Prostate enlargement

Relief from Prostate Enlargement, Without Surgery | UNC Health Talk

Prostate enlargement

You wake up in the middle of the night with an urgent need to pee. Then, before you can fall back asleep, you have to go again. If you’re a man with a condition called benign prostatic hyperplasia (BPH), this scene is all too familiar.

About half of men ages 50 and older have problems with urination because of BPH. That number increases to 80 to 90 percent in men older than 70.

In BPH, the prostate becomes enlarged to the point that men have problems such as difficulty starting urination, a weak flow, an urge to urinate again soon after urination or the need for frequent urination.

Traditional Treatments for BPH

Until recently, treatments for BPH were limited to medications such as alpha blockers (Flomax or Hytrin) and 5-alpha-reductase inhibitors (Avodart or Proscar) or surgical procedures such as transurethral resection of the prostate (TURP). In TURP, a surgical instrument is inserted into the tip of the penis and then used to trim and remove excess prostate tissue.

There are pros and cons to both treatment approaches.

Medications can help relieve symptoms and reduce the size of the prostate. However, the medications can have unpleasant side effects, including chronic stuffy nose, lightheadedness and loss of libido.

In comparison, TURP surgery is better at improving symptoms more quickly. But in some cases, a prostate is too large to be removed through a TURP procedure. TURP also carries a risk of causing new problems such as urinary incontinence, erectile dysfunction or retrograde ejaculation (the ejaculation of semen into the bladder instead of out through the penis).

A New Treatment Option for BPH

A newer, nonsurgical treatment for BPH, called prostatic artery embolization (PAE), is available at UNC Medical Center in Chapel Hill, says Ari Isaacson, MD, a vascular interventional radiologist who performs the procedure.

PAE is performed through a small puncture in the groin or the arm. A catheter is inserted through the artery and directed toward the prostate.

Once the catheter is positioned in the artery supplying blood to the prostate, tiny particles called microspheres are injected that plug up the artery, blocking blood flow. This is called embolization.

“This process is then repeated on the other side, usually through the same original puncture,” Dr. Isaacson says.

How PAE Works

The PAE procedure blocks the blood flow to the areas of the prostate that are most affected by BPH, causing these areas to become dead tissue. These areas of dead tissue then cause the prostate to soften, alleviating some of the pressure that is causing blockage of the urine.

Over several months, the body’s immune system reabsorbs the dead prostate tissue and replaces it with scar tissue. The scar tissue slowly contracts, resulting in shrinkage of the prostate. Over six months, the prostate will shrink by 20 to 40 percent, resulting in improved and less frequent urination.

General anesthesia is not used for the PAE procedure, so patients are not “put to sleep.” Instead, patients will receive IV medications that take away pain and anxiety and make them comfortable through the procedure.

“The procedure can take anywhere from one to three hours, depending on the location and size of the prostatic arteries,” Dr. Isaacson says. “Then, most patients go home the same day.”

The Path to Better Prostate Health

Because the PAE procedure does not involve surgery or physical removal of part of the prostate, patients will not see results immediately. The first changes are seen most commonly one to two months after the procedure, with continued improvement until about four months.

The most common side effects of PAE immediately after the procedure include urethral burning and increased urinary frequency. These side effects usually stop within a week.

The good news? According to Dr. Isaacson, about 75 to 80 percent of men treated with PAE experience a significant and lasting improvement.

UNC Medical Center is one of just a few hospitals in the U.S. that offers PAE to patients who are not enrolled in a clinical trial. Appointments for evaluation are available in Chapel Hill, Raleigh, Hillsborough and Siler City. You can make an appointment or email for more information.


What Is BPH?

Prostate enlargement

  • What Is BPH?
  • Symptoms
  • Tests
  • Prevention
  • Treatments

You can do a lot to take care of yourself and give your body what it needs. Still, as you get older, your body changes in ways you can’t always control. For most men, one of those changes is that the prostate gets bigger.

It’s a natural part of aging, but at some point, it can lead to a condition called BPH, or benign prostatic hyperplasia.

Your prostate surrounds part of your urethra, the tube that carries urine and semen your penis. When you have BPH, your prostate is larger than usual, which squeezes the urethra.

This can cause your pee stream to be weak, waking you up a lot at night to go to the bathroom along. it also could lead to other bothersome urinary symptoms. When you have BPH, your prostate is larger than usual.

The large prostate can squeeze the urethra.

BPH isn’t prostate cancer and doesn’t make you more ly to get it.

It’s a common condition, especially in older men, and there are a lot of treatments for it, from lifestyle changes to medication to surgery. Your doctor can help you choose the best care your age, health, and how the condition affects you.

Doctors aren’t sure exactly what makes this happen. Some think it may have to do with normal hormonal changes as you age, but it’s not clear.

