Your doctor can discuss with you the various treatment options and the likelihood of symptom relief they may provide. All treatments have various side effects, which need to be taken into consideration. Quality of life is as important as symptom severity.

Treatment Options

Medications. In general, there is no reason to treat BPH with medications unless symptoms become very bothersome. The size of the prostate, determined by exam or ultrasound, cannot indicate the need for medications. Evidence suggests that:

• Medications are the best choice for men with mild-to-moderate symptoms who want treatment. There choices include alpha-blockers, anti-androgens, a combination of the two. Specific factors indicate the best choice, although most men take an alpha-blocker.
• Men with moderate-to-severe symptoms often respond to the same medications as men with mild symptoms. Recent developments in drug therapy have reduced or delayed the need for surgery.

Surgery. A quarter of men with moderate symptoms, and even more men with severe symptoms, eventually need surgery. If a man chooses surgery, there are many choices. Transurethral resection of the prostate (TURP) is the standard procedure, but less invasive procedures, particularly those using heat or lasers to destroy prostate tissue, are becoming more common.

Click the icon to see an illustrated series detailing transurethral resection of the prostate surgery.

The most common reason for choosing surgery is obstruction of the bladder outlet, which causes urinary retention. Surgery may also be a reasonable option when BPH is clearly related to one or more of the following conditions:

• Recurrent urinary tract infection
• Blood in the urine (hematuria). Studies have suggested that when hematuria is left untreated, many patients continue to bleed. The drug finasteride may help some men with this condition and should probably be tried before surgery.
• Bladder stones
• Kidney problems
• Moderate-to-severe symptoms that are not well controlled with medications

Increased urinary flow and reduced urine retention are the greatest improvements resulting from surgery. Often, however, the benefits of surgery are not permanent.

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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)