Prostate ยท BPH pathway
Enlarged prostate (BPH) treatment: a step-by-step pathway
BPH is a common, age-related enlargement of the prostate that can restrict urine flow. Because prostate cancer is central to Dr. Mally’s practice, urinary symptoms start with the same question: what is actually causing them? This guide follows the order a careful evaluation takes: rule out the urgent, understand the pattern, test, then choose treatment.
Common signs
- Weak or stop-and-start stream
- Waking at night to urinate
- Urgency or a sense of incomplete emptying
Get seen if
- Symptoms bother you or disturb sleep
- Blood in the urine, fever or burning
- Cannot urinate: go to emergency care
Options in brief
- Monitoring and habits, then medicines
- Procedures matched to prostate size
- Surgery for large glands or complications
Recognize the pattern: BPH symptoms
The prostate is a gland below the bladder that makes semen. When it enlarges it can squeeze the urethra. Typical complaints: frequent or urgent urination, getting up at night (nocturia), trouble starting, a weak or stop-and-start stream, dribbling at the end, and a feeling the bladder has not emptied. Severity does not reliably track size: a small enlargement can cause serious symptoms and a large one very little.
Several medicines can make symptoms worse, especially decongestants and antihistamines in cold and allergy remedies, and some diuretics and antidepressants. Bring your full medication list.
Get the diagnosis right: rule out look-alikes
Urinary infection, an inflamed prostate, narrowing of the urethra, bladder or kidney stones, and prostate cancer can all produce the same complaints. Evaluation typically includes your history, a physical exam, a digital rectal exam to feel the prostate, a urine test and a PSA blood test to help rule out prostate cancer. A post-void residual (urine left after you go), a urine-flow study or ultrasound may follow.
This is where Dr. Mally’s oncology background matters: a weak stream and night-time urination can come from BPH, from the bladder, or from prostate cancer, and PSA can be raised by benign causes too. Sorting these apart is the point of the evaluation. See the prostate cancer guide for what PSA can and cannot tell you.
Choose a treatment: the options ladder
The usual progression runs from least to most invasive. You can stop on any rung that works.
- Monitoring and habits. Reasonable for mild symptoms without complications. Shift fluids earlier (nothing large in the two to three hours before bed), limit caffeine and alcohol, urinate on a schedule, stay active and do pelvic floor exercises.
- Medicines. Alpha blockers relax the bladder neck and prostate; 5-alpha reductase inhibitors shrink or slow growth of the gland; some men take both. Side effects range from minor to significant, so review them before starting.
- Procedures, matched to prostate size (below). They carry real trade-offs, and your doctor will go through them with you.
- Surgery. For symptoms not helped by medicine, severe symptoms or complications. Surgery can relieve symptoms but may not cure BPH, and usually involves a temporary catheter.
| Prostate size | Option | What it does | Trade-offs to discuss |
|---|---|---|---|
| Smaller (under about 40 cc) | UroLift | Implants lift and hold prostate tissue out of the way | Temporary urinary discomfort; rarely bleeding or infection; more treatment may be needed later |
| Prostate artery embolization | Blocks part of the blood supply to shrink the gland; done by an interventional radiologist | Results take weeks to months; puncture-site pain or bruising; rare retention | |
| Medium (about 40 to 80 cc) | Aquablation | Robotic water jet removes tissue | Overnight hospital stay; bleeding or retention; rarely stricture or sexual effects |
| TURP | Heated loop removes tissue through the urethra | Bleeding; erectile dysfunction or incontinence risk; retrograde ejaculation | |
| Larger (over about 80 cc) | HoLEP | Laser separates and removes tissue | One-night stay; bleeding or retention; retrograde ejaculation |
| Prostate artery embolization | As above | As above | |
| Robotic simple prostatectomy | Robotic removal of the inner prostate tissue | Bleeding or infection; temporary incontinence; retrograde ejaculation |
Not every option is offered by every physician or at every office. Ask which of these Dr. Mally recommends for you and where each would be done.
Know the stakes: what untreated BPH can lead to
When emptying is poor, possible complications include urinary retention, infections, bladder stones, blood in the urine and kidney problems. Most men do not get there. The aim is an informed decision about monitoring versus treating, not a rush to a procedure.
Questions & answers
What is the difference between BPH and prostate cancer?
BPH is benign growth. Prostate cancer is malignant cell growth in the prostate. They can coexist and can share urinary symptoms, so an exam and a PSA discussion are part of a sensible evaluation.
What are my BPH treatment options?
Monitoring and habit changes, medicines, minimally invasive procedures and surgery. The right rung depends on how bothersome your symptoms are, your prostate size, other health conditions and your priorities.
Why do I wake up at night to urinate?
Nocturia has many causes: BPH, fluid timing, caffeine or alcohol, sleep disorders, heart or kidney conditions and certain medicines. Treating the prostate will not help if the cause is elsewhere, which is why evaluation comes first.
Will prostate treatment affect sexual function?
Some medicines and procedures can, and some are chosen specifically to preserve it. Ask for the specific risks of each option for you before choosing.
Advanced Urology resources
- BPH care at Advanced Urology: Advanced Urology’s overview of this condition and its care team.
- UroLift at Advanced Urology
- Aquablation at Advanced Urology
This page is general information and may not apply to your situation. Talk with your doctor about what is right for you.
Next steps
BPH care at Advanced Urology or call (404) 586-4570 (Advanced Urology line)