Early in puberty, your prostate actually doubles in size. Later in life, around age 25, it starts to grow again. For most men, this growth happens for the rest of their lives. For some, it causes BPH.

As the prostate gets larger, it starts to pinch the urethra. This causes symptoms that affect your urine flow, such as:

  • Dribbling when you finish
  • A hard time getting started
  • A weak stream, or you pee in stops and starts

When your urethra is squeezed, it also means your bladder has to work harder to push urine out. Over time, the bladder muscles get weak, which makes it harder for it to empty. This can lead to:

  • Feeling you still have to pee even after you just went
  • Having to go too often — eight or more times a day
  • Incontinence (when you don’t have control over when you pee)
  • An urgent need to pee, all of a sudden
  • You wake up several times a night to pee

A larger prostate doesn’t mean you’ll have more or worse symptoms. It’s different for each person. In fact, some men with very large prostates have few, if any, issues.

Your doctor will first talk to you about your personal and family medical history. You might also fill out a survey, answering questions about your symptoms and how they affect you daily.

Next, your doctor will do a physical exam. This may include a digital rectal exam. During this, he puts on a glove and gently inserts one finger into your rectum to check the size and shape of your prostate.

Basic tests: Your doctor may start with one or more of these:

  • Blood tests to check for kidney problems
  • Urine tests to look for infection or other problems that could be causing your symptoms
  • PSA (prostate-specific antigen) blood test. High PSA levels may be a sign of a larger-than-usual prostate. A doctor can also order it as screening for prostate cancer.

Advanced tests: the results of those tests, your doctor may order additional tests to rule out other problems or to see more clearly what’s happening. These might include:

  • Different types of ultrasound to measure your prostate and see if it looks healthy.
  • A bladder ultrasound to see how well you empty your bladder.
  • Biopsy to rule out cancer.
  • Urine flow test to measure how strong your stream is and how much pee you make. 
  • Urodynamics testing to evaluate your bladder function.
  • Cystourethroscopy is a procedure using a  camera to examine the inside of the prostate, urethra and bladder. 

How your doctor handles your case varies your age, health, the size of your prostate, and how BPH affects you. If your symptoms don’t bother you too much, you can put off treatment and see how it goes.

Lifestyle changes: You may want to start with things you can control. For example, you can:

  • Do exercises to strengthen your pelvic floor muscles
  • Lower the amount of fluids you drink, especially before you go out or go to bed
  • Drink less caffeine and alcohol

Medicine: For mild to moderate BPH, your doctor might suggest medicine. Some medications work by relaxing the muscles in your prostate and bladder. Others help shrink your prostate. For some men, it takes a mix of medicines to get the best results.

Procedures: If lifestyle changes and medications don’t work, your doctor has a number of ways to remove part or all of your prostate. Many of these are called “minimally invasive,” meaning they’re easier on you than regular surgery. They use probes or scopes and don’t require large cuts in your body.

Examples of a minimally invasive procedures are TUMT, TUNA, or Rezūm which use a varied form of energy to destroy part of the prostate.

Other, more involved surgical procedures include:

  • Laser therapy to remove part of your prostate
  • Transurethral resection of the prostate, or TURP, in which the doctor uses a scope and cuts out pieces of the gland with a wire loop
  • Transurethral incision of the prostate or TUIP, in which a few small cuts are made in the prostate to reduce the gland’s pressure on the urethra.
  • UroLift system is a permanently placed device used to lift and hold the enlarged prostate tissue the way, so it no longer blocks the urethra

In some cases, your doctor may also suggest a traditional, open surgery or a robotic procedure to remove your prostate.

With any BPH surgery, there may be side effects or complications such as bleeding, narrowing of the urine tube also known as urethral stricture, urinary incontinence or leakage, erectile dysfunction, and retrograde ejaculation.

BPH doesn’t lead to prostate cancer or make you more ly to get it.

It rarely leads to other conditions, but it can, and a couple of them are serious. For example, BPH can lead to kidney damage or, worst-case, cause a problem where you can’t pee at all.

It may also cause:

  • Bladder damage
  • Bladder stones
  • Urinary tract infections
  • Blood in your urine


NIH, National Institute of Diabetes and Digestive and Kidney Diseases: “Prostate Enlargement: Benign Prostatic Hyperplasia.”

Mayo Clinic: “Benign Prostatic Hyperplasia (BPH).”

Prostate Cancer Foundation: “Benign Prostatic Hyperplasia (BPH).”

UCLA Health: “Conditions Treated.”

Johns Hopkins Medicine: “Benign Prostatic Hyperplasia.”

Radiological Society of North America: “Benign Prostatic Hyperplasia (BPH).”

