- and regular physical activity.
If symptoms remain troublesome, medicines are usually considered before a procedure.
Read the full comparison in: BPH treatment options .
When Are Prescription Medicines Considered?
The two major traditional medication groups are:
Alpha-blockers
Medicines such as tamsulosin relax smooth muscle around the prostate and bladder outlet. They can improve urinary symptoms relatively quickly but do not substantially shrink the prostate.
5-alpha-reductase inhibitors
Finasteride and dutasteride reduce DHT and can gradually reduce prostate volume and the risk of progression in appropriately selected men with enlarged prostates.
The correct treatment depends on prostate size, symptom severity, blood pressure, sexual side effects, risk of urinary retention and other clinical factors.
When to Seek Urgent Medical Care
Seek urgent assessment if you:
- become completely unable to urinate;
- develop severe lower abdominal pain with a full bladder;
- have fever or chills together with painful urination or pelvic pain;
- develop significant visible blood in the urine;
- have sudden severe testicular pain or swelling;
- or become acutely unwell with urinary symptoms.
Acute urinary retention and serious urinary infection require prompt medical assessment.
Questions to Ask at Your Next Appointment
- Are my symptoms actually typical of BPH?
- Could prostatitis or urinary infection explain the penile discomfort?
- Should I have a urinalysis or urine culture?
- How large is my prostate now?
- Do I have significant post-void residual urine?
- Would PSA testing be useful in my situation?
- Are my symptoms mild enough for watchful waiting?
- If I need medication, what are the least invasive options?
- Is there any reason for me to continue or restart saw palmetto?
Frequently Asked Questions
Is an enlarged prostate normal at age 69?
BPH is extremely common in older men, so prostate enlargement at age 69 is not unusual. However, not every urinary symptom in an older man should automatically be attributed to BPH.
Can BPH turn into prostate cancer?
No. BPH is a benign condition and does not transform into prostate cancer. Both conditions become more common as men age and can occur in the same person, which is why appropriate prostate evaluation may still be needed.
Can saw palmetto shrink an enlarged prostate?
Good-quality evidence has not shown that ordinary saw palmetto reliably reduces prostate size. Large controlled studies have also failed to show a clear benefit over placebo for typical BPH urinary symptoms.
Can I restart saw palmetto after stopping for a year?
Stopping saw palmetto does not permanently prevent you from taking it again, but there is limited evidence that restarting it will meaningfully improve BPH. Discuss supplements with your clinician, particularly if your urinary symptoms have changed.
Can castrated men develop BPH?
Men castrated before puberty historically do not develop typical age-related BPH because normal prostate development requires androgen signaling. If castration or strong androgen suppression occurs after adulthood, an existing adult prostate or pre-existing BPH may behave differently, and urinary symptoms still require individual assessment.
Does castration cause estrogen to create BPH?
That is not an accepted explanation of BPH. Estrogen may participate in complex prostate biology, but androgen signaling is central to normal prostate development and is strongly involved in the maintenance of BPH.
Does penile pain mean my prostate is enlarged?
No. Penile pain or burning can occur with several conditions, including prostatitis, infection, urethral irritation, stones and pelvic-floor problems. An examination and urine testing may be appropriate when symptoms persist or recur.
Related Guides
Medical References
-
National Institute of Diabetes and Digestive and Kidney Diseases.
Prostate Problems.
NIDDK -
National Center for Complementary and Integrative Health.
Saw Palmetto and Benign Prostatic Hyperplasia.
NCCIH -
National Center for Complementary and Integrative Health.
Benign Prostatic Hyperplasia and Complementary and Integrative
Approaches.
NCCIH -
European Association of Urology.
Management of Non-neurogenic Male Lower Urinary Tract Symptoms.
EAU Guidelines -
Izumi K, Mizokami A.
The role of the androgen receptor in prostate development and benign
prostatic hyperplasia: A review.
Asian Journal of Urology. 2020.
PubMed
Medical information notice: This article provides general patient education and does not diagnose the cause of urinary or genital symptoms. Painful urination, penile or scrotal symptoms, recurrent urinary problems and changes in urinary flow may require examination, urinalysis, PSA assessment or other testing depending on the individual clinical situation.
Written & medically reviewed by Dr. Albana Greca, MD, MMedSc • Family Physician / General Practitioner • Last medically reviewed: August 2026