Treatment

Because BPH rarely causes serious complications, men usually have a choice between treating it or opting for watchful waiting:

• Watchful Waiting. Watchful waiting (also known as active surveillance) involves lifestyle changes and an annual examination. (Even when choosing watchful waiting, it is important to have a doctor perform an initial examination to rule out other disorders.) BPH is a progressive condition and as it worsens it can cause urinary tract infections, bladder damage, and kidney damage. Your doctor needs to monitor your condition to determine when it may be time to start treatment.
• Treatment. The primary goals of treatment for BPH are to improve urinary flow and to reduce symptoms. Many options are available. They include drug therapies to help shrink or relax the prostate, minimally invasive procedures that use heat to reduce excess prostate tissue, and major surgery to remove part of the prostate.

Deciding Between Treatment and Watchful Waiting

The choice between watchful waiting and treatment usually depends on symptom severity. The American Urological Association’s BPH Symptom Score uses seven questions to evaluate a patient’s urinary symptoms during the past month. (The International Prostate Symptoms Score is another index that is also used.) The questions are:

• How often have you had a sensation of not emptying your bladder completely after you finished urinating?
• How often have you had to urinate again less than two hours after you finished urinating?
• How often have you stopped and started again several times when you urinated?
• How often have you found it difficult to urinate?
• How often have you had a weak urinary stream?
• How often had you had to push or strain to begin urination?
• How many times did you most typically get up to urinate from the time you went to bed at night until the time you got up in the morning?

Responses for the first six questions are scaled from “not at all” to “almost always.” (The last question uses answers ranging from “none” to “5 or more times”.) Each response is assigned a number on a scale of 0 to 5, and totaled into a symptom score. The symptom score can fall anywhere between 0 and 35.

Patients with mild symptoms will have low scores and may decide to delay treatment. Higher scores indicate more severe symptoms. Treatment can reduce the score:

• A score reduction of 5 points indicates modest symptom relief
• A score reduction of 5 to 10 points indicates moderate symptom relief
• A score reduction of more than 10 points indicates large symptom relief

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Review Date: 07/20/2010
Reviewed By: Harvey Simon, MD, Editor-in-Chief, Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org)