BPH / Enlarged Prostate
Getting Up Three Times a Night Isn't Just Aging. It's Treatable.
BPH affects more than half of men over 60, but most don't know how many effective options exist — from medications to 15-minute in-office procedures. A urologist can match the right treatment to your symptoms.
What Is BPH and Why Does It Cause Symptoms?
Benign prostatic hyperplasia (BPH) is a non-cancerous enlargement of the prostate gland. As the prostate grows, it can compress the urethra — the tube that carries urine from the bladder — causing the urinary symptoms that most men associate with 'just getting older.'
BPH is not cancer and does not increase your risk of prostate cancer. But it is progressive — symptoms tend to worsen over time without treatment — and it can lead to complications including urinary tract infections, bladder stones, and in severe cases, urinary retention (inability to urinate at all).
The good news: BPH is one of the most treatable conditions in urology. The range of options has expanded dramatically in the last decade, from medications that work within days to minimally invasive procedures that provide lasting relief without the side effects of traditional surgery.
What Dr. Taylor Reviews in Your Consultation
- Your AUA symptom score and which symptoms bother you most
- Prostate size (from ultrasound, MRI, or prior exam)
- PSA level and whether it's accounted for by prostate size
- Current medications and any that may be worsening symptoms
- Post-void residual (how much urine remains after voiding)
- Whether watchful waiting, medication, or a procedure is most appropriate
- Which specific medication or procedure best fits your prostate size, symptoms, and priorities
- Sexual function priorities and how they affect treatment choice
The AUA Symptom Score: How Urologists Measure BPH
The American Urological Association (AUA) Symptom Score is a 7-question survey that quantifies how much BPH is affecting your quality of life. Each question is scored 0–5; total scores guide treatment decisions.
Watchful waiting is appropriate. Lifestyle modifications (limiting fluids before bed, reducing caffeine and alcohol) may be sufficient. Annual monitoring recommended.
Medical therapy is typically recommended. Alpha-blockers, 5-alpha reductase inhibitors, or combination therapy depending on prostate size and PSA. Reassessment in 3–6 months.
Medical therapy is indicated; if medications fail or are not tolerated, minimally invasive procedures or surgery should be discussed. Quality of life is significantly impacted.
The 7 AUA Symptom Questions
- 1Incomplete emptying: How often do you feel your bladder is not completely empty after urinating?
- 2Frequency: How often do you have to urinate again less than 2 hours after finishing?
- 3Intermittency: How often do you find you stop and start again several times when urinating?
- 4Urgency: How often do you find it difficult to postpone urination?
- 5Weak stream: How often do you have a weak urinary stream?
- 6Straining: How often do you have to push or strain to begin urination?
- 7Nocturia: How many times do you typically get up to urinate between going to bed and getting up in the morning?
BPH Medications: What Each Class Does
Alpha-Blockers
Tamsulosin (Flomax), Alfuzosin, Silodosin, Doxazosin, Terazosin
Relax the smooth muscle in the prostate and bladder neck, reducing resistance to urine flow. Work quickly — most men notice improvement within days to weeks.
Men with moderate-to-severe symptoms who want rapid relief. Effective regardless of prostate size.
Dizziness (especially on standing), retrograde ejaculation (particularly with tamsulosin and silodosin), nasal congestion. Important: tell your eye surgeon if you take alpha-blockers — they can cause intraoperative floppy iris syndrome during cataract surgery.
5-Alpha Reductase Inhibitors (5-ARIs)
Finasteride (Proscar), Dutasteride (Avodart)
Block conversion of testosterone to DHT, which drives prostate growth. Shrink the prostate by 20–30% over 6–12 months. Also reduce PSA by ~50% — important to account for when interpreting PSA results.
Men with large prostates (>40cc) and elevated PSA. Reduce long-term risk of urinary retention and need for surgery. Require 6–12 months for full effect.