© 2018 WebMD, LLC. All rights reserved. Symptoms


Enlarged Prostate (BPH) Symptoms, Diagnosis, Treatment

Prostate enlargement

The prostate gland is located below the bladder in men and produces fluid components of semen. Over half of men ages 60 and above have enlargement of the prostate gland.

This condition is sometimes called benign prostatic hyperplasia or benign prostatic hypertrophy (BPH). It is not known exactly why this enlargement occurs. However, BPH is not cancer and does not cause cancer.

Some men have BPH symptoms while others do not.

The most common symptom of BPH includes having to urinate more, often at night. The reason is that the enlarged prostate gland presses on the urethra, which carries urine the body.

Because of this pressure, the bladder muscles have to work harder to excrete urine.

The bladder eventually may start to contract even when only a small amount of urine is present, creating the urge to urinate more often.

Pressure on the urethra from the enlarged gland and the additional work required of the bladder muscles lead to other symptoms of BPH as well. These include taking longer to initiate a urine stream and urinating with a weaker flow than before. Urine may dribble, or you may feel that there is still urine inside the bladder even after you have finished urinating.

If BPH completely blocks the urethra, inability to urinate may result. This can also happen as a result of infections or if the bladder muscles become excessively weak.

The inability to urinate is a serious condition that can permanently damage the kidneys or bladder. If this comes on suddenly, go to a hospital emergency department.

If you start to have symptoms of BPH, see your doctor right away in order to prevent worsening of the symptoms.

The prostate gland grows throughout a man's life, starting at puberty and again from age 25 onward. Typically, there are no symptoms from an enlarged prostate before age 40. Up to 90% of men have symptoms of BPH by age 85, but only about one-third of men with BPH symptoms are bothered by the symptoms.

No one knows why the prostate continues to enlarge throughout a man's life. Hormones testosterone, dihydrotestosterone (DHT), and estrogen may be involved in regulating the growth of the prostate. Having a vasectomy and sexual activity do not increase the risk of getting BPH. It is also not understood why some men have symptoms with BPH while others do not.

The symptoms of BPH may mimic symptoms of other conditions, including tumors and infections. A digital rectal exam can detect BPH in many patients. If you have symptoms, you should see your doctor to rule out other possible causes of the symptoms.

Some of the symptoms of BPH are the same as those of prostate cancer, so many men are fearful of the symptoms. However, BPH is far more common than prostate cancer. Men with BPH are no more ly than other men to develop prostate cancer. However, it's important to have your doctor perform a thorough examination because the two conditions share symptoms and can even coexist.

Diagnosis of BPH is based upon taking a history of your symptoms.

BPH Enlarged Prostate Tests

  • A rectal examination to assess the size and shape of the prostate
  • Ultrasound examination
  • Biopsy of the prostate
  • Urine flow studies
  • Cystoscopy, in which the doctor can see and evaluate the inside of the bladder

Whether or not BPH must be treated depends on the symptoms and their severity. Recurrent infections, problems urinating, leakage of urine, and kidney damage can all significantly impact your quality of life. Medications or surgical treatments may help if you are having severe symptoms.

Your doctor may suggest watching the condition if you have only mild symptoms. You may need to visit the doctor for a checkup once a year or more often. You may never need treatment if the symptoms do not worsen. In fact, symptoms tend to resolve on their own in up to one-third of mild cases of BPH.

Some lifestyle changes may be able to help with symptom relief.

Lifestyle Changes to Relieve BPH Symptoms

  • Avoid alcohol and caffeine
  • Avoid drinking fluids at bedtime, and drinking smaller amounts throughout the day
  • Avoid taking decongestant and antihistamine medications
  • Get regular exercise
  • Make a habit of going to the bathroom when you have the urge
  • Practice double voiding (empty the bladder, wait a moment, then try again)
  • Practice stress management and relaxation techniques

Alpha blockers, drugs often prescribed to treat high blood pressure, can help relax the muscles in the bladder and prostate, allowing urine to flow more freely. Alpha blockers that are FDA-approved to treat BPH include silodosin, alfuzosin, tamsulosin, doxazosin, and terazosin. A common side effect of these medications is decreased or lack of ejaculation.

5-alpha reductase inhibitors are drugs that can stop growth of the prostate or even shrink its size. They work by lowering the production of the hormone DHT. Examples of these medications are dutasteride and finasteride. The downside of these drugs is that they can lower sex drive and can cause erectile dysfunction. It can also take up to a year to see benefits with these drugs.

Saw palmetto is a supplement that showed benefit in some studies in managing BPH symptoms. In other studies, this effect was not seen. Because there is no clear benefit and a risk that supplements may interfere with the action of other drugs, the American Urological Association does not recommend saw palmetto or other herbal supplements for BPH.

Patients are urged to discuss the use of any complementary, herbal and/or home remedies for COPD with their doctors before use.

