SummaryA community study to determine the prevalence and natural history of benign prostatic hyperplasia (BPH) in a typical Scottish community has been undertaken in men from 40 to 79 years of age. From 2497 eligible men, 1627 (65%) agreed to take part and after screening by symptom score and urinary flow rate 561 were offered a full investigation including transrectal ultrasonography; 492 (87.7%) attended and 415 were found to have BPH, which was defined as a prostate ≥ 20 g. Following urological consultation, 3 groups of patients with BPH were recognised: those requiring no therapy (39.5%), those in whom therapy options were considered (50.5%) and those where operation was advised (10%). Seventeen patients with prostatic carcinoma were found, 4 of whom were treated by radical prostatectomy. A total of 67 operations for BPH resulted from the study in patients not previously referred to our urological unit, the majority of whom had not consulted their GP for symptoms of prostatism. This represents a serious challenge to British urolog