About this page. This is a plain English summary of how an enlarged prostate (BPH) is managed without surgery. It does not replace medical advice from your own doctor or specialist.
For full information and references, please read the detailed page.
First, the good news
An enlarged prostate is not cancer. The two are separate problems and one does not cause the other. For some men the most useful thing is simply to be told that, and reassured.
Treatment depends on how much the symptoms bother you, not on the size of the prostate alone. If you are not bothered, you may not need any treatment.
Medications: the three families
If symptoms are mild to moderate, medications are usually tried first. There are three main families:
- Alpha blockers. These tablets relax the bladder neck and the prostate, so urine flows more easily. They take about two weeks to work and are usually taken long term. The main side effects are dizziness or feeling lightheaded. Some men get retrograde ejaculation (semen passes back into the bladder); this reverses if the medication is stopped.
- 5-alpha reductase inhibitors. These tablets shrink the prostate over time. They take around three months to work. Possible side effects include erection problems and breast tenderness. They are most useful for very large prostates or for men with recurrent bleeding from the prostate.
- Herbal medicines such as Saw Palmetto. Some men report a benefit, but a large review in The Lancet found no clear extra benefit over placebo.
About 1 in 5 men get better on their own without any treatment, so it is worth pausing medication from time to time to see if you still need it.
What if medications are not enough?
If symptoms stay troublesome, or if there are problems like repeated infections, urinary retention, or bladder damage, then surgical or heat-based treatments are discussed. Dr Kooner offers all the main options - see the short version: surgery for an enlarged prostate for plain English summaries.
Important things to know
- Treatment is guided by symptoms, not just prostate size. A large prostate that is not causing problems often needs no treatment at all.
- Every medication has side effects. The right choice depends on which side effects you are willing to accept and which symptoms bother you most.
- If you start a medication, it is reasonable to stop and review at some point - some men no longer need it.
- If you have blood in the urine, sudden inability to pass urine, or repeated urinary infections, please see your doctor promptly. These are reasons to look at the prostate (and sometimes the bladder and kidneys) more carefully.
What you can do next
- Read the full detailed page with references and patient brochures.
- Short version overview of an enlarged prostate.
- Short version: how an enlarged prostate is assessed.
- Short version: the surgical options.
- Request a second opinion on a treatment plan.
- Call 02 8382 6980 to make an appointment.