Saw palmetto is a supplement that showed benefit in some studies in managing BPH symptoms. In other studies, this effect was not seen. Because there is no clear benefit and a risk that supplements may interfere with the action of other drugs, the American Urological Association does not recommend saw palmetto or other herbal supplements for BPH.

When medicines are not effective for symptom relief, procedures to remove excess prostate tissue can be considered. Two procedures can usually be done in a urologist's office: transurethral needle ablation (TUNA), also known as radiofrequency ablation, and transurethral microwave therapy (TUMT). These procedures are less invasive than surgery and can be done in less than one hour.

  1. Transurethral Resection of the Prostate (TURP)
    TURP is a surgical procedure for relief of BPH. In this procedure an instrument is inserted through the penis and into the urethra to remove some of the prostate tissue.

  2. Transurethral Laser Surgery
    Transurethral laser surgery is more commonly performed now than TURP. There are three different laser procedures.

  3. Photoselective Vaporization of the Prostate (PVP)
    In this procedure, a laser is used to melt away (vaporize) excess prostate tissue to open the urinary channel.

  4. Holmium Laser Ablation of the Prostate (HoLAP)
    This is a similar procedure to PVP, except that a different type of laser is used to melt away (vaporize) the excess prostate tissue.

  5. Holmium Laser Enucleation of the Prostate (HoLEP)
    In HoLEP surgery, the laser is used to cut and remove the excess tissue that is blocking the urethra. Another instrument, called a morcellator, is then used to chop the prostate tissue into small pieces that are easily removed.

The prostate is an important part of the male sexual anatomy. Prostates produce semen, and stimulation of the prostate can bring about orgasm.

Some evidence suggests that older men with BPH may have more sexual problems than other men their age, and some drugs used to treat BPH can cause problems with erection and ejaculation. You should talk to your doctor if you develop these problems, since a change in medications may relieve them.

Many men never know they have BPH, and others are never bothered by its symptoms. But for those who do have troubling symptoms, there are many treatment options available. See your doctor as soon as you notice any symptoms.



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  • Medscape: “Enlarged Prostate (BPH)”


Urinary Difficulties Can Be a Sign of An Enlarged Prostate

Prostate enlargement

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An enlarged prostate is a common problem among men over the age of 50. It may cause bladder-related symptoms such as urinary frequency and urgency. There are several causes of an enlarged prostate, including hormonally-mediated enlargement, inflammation, and cancer.

The treatment of prostate enlargement varies depending on the cause. You may need blood tests or imaging studies to identify the reason for your prostate enlargement. The outcome is usually very good after treatment—but since cancer is one of the possible causes it is important not to ignore signs and symptoms of prostate enlargement.

An enlarged prostate does not always cause symptoms, and about half of men who have this condition do not experience any symptoms at all. Some men develop symptoms early, while others do not develop any effects until the prostate becomes significantly enlarged. This has to do with the position of the enlarged area (or areas) of the prostate in relation to the bladder.

If you develop symptoms of an enlarged prostate, you may frequently feel a sudden need to rush to the bathroom. But then when you are there, you only urinate a little and may have a weak stream. You may also continue to leak or dribble when you have stopped urinating.

The most common symptoms of prostate enlargement are:

  • Urinary frequency: Urinating much more frequently than normal
  • Urinary urgency: Having an urgent sensation that you need to urinate immediately
  • Nocturia: Getting up to urinate multiple times during the night
  • Hesitancy: Difficulty starting the urine stream
  • Bladder retention: Incomplete emptying of the bladder
  • Incontinence: Losing bladder control

Incomplete emptying of the bladder can result in a urinary tract infection (UTI), which causes pain and burning with urination. You are more ly to experience incontinence if you develop a UTI.

A UTI or cancer can result in blood in the urine. Be sure to talk to your doctor if you have occasional blood-tinged urine. If you have blood clots in your urine, you should get urgent medical attention.

If you are completely unable to urinate, you should get urgent medical attention. If the obstruction is severe enough, it can result in kidney damage.

Men have a prostate gland and women do not. The prostate is located just below the area where the bladder empties into the urethra. The urethra is a thin tube that carries urine from the bladder. In men, the urethra runs inside the penis to outside the body. As the prostate enlarges, it impinges the flow of urine through the urethra.

There are several reasons why the prostate may become enlarged.

Benign prostatic hyperplasia (BPH) is a non-cancerous increase in prostate size. Fifty percent of men in their 50s and 90 percent of men over age 80 have BPH.

The prostate enlarges when exposed to male hormones such as testosterone. During adolescence, the prostate goes through a phase of very rapid enlargement, but this levels off after puberty. The prostate continues to grow, but very slowly.

Due to the slow progression of growth during adulthood, most men do not notice any symptoms of BPH until they are older and the prostate has grown to such a size that it impinges on the outflow of urine from the bladder.

