Treatment Overview

Benign prostatic hyperplasia (BPH) cannot be cured, so treatment focuses on reducing your symptoms. Treatment is based on how severe your symptoms are, how much they bother you, and whether you have complications.

Deciding how to treat BPH is greatly influenced by how bothersome your symptoms are. The American Urological Association (AUA) symptom index is an interactive questionnaire that can help you tell how bad your symptoms are and measure how well your treatment is working. This questionnaire ranks the severity of your symptoms on a numerical scale. The higher the number, the more you are bothered by your symptoms and the more aggressive you may want to be in your treatment.

Initial treatment

The American Urological Association (AUA) makes the following treatment recommendations for benign prostatic hyperplasia (BPH) based on how bad your symptoms are.²

• Symptoms that are mild or that do not bother you (AUA score of 0 to 7) may be best treated by watchful waiting. This means you may make small changes to your lifestyle to control your symptoms, but you do not take medicines or have surgery. You have regular checkups to be sure your symptoms are not getting worse.
• The treatment of moderate to severe symptoms (AUA score of 8 or more) depends on how much you are bothered by them. If the symptoms are not greatly affecting your quality of life, you may choose watchful waiting or treatment with medicine. If the symptoms are bothersome or you want more aggressive treatment, you may be offered surgery or less invasive therapies, such as transurethral microwave therapy (TUMT) or transurethral needle ablation (TUNA).
• Severe symptoms, such as ongoing inability to urinate, bladder stones, kidney damage, or ongoing blood in your urine, should be treated with surgery.

There are some things you can do that may help reduce how much BPH affects your quality of life.

• Do not try to rush your urination. Try to relax while using the bathroom.
• Spread your fluid intake throughout the day. Limit fluid intake in the evening if you often wake up at night to urinate.
• If possible, avoid medicines that make your symptoms worse.
• Consider trying an herbal therapy for BPH, such as saw palmetto or beta-sitosterol. Talk with your doctor before starting any herbal therapy.

Enlarged Prostate: Should I Take Medicine?

Ongoing treatment

If your symptoms of benign prostatic hyperplasia (BPH) remain mild and not bothersome, watchful waiting may be your best treatment. With this treatment, you may make small changes to your lifestyle to control your symptoms, but you do not take medicines or have surgery. You have regular checkups to be sure your symptoms are not getting worse.

There are some things you can do that may help reduce how much BPH affects your quality of life.

• Do not try to rush your urination. Try to relax while using the bathroom.
• Spread your fluid intake throughout the day. Limit fluid intake in the evening if you frequently awaken at night to urinate.
• If possible, avoid medicines that make your symptoms worse.
• You may want to try an herbal therapy for BPH, such as saw palmetto or beta-sitosterol. Talk with your doctor before starting any herbal therapy.

If symptoms get worse or become bothersome, or if you develop complications, you should consider medicine or surgery.

Enlarged Prostate: Should I Take Medicine?

Enlarged Prostate: Should I Have Surgery?

Treatment if the condition gets worse

If any of the following occur, you will probably need surgery for benign prostatic hyperplasia (BPH):

• You cannot urinate. About half of men who cannot urinate need catheterization. Half of these men will be able to urinate again after catheterization. Those who do not improve may need surgery.
• Your BPH is causing repeated urinary tract infections, bladder stones, or bladder damage.
• You have blood in your urine that is not getting better and is causing other problems such as clots that make it hard to urinate.
• You have kidney damage.

Enlarged Prostate: Should I Have Surgery?

What To Think About

Unless surgery is required because of a complication, choosing a treatment is largely up to you and your doctor. If complications arise, surgery may be needed.

The extent to which treatment improves your symptoms depends partly on how bad your symptoms are and how much you are bothered by them. If you are not bothered by your symptoms before treatment, you are less likely to notice much improvement after treatment.

Surgery offers the best chance for improving the symptoms but also has the risk of causing other problems. For more information, see the Surgery section of this topic.