Your doctor will start by asking detailed questions about your symptoms and doing a physical exam. This initial exam is likely to include:
- Digital rectal exam. The doctor inserts a finger into the rectum to check your prostate for enlargement.
- Urine test. Analyzing a sample of your urine can help rule out an infection or other conditions that can cause similar symptoms.
- Blood test. The results can indicate kidney problems.
- Prostate-specific antigen (PSA) blood test. PSA is a substance produced in your prostate. PSA levels increase when you have an enlarged prostate. However, elevated PSA levels can also be due to recent procedures, infection, surgery or prostate cancer.
After that, your doctor might recommend additional tests to help confirm an enlarged prostate and to rule out other conditions. These tests include:
- Urinary flow test. You urinate into a receptacle attached to a machine that measures the strength and amount of your urine flow. Test results help determine over time if your condition is getting better or worse.
- Postvoid residual volume test. This test measures whether you can empty your bladder completely. The test can be done using ultrasound or by inserting a catheter into your bladder after you urinate to measure how much urine is left in your bladder.
- 24-hour voiding diary. Recording the frequency and amount of urine might be especially helpful if more than one-third of your daily urinary output occurs at night.
If your condition is more complex, your doctor may recommend:
- Transrectal ultrasound. An ultrasound probe is inserted into your rectum to measure and evaluate your prostate.
- Prostate biopsy. Transrectal ultrasound guides needles used to take tissue samples (biopsies) of the prostate. Examining the tissue can help your doctor diagnose or rule out prostate cancer.
- Urodynamic and pressure flow studies. A catheter is threaded through your urethra into your bladder. Water — or, less commonly, air — is slowly injected into your bladder. Your doctor can then measure bladder pressure and determine how well your bladder muscles are working. These studies are usually used only in men with suspected neurological problems and in men who have had a previous prostate procedure and still have symptoms.
- Cystoscopy. A lighted, flexible instrument (cystoscope) is inserted into your urethra, allowing your doctor to see inside your urethra and bladder. You will be given a local anesthetic before this test.
Tests and diagnosis at Mayo Clinic
Mayo Clinic specialists have experience diagnosing complex conditions involving enlarged prostate. You have access to the latest diagnostic testing, including urodynamic and pressure flow studies.
A wide variety of treatments are available for enlarged prostate, including medication, minimally invasive therapies and surgery. The best treatment choice for you depends on several factors, including:
- The size of your prostate
- Your age
- Your overall health
- The amount of discomfort or bother you are experiencing
If your symptoms are tolerable, you might decide to postpone treatment and simply monitor your symptoms. For some men, symptoms can ease without treatment.
Medication is the most common treatment for mild to moderate symptoms of prostate enlargement. The options include:
- Alpha blockers. These medications relax bladder neck muscles and muscle fibers in the prostate, making urination easier. Alpha blockers — which include alfuzosin (Uroxatral), doxazosin (Cardura), tamsulosin (Flomax) and silodosin (Rapaflo) — usually work quickly in men with relatively small prostates. Side effects might include dizziness and a harmless condition in which semen goes back into the bladder instead of out the tip of the penis (retrograde ejaculation).
- 5-alpha reductase inhibitors. These medications shrink your prostate by preventing hormonal changes that cause prostate growth. These medications — which include finasteride (Proscar) and dutasteride (Avodart) — might take up to six months to be effective. Side effects include retrograde ejaculation.
- Combination drug therapy. Your doctor might recommend taking an alpha blocker and a 5-alpha reductase inhibitor at the same time if either medication alone isn't effective.
- Tadalafil (Cialis). Studies suggest this medication, which is often used to treat erectile dysfunction, can also treat prostate enlargement.