Prostate cancer may result in an enlarged prostate, although it doesn't always cause symptoms. Prostate cancer can often be diagnosed early and treated successfully. However, if left untreated, prostate cancer can metastasize (spread) to other areas of the body.

Get our printable guide for your next doctor's appointment to help you ask the right questions.

Prostatitis is inflammation of the prostate. This may occur as the result of an infection, an inflammatory process, irritation, or an injury.

If you have developed the effects of prostate enlargement, it can be difficult to determine the cause your symptoms alone. And because symptoms of BPH and the symptoms of prostate cancer are very similar, it is important that you work with your medical team to get to the bottom of the situation.

As part of your physical examination, you may need to undergo a digital rectal examination (DRE). The prostate is not visible from outside the body, but it can be examined with a simple test. During this examination, your doctor would insert a lubricated gloved finger into your rectum to evaluate the size and consistency of the prostate.

A DRE should not be painful or produce any bleeding—if it does, this is a sign that you may have a prostate problem that requires further evaluation. An enlarged, lumpy, or asymmetric prostate may indicate the need for further testing.

A prostate-specific antigen (PSA) blood test measures a protein that is produced by the prostate. Elevated PSA blood levels may be present if you have cancer, but they can also be elevated if you have prostatitis. And sometimes, PSA can be normal in men who have prostate cancer.

This blood test must be interpreted in light of your other diagnostic test results, and it cannot be used to rule in or rule out any specific cause of prostate enlargement.

A urinalysis can measure the volume of your urine and can be used to detect blood, inflammatory cells, or infectious organisms.

Several tests can assess your ability to urinate. These tests may involve placement of a catheter (tube) into your penis to help identify areas of obstruction or alterations in flow.

Urodynamic tests give your medical team information about the flow and stream of your urine and can help point to structural abnormalities that could be interfering with your ability to urinate. Pressure flow studies can measure the pressure in your bladder when you urinate to help identify areas of obstruction.

Uroflowmetry can measure the rate at which your bladder fills and empties. And a post void residual urine study measures the volume of urine that remains in your bladder after you urinate.

You may need a combination of these tests to help your doctors understand the anatomic structure in and around your bladder and prostate gland as well as your urinary function.

You may need to have an imaging test, such as computerized tomography (CT) of your abdomen and pelvis, or an MRI of your prostate. Another imaging test, a transrectal ultrasound, involves placing a device into the rectum to help in obtaining an image of the structures.

If there is a concern that your enlarged prostate could be caused by cancer, you may need to have a cystoscopy or a prostate biopsy. These are invasive tests in which a sample of tissue is collected and examined under a microscope to look for signs of cancer.

There are different approaches to the treatment of an enlarged prostate. Symptomatic management is important, and treatment of the underlying cause is often vital.

Some strategies that can help prevent incontinence, nocturia, and bladder infections include:

  • Urinating on a regular schedule and when you feel the urge
  • Limiting alcohol and caffeine
  • Avoiding beverages a few hours before sleep
  • Discuss your use of over-the-counter antihistamines and decongestants with your doctor—these medications can exacerbate bladder control issues

If urinary retention is a chronic problem, you may need to learn how to self-catheterize yourself. This involves placing a thin tube into the urethra to release urine.

There is no evidence that herbs or supplements can shrink an enlarged prostate or alleviate any of the symptoms.

A number of different types of prescription medications are used for symptomatic management or for treatment of bladder enlargement.

Medications described as 5-alpha-reductase enzyme inhibitors can help shrink the prostate gland.

Avodart (dutasteride) and Proscar (finasteride) are used to reduce the size of the prostate gland in BPH and in prostate cancer.

 They reduce the action of testosterone, and they can produce reversible side effects related to this mechanism, including decreased libido and breast enlargement.

Some medications help ease urinary symptoms by relaxing the muscles around the urethra. These medications, which fall in the category of alpha blockers, include Flomax (tamsulosin), Cardura (doxazosin), Hytrin (terazosin), Rapaflo (silodosin), Minipress (prazosin), and Uroxatral (alfuzosin). These medications can cause low blood pressure and dizziness.

Prostatitis caused by a bacterial infection can be treated with antibiotics.

There are several procedures used to treat an enlarged prostate. These procedures can also be used to remove prostate cancer.

An open prostatectomy is a surgical procedure that involves surgical removal of a portion of the prostate gland or the whole entire gland.

A newer procedure, the Rezūm System, uses steam to destroy prostate cells.

Prostate enlargement is common. Often, when there are no symptoms, treatment is not necessary for BPH. Because prostate cancer does not always cause symptoms, this condition must be treated even when it does not produce any symptoms.

Men often consider frequent urination to be a part of getting older, but you should seek medical attention if you develop these symptoms because they can be a sign of a treatable or potentially serious medical issue.


