I am 79 and have only a minor slowdown in my urine stream. My urologist says my prostate is a little enlarged but has not recommended treatment. My father later needed an urgent prostate operation and was diagnosed with prostate cancer at age 80. He died at 85. I want to prevent future problems and avoid surgery and its side effects. Would it be better to take action now?
Quick Answer
If your urinary symptoms are genuinely mild and not bothersome, aggressive treatment now is not automatically better. For uncomplicated mild BPH, monitoring can be entirely appropriate.
The more useful question is your future risk. A urologist can estimate that from symptom severity, prostate size, PSA when appropriate, urine-flow rate, post-void residual, and whether you have complications such as retention, recurrent infection, bladder stones, bleeding or kidney effects.
Your father’s prostate cancer is relevant because a first-degree family history increases your risk. But at age 79, PSA screening should be individualized according to prior PSA values, general health and life expectancy rather than performed automatically or very frequently.
There is no evidence-based reason to have preventive prostate surgery simply because your father later required an operation.
Hello Barry,
Your goal of preventing an emergency is sensible. But with benign prostatic hyperplasia (BPH), prevention usually means risk assessment and follow-up, not early surgery for a mildly bothersome symptom.
Does a Slightly Slower Urine Stream Need Treatment?
Not always. A slightly reduced stream can occur with BPH, but treatment is generally guided by how bothersome the symptoms are, whether the bladder empties adequately, prostate size and anatomy, urine-flow measurements, risk of future retention or progression, and whether complications are already present.
Should You Treat BPH Before It Gets Worse?
That depends on your individual progression risk. Some men with a clearly enlarged prostate benefit from medicine that reduces future retention and surgery risk. Other men with mild symptoms may gain little from years of medication and its side effects.
What Tests Help Estimate Your Future Risk?
Symptom Score
The International Prostate Symptom Score (IPSS) can document whether your symptoms are mild, moderate or severe and how much they affect quality of life.
Post-Void Residual
A bladder scan shows how much urine remains after you urinate. A persistently high residual can indicate impaired emptying, although it does not by itself prove prostate obstruction.
Urine-Flow Testing
Uroflowmetry measures how fast and steadily you urinate.
Prostate Size
Prostate volume helps estimate progression risk and can influence medication choice.
PSA When Appropriate
PSA can contribute to prostate-cancer risk assessment and may also provide indirect information about prostate volume in men with BPH. See our prostate and urinary testing guide.
When Can Medication Reduce BPH Progression Risk?
If your prostate is substantially enlarged, a 5-alpha-reductase inhibitor such as finasteride or dutasteride may be worth discussing. AUA guidance supports these medicines when enlargement is demonstrated, for example by prostate volume above about 30 g on imaging, PSA above about 1.5 ng/mL when interpreted appropriately, or palpable enlargement on examination.
These medicines can gradually shrink the prostate by roughly 15–25% and reduce the long-term risk of acute urinary retention and BPH-related surgery in appropriately selected men.
What About an Alpha Blocker?
Alpha blockers such as tamsulosin can improve a weak stream by relaxing smooth muscle around the prostate and bladder neck. They work relatively quickly, but they do not meaningfully shrink the prostate or prevent long-term BPH progression on their own.
If your stream is only mildly slower and does not bother you, the benefit may not justify side effects such as dizziness, low blood pressure or ejaculatory dysfunction. At age 79, avoiding dizziness and falls is especially important.
Does Being Able to Afford Any Treatment Mean Earlier Treatment Is Better?
No. The most expensive or newest treatment is not automatically the best preventive treatment. An invasive procedure exposes you to risks now in order to relieve an obstruction that may never become sufficiently bothersome to justify those risks.
When Is BPH Surgery Actually Recommended?
Current AUA guidance recommends surgery particularly when BPH causes:
- kidney insufficiency caused by obstruction;
- refractory urinary retention;
- recurrent urinary tract infections;
- recurrent bladder stones;
- recurrent visible bleeding attributed to BPH; or
- bothersome lower urinary tract symptoms that remain unacceptable despite, or instead of, other therapies.
There is no rule that surgery is performed only when the prostate becomes 10 or 15 times normal size. The original page’s size threshold was incorrect. See our current BPH procedures and surgery guide.
Does Your Father’s Prostate Cancer Matter?
Yes. A father with prostate cancer is a first-degree family history and increases your prostate-cancer risk compared with a man without that history. But your father’s experience does not mean that your mild urinary slowdown is prostate cancer or that you will follow the same course.
BPH and prostate cancer are separate conditions. BPH does not turn into prostate cancer.
Should a 79-Year-Old Still Have PSA Screening?
This should be individualized. AUA/SUO guidance emphasizes shared decision-making in older men because the potential benefit of detecting aggressive cancer must be balanced against competing health risks, overdiagnosis and treatment harms.
