I often encounter patients who ask the question, “I have prostate enlargement and I am taking medication, but do I need surgery? When should I have surgery?” To answer this question, it is crucial to figure out the progression of prostate hyperplasia and the role and side effects that medication can play. Prostate enlargement is a gradual process, in other words, if you are old enough, you will eventually get prostate enlargement. But age cannot be infinite, which dictates that some patients may have prostate enlargement but have mild symptoms and do not need surgery for life, but some patients develop the condition and eventually need surgery. Another deciding factor is whether the complications and pain of surgery are great. If it is a very easy surgery and the results are very positive, of course, you don’t need to think too much about it and make surgery as a first line of treatment well. If the surgery is risky, the risks need to be evaluated and trade-offs made based on the pros and cons. There is also the fact that many patients are concerned that the prostate will grow again after surgery and will need to be operated on again. These are the most decisive factors for patients to consider whether surgery is the most important. Well, actually, all these issues have been considered for you by your doctor (if it is a sufficiently experienced urologist). My approach is to often ask myself if I would do this surgery if the patient were myself or my loved one. Now there are several common misconceptions: First, that surgery will solve all the symptoms caused by prostate enlargement, or that the patient has all the existing symptoms, (some of which are actually prostatitis or bladder function problems). Second, the effect of surgery can make me a young man’s urinary condition, (in fact, only most of them can reach the state of youth, and a small part can only have varying degrees of improvement). Third, it is the same to do the surgery later, for example, the grandfather next door was done at 80 years old and the effect can be. (In fact, a long time of obstruction can damage bladder function, and the effect of surgery is rather inferior to doing it earlier). I often see some elderly people take medication for many years and end up having surgery, and I can’t help but wonder why they didn’t have surgery earlier. Medications cannot be a cure-all and only fit a subset of patients. And, nowadays, in the hands of experienced doctors, the results of surgery are very satisfactory. In wishing the elderly all the best for a long life, we have to face the fact that a person’s increasing longevity means that prostate enlargement is more likely to affect a person’s quality of life and more people will need surgery. Operating on people over 85 or even 90 years old who also have heart disease and lung disease is a really big risk. It seems that urologists need to be good urinary consultants for the elderly and accurately assess whether an elderly person will eventually need a prostatectomy so that they can operate on patients who must have the procedure when they are relatively younger and less risky.