Prostate Enlargement

Prostate enlargement

What is benign prostatic hyperplasia (BPH)?
Benign prostatic hyperplasia (BPH) is an enlargement of the prostate gland. As men age, it’s common for the prostate to get larger. BPH does not lead to prostate cancer.

The prostate gland is in the abdomen below the bladder. It’s about the size and shape of a walnut. As part of the male reproductive system, it produces a milky white fluid that helps to transport sperm during ejaculation enlargement of the prostate may affect the flow of urine (urination).

Who is at risk for benign prostatic hyperplasia (BPH)?

  • BPH affects more than half of men in their 60s and most men in their 70s and 80s.
  • lihood of developing enlarged prostate increases with age
  • Family history, ethnicity (less common in Asians), obesity, and sedentary lifestyle are risk factors
  • BPH often occurs in men who also have an inability to get an erection sufficient to have sexual intercourse (erectile dysfunction or ED)

What are the signs and symptoms of BPH?
As the prostate enlarges, it can squeeze the urethra (the tube for urine to pass the body). Common symptoms of BPH are referred to as lower urinary tract symptoms (LUTS):

  • Frequent urination (especially at night)
  • Urgent need to urinate
  • Trouble or hesitation when starting to urinate
  • Weak urinary flow that may be interrupted with dribbling or leakage after urination
  • Feeling that the bladder is not empty after urination
  • If severe, complete inability to urinate (requires urgent medical attention)

How is BPH diagnosed?

  • To determine if you have BPH, your doctor will
  • Take your medical history
  • Ask you to describe the severity of your symptoms
  • Ask if you are taking medications that may worsen symptoms (antihistamines, decongestants, certain antidepressants, water pills [diuretics], or asthma medications [bronchodilators])
  • Examine your abdomen to check for bladder enlargement
  • Perform a digital rectal exam to determine the size and shape of your prostate and whether there is a lump or hardness that may indicate prostate cancer
  • Order a urinalysis (a urine exam) to look for signs of infection and/or to see if the kidneys have been affected (and sometimes measure the amount of urine that is left in the bladder after urination, usually done with a sound wave machine called an ultrasound bladder scanner)
  • Order a blood test for prostate-specific antigen (PSA) to screen for prostate cancer

How is BPH treated?
Treatment for BPH and its symptoms usually begins with your family doctor, who may refer you to a urologist. Your doctor may ask you to stop or change medications or treat a urinary tract infection that might be worsening your symptoms.

Your doctor will usually base your treatment on the severity of your symptoms and how they affect your quality of life, rather than on the size of the prostate or medical need (unless the kidneys are affected).

The most common complaints leading to treatment are interrupted sleep because of the need to urinate at night, and frequency and urgency with inability to control urination on a regular basis.

Although for most men many of the symptoms do not get worse for years, and may even get better with time, a rare complication of BPH involves a sudden and complete blockage of urination. This needs to be treated immediately.

For moderate to severe symptoms that interfere with daily life, there are three types of drug treatment:

  1. Alpha-adrenergic blockers (doxazosin, terazosin, alfuzosin, tamsulosin, and silodosin)
  2. Phosphodiesterase type 5 inhibitor (tadalafil)
  3. 5-alpha-reductase inhibitors (finasteride and dutasteride)

Some men may benefit from using both alpha-adrenergic blockers and 5-alphareductase inhibitors at the same time. One or both drugs are usually continued for the rest of your life. If you stop taking them, your symptoms will return.

The main surgical treatment for BPH is a transurethral resection of the prostate (TURP) or similar procedures to remove excessive prostate tissue blocking urine flow. Surgery is an option if you:

  • Are not able to completely empty your bladder (which can damage the kidneys)
  • Are not able to urinate
  • Are not able to hold your urine (incontinence)
  • Have bladder stones
  • Have repeated infections that are difficult to treat (due to incomplete emptying of the bladder)
  • Have large amounts of blood in the urine on a regular basis

Although surgery can improve symptoms of BPH, it is less common since medical treatments became available. Surgery can cause long-term complications including ED and incontinence. And a small number of men need a second operation because of continued prostate growth or a narrowed urethra caused by the first surgery.

Questions to ask your doctor

  • Are my symptoms from BPH? 
  • What are my treatment options? 
  • What are the advantages and disadvantages of each of my treatment options? 
  • Should I see a urologist for my condition?

Editor(s): Caroline Davidge-Pitts, MBBCH, Alvin Matsumoto, M.D.

Last Updated: May 2018


4 tips for coping with an enlarged prostate

Prostate enlargement

When a man reaches about age 25, his prostate begins to grow. This natural growth is called benign prostatic hyperplasia (BPH) and it is the most common cause of prostate enlargement. BPH is a benign condition that does not lead to prostate cancer, though the two problems can coexist.