For men aged 75 or older with a PSA below 3 ng/mL, clinicians may discontinue or substantially lengthen the screening interval. On the other hand, in a very healthy older man with an estimated life expectancy of at least 10 years, continued PSA screening every two to four years can still be reasonable after an informed discussion.
What If Your PSA Is Newly Elevated?
A newly elevated PSA should usually be repeated before moving directly to biomarkers, MRI or biopsy. Urinary infection, urinary retention, recent catheterization and recent prostate instrumentation can temporarily raise PSA. An elevated PSA does not automatically mean cancer. See our PSA guide.
Would Prostate Cancer at Your Age Automatically Mean Surgery?
No. Modern prostate-cancer management is individualized. Depending on Grade Group, PSA, stage, MRI/biopsy findings, overall health and life expectancy, options may include active surveillance, watchful waiting, radiation therapy, surgery in selected patients, hormonal/systemic treatment for more advanced disease, or combinations of therapies.
NCI recognizes active surveillance and watchful waiting as standard approaches for selected prostate cancers, including in older men. Surgery is not automatically required simply because cancer is found.
Should You Start Saw Palmetto or Pygeum “Just in Case”?
I would not use them to prevent future retention or surgery.
Saw Palmetto
NCCIH concludes that saw palmetto used alone provides little or no benefit for BPH urinary symptoms in high-quality reviews. It has not been shown to prevent urinary retention or reliably shrink the prostate.
Pygeum
Pygeum has some limited evidence for short-term improvement in urinary symptoms, but studies have generally been small and short. It has not been shown to provide the same proven reduction in BPH progression risk as a 5-alpha-reductase inhibitor.
See our evidence-based guide to natural remedies for BPH.
What About Kegel Exercises?
Kegel exercises can help some forms of urinary incontinence, particularly after prostate surgery. They do not shrink the prostate or prevent BPH progression, so they are not the main strategy for a mildly reduced urinary stream.
What Can You Do Now Without Medication or Surgery?
- avoid unnecessarily delaying urination for long periods;
- reduce evening fluids if nocturia develops, without becoming dehydrated;
- reduce caffeine or alcohol if they clearly worsen urinary symptoms;
- avoid over-the-counter decongestants or antihistamines that worsen flow unless medically necessary;
- stay physically active;
- manage constipation; and
- monitor whether stream, urgency, nighttime urination or incomplete-emptying sensation changes.
A Better “Action Now” Plan
- Document your current IPSS symptom score.
- Measure post-void residual urine.
- Obtain a urine-flow measurement if your urologist considers it useful.
- Clarify your prostate volume.
- Review previous PSA results and family history.
- Discuss whether continued PSA screening makes sense at age 79 given your health and life expectancy.
- If your prostate is substantially enlarged, ask whether a 5-alpha-reductase inhibitor would reduce progression risk enough to justify its side effects.
- Agree on a follow-up plan and warning signs that should trigger earlier review.
When Should You Contact the Urologist Earlier?
- you cannot pass urine;
- you develop a painful, increasingly full bladder;
- you have visible blood in the urine;
- you develop fever or chills with urinary symptoms;
- you have recurrent urinary infections;
- your urinary flow worsens rapidly; or
- you develop significant flank or kidney-area pain.
I agree with your goal of avoiding a future emergency, but I would not equate “taking action now” with starting herbs, taking medication automatically or having an early prostate procedure.
Because your symptoms are currently minor, I would ask your urologist to document your baseline risk: prostate size, post-void residual, symptom score, urine flow if needed, and PSA history. Your father’s prostate cancer is relevant, so I would also have a specific shared decision-making discussion about whether continued PSA screening is worthwhile for you at age 79.
If your prostate is substantially enlarged and your estimated progression risk is high enough, a 5-alpha-reductase inhibitor may be a rational preventive treatment to discuss. If your risk is low and the symptom barely bothers you, careful monitoring may be the better choice.
The objective is not to treat the prostate as early as possible. It is to intervene at the point where the expected benefit is greater than the medication or procedural risk.
Dr. Albana Greca, MD, MMedSc
Family Physician / General Practitioner
Founder & Lead Medical Author, Prostate Treatment Options
Medical References
American Urological Association. Management of Lower Urinary Tract Symptoms Attributed to Benign Prostatic Hyperplasia: AUA Guideline.
American Urological Association / Society of Urologic Oncology. Early Detection of Prostate Cancer Guideline, 2023; current AUA guideline listing amended 2026.
National Cancer Institute. Prostate Cancer Treatment (PDQ): active surveillance, watchful waiting, surgery and radiation.
National Center for Complementary and Integrative Health. Saw Palmetto; Benign Prostatic Hyperplasia and Complementary Health Approaches.
Last evidence update: September 2026.