The prostate is a walnut-sized gland located between the bladder and the penis. It surrounds part of the urethra, which is the tube that carries urine and semen out of the body. As the prostate gets larger, it can squeeze the urethra. This can cause you to wake up at night to go to the bathroom – as much as every hour or two. While BPH may cause problems and discomfort, it is not cancer. 

“Not all men with BPH need immediate treatment,” said Kevin T. McVary, MD, chair of the Division of Urology at Southern Illinois University School of Medicine in Springfield, Illinois. “But for those men who decide to get treated for BPH, there are a large, and growing number of treatment options.” 

While the exact cause of BPH is not well understood, the chance of being told you have it does increase with age. Men with a family history of the condition are also more likely to develop BPH. 

There is no sure way to prevent BPH, but being physically active and eating a healthy diet, with fruits and vegetables, may help to prevent it. “Losing weight and exercising can help reduce symptoms in men who already have BPH,” Dr. McVary says. “Getting treatment for sleep disorders, such as sleep apnea, can also drastically improve symptoms of BPH,” he added.

In addition to needing to urinate often, other symptoms of BPH may include:

• Feeling the bladder is full, even right after urinating
• Weak urine flow
• Dribbling of urine
• The need to stop and start urinating several times
• Trouble urinating
• The need to push or strain to urinate 

To diagnose BPH, your urologist will review your symptoms, take a medical history and do a physical exam. Your provider will perform a digital rectal exam to check the size and shape of your prostate. You may be asked for a urine sample to see if you have a bladder infection. You may also have a prostate-specific antigen (PSA) 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. BPH does not cause cancer, but a man can have BPH and prostate cancer at the same time.

Based on how many symptoms you have and how often you have them, your doctor will determine whether you have mild, moderate or severe BPH.

Men with BPH can make some easy lifestyle changes to reduce symptoms. Dr. McVary suggests limiting fluids a few hours before bedtime and drinking less fluids that can make you go more often, like alcohol, soda or other fluids with caffeine. 

There are many effective options for treating BPH. However some men may decide with their doctor to monitor their BPH, and not actively treat it. This is called “watchful waiting or active surveillance.” If you begin to have worse or new symptoms, your doctor may recommend beginning an active treatment. “A retiree who doesn’t mind getting up in the middle of the night to go to the bathroom and who can sleep in the next day may decide to opt for watchful waiting,” said Dr. McVary. “But a man whose boss notices every time he leaves his desk to go to the bathroom may feel he needs to actively treat the problem.”

In a small percentage of cases, untreated BPH can lead to other health problems such as a urinary tract infection, bladder stones or kidney damage. In these cases, immediate treatment is necessary.

The main treatments for BPH are medication, minimally invasive surgery or traditional surgery. While many men decide to try medication first, others opt for surgery because they want an immediate, permanent solution, Dr. McVary notes. 

Alpha blockers are pills that relax the muscles of the prostate and bladder, and improve urine flow. These medications include alfuzosin (Uroxatral), doxazosin (Cadura), silodosin (Rapaflow), tamsulosin (Flomax), and terazosin (Hytrin). These drugs are recommended for men with moderate to severe BPH.

5-Alpha reducatase inhibitors block the production of a male hormone that plays a role in prostate development and growth. These pills also aim to increase urine flow and shrink the prostate and include dutasteride (Avodart) and finasteride (Proscar). These drugs may be best for men with very large prostates.

Both alpha blockers and 5-alpha reductase inhibitors must be taken indefinitely to prevent symptoms. In some cases, the doctor may prescribe a combination of these drugs (Jaylan). These medications can sometimes have an impact on a man’s sexual function.

Phosphodiesterase-5 inhibitors such as tadalafil (Cialis) are often used to treat erectile dysfunction, but can also treat BPH.

For men who choose surgery, a range of procedures are available. Doctors choose the best option based on the size and shape of the prostate, as well as the patient’s preference and overall medical condition.

The traditional gold standard for BPH surgery is Transurethral Resection of the Prostate (TURP). It involves “shaving” the enlarged prostate tissues with an electric current delivered through a wire loop. This procedure generally requires an overnight hospital stay. TURP largely has excellent results, but carries a small risk of complications such as bleeding or retrograde ejaculation, which is when semen enters the bladder rather than being sent out of the body. For many men, TURP side effects lessen with time. 

A variation of the TURP is called the BUTTON, a name based on the small round shape of the instrument used. Because of modifications with the instruments and the fluid used during the operation, this variation offers less blood loss, less time with a catheter and other safety measures to those men choosing to undergo this procedure.

This surgery removes part of the prostate gland, without any incision in your skin. It improves the flow of urine. There are a variety of minimally invasive procedures for BPH. 

One type is called UroLift. This procedure uses a needle to lift and staple the prostate to open up the urethra. This relieves pressure on the urethra, and allows urine to flow normally. “The procedure is relatively fast and can be done in the doctor’s office or an operating room,” Dr. McVary said. “It does not affect a man’s erection or impact his ejaculation, but in about one-third of men, the procedure cannot be done because of the shape of the prostate,” he noted. About a third of men who do have the procedure need another UroLift procedure, standard surgery or medication after five years.

A newer type of minimally invasive surgery is called water vapor energy ablation, or Rezum. This treatment was approved by the U.S. Food and Drug Administration in 2015. The doctor uses a device with a camera to deliver drops of water vapor to the prostate. The water vapor condenses, releasing energy that causes the surrounding cells to die off. This kills prostate-blocking tissue and opens up the urethra. It generally takes only seconds to work. Rezum does not affect a man’s erection or ejaculation. 

“Since Rezum is a relatively new procedure, we still don’t have real long-term data (more than 3 years) on its effectiveness,” noted Dr. McVary. He says while older surgical procedures for BPH generally are covered by Medicare, coverage varies by state for Rezum, but is getting better over time.

Whether you have mild, moderate or advanced BPH, are getting treatment for the first time or seeking retreatment, highly effective options are available. Discuss the treatment options for BPH with your urologist and find out which ones are right for you.

To learn more about BPH, visit: www.UrologyHealth.org/BPH. 

Learn more about BPH, also known as an enlarged prostate, in our video that discusses this topic further in-depth.

In this episode of the Urology Care Podcast, we sat down with Dr. Viprakasit to discuss what you need to know about BPH.