Although 50% to 60% of men with BPH may never develop any symptoms, others find that BPH can make life miserable. The symptoms of BPH include:

  • a hesitant, interrupted, weak urine stream
  • urgency, leaking, or dribbling
  • a sense of incomplete emptying
  • more frequent urination, especially at night.

As a result, many men seek treatment. The good news is that treatments are constantly being improved. Patients and their physicians now have more medications to choose from, so if one doesn't do the trick, another can be prescribed. And thanks to some refinements, surgical treatments are more effective and have fewer side effects than ever before.

But there are some things men dealing with BPH can do on their own. When symptoms are not particularly bothersome, watchful waiting may be the best way to proceed.

This involves regular monitoring to make sure complications aren't developing, but no treatment. For more troubling symptoms, most doctors begin by recommending a combination of lifestyle changes and medication.

Often this will be enough to relieve the worst symptoms and prevent the need for surgery

Tips for relieving BPH symptoms

Four simple steps can help relieve some of the symptoms of BPH:

  1. Some men who are nervous and tense urinate more frequently. Reduce stress by exercising regularly and practicing relaxation techniques such as meditation.
  2. When you go to the bathroom, take the time to empty your bladder completely. This will reduce the need for subsequent trips to the toilet.
  3. Talk with your doctor about all prescription and over-the-counter medications you're taking; some may contribute to the problem. Your doctor may be able to adjust dosages or change your schedule for taking these drugs, or he or she may prescribe different medications that cause fewer urinary problems.
  4. Avoid drinking fluids in the evening, particularly caffeinated and alcoholic beverages. Both can affect the muscle tone of the bladder and stimulate the kidneys to produce urine, leading to nighttime urination.

For more on advances in the diagnosis and treatment of prostate diseases, read the Annual Report on Prostate Diseases from Harvard Medical School.

Image: iStock

As a service to our readers, Harvard Health Publishing provides access to our library of archived content. Please note the date of last review or update on all articles. No content on this site, regardless of date, should ever be used as a substitute for direct medical advice from your doctor or other qualified clinician.


Enlarged prostate: MedlinePlus Medical Encyclopedia

Prostate enlargement

The treatment you choose will be how bad your symptoms are and how much they bother you. Your provider will also take into account other medical problems you may have.

Treatment options include “watchful waiting,” lifestyle changes, medicines, or surgery.

If you are over 60, you are more ly to have symptoms. But many men with an enlarged prostate have only minor symptoms. Self-care steps are often enough to make you feel better.

If you have BPH, you should have a yearly exam to monitor your symptoms and see if you need changes in treatment.


For mild symptoms:

  • Urinate when you first get the urge. Also, go to the bathroom on a timed schedule, even if you don't feel a need to urinate.
  • Avoid alcohol and caffeine, especially after dinner.
  • DO NOT drink a lot of fluid all at once. Spread out fluids during the day. Avoid drinking fluids within 2 hours of bedtime.
  • Try NOT to take over-the-counter cold and sinus medicines that contain decongestants or antihistamines. These drugs can increase BPH symptoms.
  • Keep warm and exercise regularly. Cold weather and lack of physical activity may worsen symptoms.
  • Reduce stress. Nervousness and tension can lead to more frequent urination.


Alpha-1 blockers are a class of drugs that are also used to treat high blood pressure. These medicines relax the muscles of the bladder neck and prostate. This allows easier urination. Most people who take alpha-1 blockers notice improvement in their symptoms, usually within 3 to 7 days after starting the medicine.

Finasteride and dutasteride lower levels of hormones produced by the prostate. These drugs also reduce the size of the gland, increase urine flow rate, and decrease symptoms of BPH. You may need to take these medicines for 3 to 6 months before you notice symptoms getting better. Possible side effects include decreased sex drive and impotence.

Antibiotics may be prescribed to treat chronic prostatitis (inflammation of the prostate), which may occur with BPH. BPH symptoms improve in some men after a course of antibiotics.

Watch out for drugs that may make your symptoms worse:


Many herbs have been tried for treating an enlarged prostate. Many men use saw palmetto to ease symptoms. Some studies have shown that it may help with symptoms, but results are mixed, and more research is needed. If you use saw palmetto and think it works, ask your doctor if you should still take it.


Prostate surgery may be recommended if you have:

The choice of which surgical procedure is recommended is most often the severity of your symptoms and the size and shape of your prostate gland. Most men who have prostate surgery have improvement in urine flow rates and symptoms.

Transurethral resection of the prostate (TURP): This is the most common and most proven surgical treatment for BPH. TURP is performed by inserting a scope through the penis and removing the prostate piece by piece.

Simple prostatectomy: It is a procedure to remove the inside part of the prostate gland. It is done through a surgical cut in your lower belly. This treatment is most often done on men who have very large prostate glands.