Decreased libido, erectile dysfunction, ejaculatory dysfunction, gynecomastia (breast tenderness/enlargement). Side effects are reversible on discontinuation.
Combination Therapy
Tamsulosin + Dutasteride (Jalyn)
Combines the rapid symptom relief of an alpha-blocker with the long-term prostate shrinkage of a 5-ARI. More effective than either drug alone for men with large prostates and significant symptoms.
Men with large prostates, significant symptoms, and elevated PSA who want both immediate and long-term benefit.
Combined side effect profile of both drug classes.
PDE5 Inhibitors
Tadalafil (Cialis) 5mg daily
Relaxes smooth muscle in the prostate, bladder neck, and urethra. FDA-approved for BPH and also treats erectile dysfunction — a useful combination for men with both conditions.
Men with BPH and concurrent erectile dysfunction. Modest symptom improvement compared to alpha-blockers.
Headache, flushing, back pain. Contraindicated with nitrates.
Anticholinergics / Beta-3 Agonists
Oxybutynin, Solifenacin, Mirabegron (Myrbetriq)
Target overactive bladder symptoms (urgency, frequency, nocturia) rather than obstruction. Often added to alpha-blockers when storage symptoms predominate.
Men whose primary symptoms are urgency and frequency rather than weak stream or straining. Use with caution in men with significant obstruction — can precipitate urinary retention.
Dry mouth, constipation, blurred vision (anticholinergics); increased blood pressure (mirabegron).
Minimally Invasive Procedures: The Options Beyond Medication
When medications don't provide adequate relief, cause intolerable side effects, or when a man prefers a more durable solution, minimally invasive procedures offer excellent results with much lower risk than traditional surgery.
UroLift
Small implants are placed through a cystoscope to pull the enlarged prostate lobes apart and hold them open, like opening curtains. No tissue is removed or destroyed. Procedure takes 15–20 minutes under local or light sedation; most men go home the same day.
Preserves ejaculatory function (important for men concerned about sexual side effects). Rapid recovery. No catheter needed in most cases.
Not effective for very large prostates (>80cc) or median lobe enlargement. May require retreatment over time. Less durable than TURP.
Men with moderate BPH who want to preserve sexual function and avoid general anesthesia.
Rezum Water Vapor Therapy
Pulses of steam (water vapor) are injected directly into the prostate tissue, causing cell death and prostate shrinkage over 4–6 weeks. Performed in the office or outpatient setting under local anesthesia.
Preserves ejaculatory function. Effective for median lobe enlargement (unlike UroLift). Durable results at 5 years.
Requires catheter for 3–7 days after procedure. Full effect takes 4–6 weeks. Not for very large prostates (>80cc).
Men with moderate-to-large prostates including median lobe, who want to preserve sexual function.
TURP (Transurethral Resection of the Prostate)
The traditional surgical standard. A resectoscope removes prostate tissue from the inside, creating a wider channel for urine flow. Performed under spinal or general anesthesia; typically a 1–2 night hospital stay.
Most durable results of any BPH treatment. Effective for all prostate sizes. Decades of outcome data.
Retrograde ejaculation occurs in 65–90% of men (semen goes backward into the bladder rather than forward — not harmful but permanent). Risk of bleeding, urinary incontinence (rare). Catheter for 1–3 days.
Men with severe symptoms, large prostates, or who have failed other treatments and are willing to accept retrograde ejaculation for the most durable result.
HoLEP (Holmium Laser Enucleation of the Prostate)
A holmium laser is used to enucleate (shell out) the entire enlarged prostate tissue from the inside, which is then morcellated and removed. Effective for any prostate size, including very large glands (>100cc).
Most effective procedure for large prostates. Very low bleeding risk (important for men on blood thinners). Durable long-term results comparable to open prostatectomy.
Technically demanding — outcomes depend heavily on surgeon experience. Retrograde ejaculation common. Temporary urinary incontinence in some men (usually resolves).
