Go to the emergency room now if you cannot urinate at all, especially if your lower belly feels full and painful. This is called urinary retention, and your bladder needs to be drained. Heavy bleeding in the urine with clots also needs emergency care.
What an enlarged prostate is
The prostate is a walnut-sized gland that sits just below the bladder. It wraps around the urethra, the tube that carries urine out of the body. In many men the prostate slowly grows with age. Doctors call this benign prostatic hyperplasia, or BPH. “Benign” means it is not cancer.
As the prostate grows, it can squeeze the urethra, and the bladder has to work harder to push urine out. The exact cause is not known. It is thought to be related to changes in hormone levels as men age. Family history and obesity may also play a part, and some medicines, such as certain cold and allergy pills, can make symptoms worse.
Common symptoms
- Trouble starting to urinate, or a stream that stops and starts
- A weak or slow stream
- Needing to go often, or suddenly and urgently
- Getting up at night to urinate
- Feeling that your bladder is not empty when you finish
- Dribbling at the end
Prostate size and symptoms do not always match. Some men with a large prostate have few problems, while others with a smaller one have a lot of trouble. Treatment is guided by how much your symptoms bother you and whether they are affecting your bladder or kidneys.
Why these symptoms deserve a proper check
The same urinary symptoms can come from other conditions, including prostate cancer, bladder problems, infection or stones. BPH itself is not cancer and does not raise your risk of prostate cancer, but a man can have both at the same time. That is why it is important to have urinary symptoms checked rather than assume they are just part of getting older.
Depending on your symptoms, your visit may include a short symptom questionnaire, a urine test, a PSA blood test, a prostate exam and a quick scan to see how well your bladder empties. If your PSA is high, Dr. Su explains what it means and what comes next. You can read more in what happens after a high PSA.
Treatment, step by step
Most men start with the simplest option that controls their symptoms and move to the next step only if they need to.
Watchful waiting
If your symptoms are mild and do not bother you much, you may not need treatment yet. Simple changes often help: drink less in the evening, cut back on caffeine and alcohol, and review any medicines that make urinating harder. Dr. Su checks in over time to make sure nothing is changing.
Alpha-blockers
These pills relax the muscles in the prostate and at the opening of the bladder so urine flows more easily. They often help within days to weeks. Tamsulosin is a common example. Some men feel lightheaded when they stand up, and some notice less fluid when they ejaculate.
5-alpha-reductase inhibitors
These pills, such as finasteride and dutasteride, slowly shrink the prostate. They take several months to work fully and help most when the prostate is large. They also lower your PSA number, so tell anyone who checks your PSA that you take one. They can be combined with an alpha-blocker.
A procedure
A procedure makes sense when medicine does not help enough, causes side effects, or you would rather not take pills every day. It is also recommended when BPH leads to problems such as not being able to urinate, repeat infections, bladder stones, bleeding or strain on the kidneys.
Procedures Dr. Su performs
Dr. Su performs a range of procedures for an enlarged prostate, including the ones below. Each works differently and has its own trade-offs.
| Procedure | How it works | Setting | Good to know |
|---|---|---|---|
| UroLift | Small implants lift and hold the enlarged tissue away from the urethra, like tiebacks on a curtain. No tissue is removed. | Minimally invasive; outpatient | Less risk of ejaculation problems |
| Rezūm | Steam (water vapor) is used to destroy the extra prostate tissue. | Minimally invasive; outpatient | Less risk of ejaculation problems. Urinary irritation can be more noticeable for a while afterward. |
| GreenLight PVP | A laser destroys the tissue that is blocking the flow. PVP stands for photoselective vaporization of the prostate. | General anesthesia; can be outpatient | Less bleeding. More irritation (burning or urgency) for a while afterward. |
| Aquablation | A high-velocity, heat-free waterjet guided by a robotic system removes the extra prostate tissue. | General anesthesia; about 60 minutes; usually home the same day, sometimes one night | Less risk of ejaculation problems |
| TURP | Transurethral resection of the prostate. The extra tissue is trimmed away from the inside with an electric loop, which is why it is nicknamed the “roto-rooter.” | General anesthesia; about 60 minutes; overnight stay | The long-established standard, with a high success rate. Higher chance of ejaculation problems. |
| Robotic simple prostatectomy | Through small incisions in the abdomen, the inside of the prostate is removed and the outer shell is left in place: the orange, not the peel. | General anesthesia; overnight stay; catheter for about 1 week | Very effective for large prostates, over 100 grams |
“Ejaculation problems” usually means retrograde ejaculation, where semen flows backward into the bladder instead of out through the penis. It is not harmful, but it matters to many men, especially those who hope to father children. Tell Dr. Su if keeping normal ejaculation is important to you.
How Dr. Su helps you choose
No single procedure is right for everyone. Dr. Su looks at the size and shape of your prostate, how strong your symptoms are, your other health conditions and medicines (such as blood thinners), and what matters most to you. For one man that is a quick recovery; for another it is avoiding a hospital stay or protecting ejaculation. She goes through the options with you and explains why she recommends one over another. For a longer look at the trade-offs, read choosing an enlarged prostate procedure.
Questions patients ask
Is an enlarged prostate a sign of cancer?
No. BPH is not cancer and does not raise your risk of prostate cancer. But the symptoms can overlap, and a man can have both, which is why Dr. Su checks for other causes before treating your symptoms as BPH.
Will I need surgery?
Most men do not start there. Lifestyle changes and medicine control symptoms for many men. A procedure is usually considered when medicine is not enough, causes side effects, or BPH starts causing problems such as not being able to urinate.
Will I go home with a catheter?
It depends on the procedure. After Aquablation you wake up with a catheter and usually go home the same day with it in place for a short time. After robotic simple prostatectomy, the catheter usually stays in for about a week. Dr. Su will tell you what to expect for the procedure you choose.
My prostate is very large. Can it still be treated?
Yes. Robotic simple prostatectomy is very effective for prostates over 100 grams, and Aquablation is another option for many large prostates. Dr. Su will review your imaging and explain which approaches fit you.