Other less-invasive procedures use heat or a laser to destroy prostate tissue. Another less-invasive procedure works by “tacking” the prostate open without removing or destroying tissues. None have been proven to be better than TURP. People who receive these procedures are more ly to need surgery again after 5 or 10 years. However, these procedures may be a choice for:

  • Younger men (many of the less-invasive procedures carry a lower risk for impotence and incontinence than TURP, although the risk with TURP is not very high)
  • Older people
  • People with severe medical conditions, including uncontrolled diabetes, cirrhosis, alcoholism, psychosis, and serious lung, kidney, or heart disease
  • Men who are taking blood-thinning drugs
  • Men who are otherwise at an increased surgical risk


The growing problem of an enlarged prostate gland

Prostate enlargement
Harvard Men's Health Watch

By age 60, half of all men will have an enlarged prostate, a condition also known as benign prostatic hyperplasia, or BPH. By age 85, the proportion reaches 90%.

While BPH does not increase your risk of getting prostate cancer or having sexual problems, it can affect quality of life, specifically by causing annoying and embarrassing urination problems.

“Since prostate enlargement happens gradually, men often think more frequent trips to the bathroom are a natural part of aging,” says Dr.

Howard LeWine, chief medical editor at Harvard Health Publishing and an assistant professor of medicine at Harvard-affiliated Brigham and Women's Hospital.

“But a little medication can help relieve symptoms, meaning less urinary urgency and fewer nighttime awakenings to use the bathroom.”

Illustration by Scott Leighton

An enlarged prostate places pressure on the urethra, which makes urine harder to expel.

Feeling the pressure

As you age, your prostate can grow from the size of a walnut to about the size of a lemon. It's not clear why the prostate grows this, but it's believed certain male hormones such as dihydrotestosterone tend to act more strongly on the prostate gland later in life.

Because the prostate is located just below the bladder, when it becomes larger it can place pressure on the urethra, the tube that carries urine from the bladder through the penis and the body. This may lead to a variety of urination problems.

For example, you may have trouble beginning to urinate, continue to dribble afterward, and feel you have not fully emptied your bladder.

Urine that doesn't get expelled and collects in the bladder can increase the risk of infection, which in turn makes it painful to urinate and causes even more bathroom trips and potentially loss of bladder control. Urinary tract (or bladder) infections can also lead to a kidney infection.

Early research suggested that 5-alpha-reductase inhibitors (5-ARIs), a class of drugs used to treat prostate enlargement, might increase the risk of developing more aggressive prostate cancer. However, newer studies have found that not only do the drugs appear to pose no extra risk, they may even protect against prostate cancer.

For instance, research from the Prostate Cancer Prevention Trial study in 2013 showed that taking the 5-ARI finasteride (Proscar) for seven years could lower the chance of getting low-grade prostate cancer by 25% among men ages 55 and older.

A follow-up study of almost 9,500 men, published in the Nov.

1, 2018, issue of the Journal of the National Cancer Institute, also showed that finasteride lowered the risk by a similar amount (21%), and found the protective effect lasted for at least 16 years.

Treating with drugs

See your doctor if you have any of these problems. A digital rectal exam can often confirm an enlarged prostate, and your doctor may take a urine sample to check for a bladder infection that can be treated with antibiotics.

If your prostate is causing symptoms, your doctor will ly offer you medication to improve and manage them. Two main classes of drugs are used: alpha blockers and 5-alpha-reductase inhibitors (5-ARIs). Your doctor may prescribe one or both types, depending on your symptoms and the size of your prostate gland.

Alpha blockers. These drugs relax the muscles around the prostate and the opening of the bladder, so urine can flow more easily. Common BPH symptoms often improve within two days.

They are most effective for men with normal to moderately enlarged prostates.

Commonly prescribed drugs in this class include alfuzosin (Uroxatral), doxazosin (Cardura), silodosin (Rapaflo), tamsulosin (Flomax), and terazosin (Hytrin).

5-ARIs. Drugs in this class slowly shrink the prostate so it stops pressing on the urethra. Treatment often reduces the prostate's size by one-quarter after six months to a year. The two common drugs are finasteride (Proscar) and dutasteride (Avodart).

Men might opt for surgery to remove excess tissue from the prostate if medications do not relieve symptoms sufficiently or cause undesirable side effects, or if there are complications urinary retention or recurring urinary tract infections, adds Dr. LeWine.

For men who have both erectile dysfunction and symptoms of BPH, once-daily low-dose tadalafil (Cialis) is another option.

As a service to our readers, Harvard Health Publishing provides access to our library of archived content. Please note the date of last review or update on all articles. No content on this site, regardless of date, should ever be used as a substitute for direct medical advice from your doctor or other qualified clinician.