Treatments for Enlarged Prostate (BPH)

Reviewed by Brunilda Nazario, MD, March 2006

Symptoms and the need for treatment vary with each man's enlarged prostate, also called benign prostatic hyperplasia (BPH). And every treatment has its own benefits and risks. These factors must be weighed as you decide how to treat your BPH symptoms.

Your Quality of Life With BPH

If your BPH symptoms are mild and not bothersome, there's likely no need for treatment. One-third of men with mild BPH find that their symptoms clear up without treatment. They may just practice watchful waiting.

However, when enlarged prostate symptoms are bothersome or are affecting your quality of life or overall health, it's time to talk to your doctor about the treatment options. Together you will determine if you would benefit most from medication, a minimally invasive procedure, or surgery.

It's important to talk with a doctor when you begin noticing changes in your urinary function. You need to find out what's going on so you can be treated for enlarged prostate if necessary. For many men, especially those who are young when the prostate starts growing, getting early treatment can prevent complications later on.

Assessing the Symptoms of Your Enlarged Prostate

To help your doctor understand how bothersome your symptoms are for you, the American Urological Association has developed a BPH Symptom Index. This is a brief questionnaire that asks about specific symptoms and how frequently they occur. Each answer is assigned a number - and your total is ranked on a scale ranging from mild to severe.

An AUA score of 0 to 7 is considered a mild symptom score; 8 or over is considered moderate to severe.

The AUA recommends the following treatment for enlarged prostate based on the severity of symptoms:

• Mild symptoms that don't bother you (AUA score 0 to 7): If you are not bothered by your symptoms, and they don't affect your daily life, watchful waiting is the best option for you. You should get regular checkups to make sure that you are not developing complications.
• Moderate to severe symptoms (AUA score of 8 or more): If you are not bothered by your symptoms, you may choose watchful waiting. However, if your symptoms do start to interfere, you may choose medication, a minimally invasive procedure, or surgery.
• Moderate to severe symptoms (AUA score of 8 or more) with complications: If symptoms are bothersome and you have developed complications such as inability to urinate, you may need a catheter, surgery, or another treatment.

Questions to Ask Yourself About BPH Treatment

When you discuss your treatment options with your doctor, keep these points in mind:

• How much are my symptoms bothering me?
• Do they keep me from doing things I enjoy?
• How long do I want to deal with them?
• Am I willing to accept small risks to improve my symptoms?
• Do I understand the risks?
• Am I ready to do something about this problem?

Other Points to Consider With Enlarged Prostate

Need for repeat procedures: With minimally invasive procedures for enlarged prostate, there is a chance you will need to have a repeat procedure later on. Having the procedure when you're young makes that a near certainty. However, that may be a risk you're willing to take -- to avoid surgery and the associated risks in the short term.

Side effects of treatments: Some BPH treatments cause erection problems, although that risk is low. Some treatments cause retrograde ejaculation (the man ejaculates into the bladder instead of through the urethra). Fertility can also be affected, but is still possible with newer assisted reproductive techniques. With any BPH surgery, there may be a slight risk of erection problems. However, men who have normal erections before surgery will not likely have trouble afterward.

Multiple health problems: If you have other health problems, your treatment options for enlarged prostate may be affected. For example, if you have had heart bypass surgery in the past, having surgery with general anesthesia may be too risky. However, spinal anesthesia may be safe for you -- or you may wish to have a minimally invasive office procedure that doesn't require anesthesia at all.

Talk to your doctor about your symptom score, your concerns, and about the plan of treatment that works best for your enlarged prostate problems.

Published March 2006.

SOURCES: American Urological Association: "Diagnosis of BPH," "Benign Prostatic Hyperplasia (BPH)," "Clinical Guidelines." National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC): "Prostate Enlargement: Benign Prostatic Hyperplasia." William Jaffe, MD, professor of urology, Temple University School of Medicine, Philadelphia.