The Best Approach to an Enlarged Prostate?

Each man has a different tolerance for symptoms of benign prostatic hyperplasia (BPH), also known as an enlarged prostate. If your symptoms are not bothering you greatly -- and you have not developed any urinary complications -- you may choose watchful waiting as your treatment strategy.

This means seeing your doctor once a year -- or sooner if your symptoms change.

Watchful Waiting for an Enlarged Prostate

If you choose watchful waiting in regards to an enlarged prostate, there are things you can do to reduce symptoms:

  • Make simple changes in your habits, like drinking fewer liquids before bedtime -- and drinking less caffeine and alcohol generally.
  • Don't take over-the-counter cold and sinus medicines with decongestants, which can make a prostate problem worse.

Watchful waiting is the least invasive treatment for an enlarged prostate. You avoid the risks and costs of medications, procedures, and surgery. For some men, mild BPH symptoms improve with time. If symptoms become worse, it's time to talk to your doctor about treatment.

An Enlarged Prostate and Prescription Drugs

When enlarged prostate symptoms become more bothersome, drugs may help provide relief. Two types of medications are available to treat moderate BPH. Each works differently in the body, and each has its own side effects.

The two classes of drugs for an enlarged prostate are:

  • Alpha blockers, which relax muscles of the prostate to relieve symptoms
  • 5-alpha reductase inhibitors, which help shrink the prostate and prevent additional growth

Men with very enlarged prostates may take both types of drugs, called combination therapy, to reduce the need for surgery. However, men taking combination therapy may experience the side effects of both drugs. Also, the FDA is revising labels on several BPH drugs -- Proscar, Avodart, and Jalyn -- to include a warning that the drugs lower the risk for prostate cancer but may be linked to an increased risk of high-grade prostate cancer.

Deciding on Enlarged Prostate Treatment

The choice between watchful waiting and taking medications for an enlarged prostate is something to be discussed with your doctor. Together, you must weigh the risks and benefits of each.

Ask yourself about each treatment option:

  • How much is my quality of life affected right now?
  • How much will it improve?
  • How long will the effects last?
  • Is there a risk that the treatment will cause problems?


Points to Consider in Treating an Enlarged Prostate

Reasons to use medication for an enlarged prostate:

  • You have moderate, bothersome BPH symptoms.
  • You have tried watchful waiting, but symptoms are still bothersome.
  • You've tried making lifestyle changes, like drinking fewer liquids.
  • You are at risk for complications related to BPH, like urinary retention.

Reasons to try watchful waiting for an enlarged prostate:

  • Your BPH symptoms are mild and not bothersome.
  • You don't want the side effects of medications.
  • It’s less costly than medical or surgical treatments.
  • From one-third to one-half (31% to 55%) of men with mild BPH symptoms find that symptoms improve without treatment.
  • You must take medications indefinitely to control BPH symptoms.
WebMD Medical Reference Reviewed by Stuart Bergman, MD on September 14, 2015



FDA web site. 

American Urological Association: "Benign Prostatic Hyperplasia (BPH): A Patient's Guide; "Benign Prostatic Hyperplasia (BPH);" and "Clinical Guidelines."

Agency for Healthcare Policy Research.

William Jaffe, MD, professor of urology, Temple University School of Medicine, Philadelphia.

National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC): "Prostate Enlargement: Benign Prostatic Hyperplasia."

Lebdai S, BJU Int, Feb. 2010.


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