Men with very large prostates (>80–100cc) or those on anticoagulation who need definitive treatment.
Aquablation (AQUABEAM)
Uses a robotic, image-guided waterjet to remove prostate tissue with precision. MRI or ultrasound maps the prostate; the robot executes the resection. Effective for prostates 30–150cc.
Preserves ejaculatory function better than TURP. Consistent results regardless of prostate shape or size. Shorter learning curve for surgeons.
Requires general or spinal anesthesia. Catheter for 1–2 days. Less widely available than TURP or UroLift.
Men with moderate-to-large prostates who want effective treatment with lower risk of ejaculatory dysfunction than TURP.
When Watchful Waiting Is the Right Choice
Not every man with BPH needs treatment. If your AUA symptom score is mild (0–7) and your symptoms aren't significantly affecting your quality of life, watchful waiting with annual monitoring is a completely reasonable approach.
Lifestyle modifications can meaningfully reduce symptoms: limiting fluid intake in the 2–3 hours before bed, reducing caffeine and alcohol (both irritate the bladder), avoiding medications that worsen urinary symptoms (decongestants, antihistamines, some antidepressants), and double-voiding (urinating, waiting a minute, then trying again).
Watchful waiting is not appropriate if you have urinary retention, recurrent UTIs, bladder stones, kidney damage from obstruction, or if symptoms are significantly affecting your sleep and quality of life.
Questions Patients Ask About BPH
Does BPH cause prostate cancer?
No. BPH is a completely separate condition from prostate cancer. Having BPH does not increase your risk of developing prostate cancer. However, both conditions can cause elevated PSA, and both can coexist in the same prostate — which is why PSA interpretation requires clinical context.
I'm on tamsulosin and it's helping, but I'm having retrograde ejaculation. Is this permanent?
Retrograde ejaculation from tamsulosin is usually reversible — it typically resolves when the medication is stopped. If ejaculatory function is a priority, switching to alfuzosin (which has a lower rate of retrograde ejaculation) or considering a procedure that preserves ejaculation (UroLift, Rezum) may be worth discussing with your urologist.
My prostate is very large (80+ cc). What are my options?
Very large prostates (>80cc) are not good candidates for UroLift or Rezum. HoLEP is the gold standard for large glands — it can handle any prostate size and has excellent long-term results. Aquablation is also effective up to 150cc. TURP is less ideal for very large prostates due to bleeding risk and longer operative time. Your urologist will recommend based on your specific anatomy.
I wake up 3–4 times a night to urinate. Is that from BPH?
Nocturia (nighttime urination) is one of the most bothersome BPH symptoms, but it's not always caused by BPH alone. Other contributors include overactive bladder, nocturnal polyuria (producing too much urine at night — often related to fluid intake, heart failure, or sleep apnea), and poor sleep. A urologist will evaluate whether your nocturia is primarily obstructive (BPH) or storage-related (overactive bladder) — the treatment differs.
Can I avoid surgery entirely?
Many men manage BPH successfully with medication alone for years. Minimally invasive procedures like UroLift and Rezum offer a middle ground — more durable than medication, less invasive than surgery, and performed in an outpatient setting. Whether you need surgery depends on your prostate size, symptom severity, and response to other treatments.
My doctor mentioned my PSA is elevated because of BPH. How do I know it's not cancer?
BPH and prostate cancer can both elevate PSA, and they can coexist. PSA alone cannot distinguish between them. PSA density (PSA divided by prostate volume), free PSA ratio, PSA trend, and prostate MRI are the tools urologists use to assess cancer risk in men with BPH and elevated PSA. A urologic consultation can help you understand your specific risk level.
You Don't Have to Accept These Symptoms as Normal
BPH is highly treatable. Dr. Taylor will review your symptoms and history, explain your options honestly, and recommend the approach that fits your prostate, your lifestyle, and your priorities.
Schedule a Consultation — $295