Minimally invasive or surgical therapy
Minimally invasive or surgical therapy might be recommended if:
- Your symptoms are moderate to severe
- Medication hasn't relieved your symptoms
- You have a urinary tract obstruction, bladder stones, blood in your urine or kidney problems
- You prefer definitive treatment
Minimally invasive or surgical therapy might not be an option if you have:
- An untreated urinary tract infection
- Urethral stricture disease
- A history of prostate radiation therapy or urinary tract surgery
- A neurological disorder, such as Parkinson's disease or multiple sclerosis
Any type of prostate procedure can cause side effects. Depending on the procedure you choose, complications might include:
- Semen flowing backward into the bladder instead of out through the penis during ejaculation (retrograde ejaculation)
- Temporary difficulty with urination
- Urinary tract infection
- Erectile dysfunction
- Very rarely, loss of bladder control (incontinence)
There are several types of minimally invasive or surgical therapies.
Transurethral resection of the prostate (TURP)
A lighted scope is inserted into your urethra, and the surgeon removes all but the outer part of the prostate. TURP generally relieves symptoms quickly, and most men have a stronger urine flow soon after the procedure. After TURP you might temporarily need a catheter to drain your bladder.
Transurethral incision of the prostate (TUIP)
A lighted scope is inserted into your urethra, and the surgeon makes one or two small cuts in the prostate gland — making it easier for urine to pass through the urethra. This surgery might be an option if you have a small or moderately enlarged prostate gland, especially if you have health problems that make other surgeries too risky.
Transurethral microwave thermotherapy (TUMT)
Your doctor inserts a special electrode through your urethra into your prostate area. Microwave energy from the electrode destroys the inner portion of the enlarged prostate gland, shrinking it and easing urine flow. TUMT might only partially relieve your symptoms, and it might take some time before you notice results. This surgery is generally used only on small prostates in special circumstances because re-treatment might be necessary.
Transurethral needle ablation (TUNA)
In this outpatient procedure, a scope is passed into your urethra, allowing your doctor to place needles into your prostate gland. Radio waves pass through the needles, heating and destroying excess prostate tissue that's blocking urine flow.
This procedure might be a good choice if you bleed easily or have certain other health problems. However, like TUMT, TUNA might only provide partial relief and results might take some time.
A high-energy laser destroys or removes overgrown prostate tissue. Laser therapy generally relieves symptoms right away and has a lower risk of side effects than does nonlaser surgery. Laser therapy might be used in men who shouldn't have other prostate procedures because they take blood-thinning medications.
The options for laser therapy include:
- Ablative procedures. These procedures vaporize obstructive prostate tissue to increase urine flow. Examples include photoselective vaporization of the prostate (PVP) and holmium laser ablation of the prostate (HoLAP). Ablative procedures can cause irritating urinary symptoms after surgery, so in rare situations another resection procedure might be needed at some point.
- Enucleative procedures. Enucleative procedures, such as holmium laser enucleation of the prostate (HoLEP), generally remove all the prostate tissue blocking urine flow and prevent regrowth of tissue. The removed tissue can be examined for prostate cancer and other conditions. These procedures are similar to open prostatectomy.
Prostatic urethral lift (PUL)
In this relatively new transurethral procedure, special tags are used to compress the sides of the prostate to increase the flow of urine. The procedure might be recommended if you have lower urinary tract symptoms. However, PUL might not be as effective at reducing long-term urinary symptoms as TURP. More research is needed. PUL also might be offered to some men concerned about treatment impact on erectile dysfunction and ejaculatory problems, since the effect on ejaculation and sexual function is much lower with PUL than it is with TURP.
In this experimental procedure, the blood supply to or from the prostate is selectively blocked, causing the prostate to decrease in size. Long-term data on the effectiveness of this procedure aren't available.
Open or robot-assisted prostatectomy
The surgeon makes an incision in your lower abdomen to reach the prostate and remove tissue. Open prostatectomy is generally done if you have a very large prostate, bladder damage or other complicating factors. The surgery usually requires a short hospital stay and is associated with a higher risk of needing a blood transfusion.
Your follow-up care will depend on the specific technique used to treat your enlarged prostate.
Your doctor might recommend limiting heavy lifting and excessive exercise for seven days if you have laser ablation, transurethral needle ablation or transurethral microwave therapy. If you have open or robot-assisted prostatectomy, you might need to restrict activity for six weeks.
Mayo Clinic Minute: Steam treatment for enlarged prostate
It's a common problem for older men: benign prostatic hyperplasia, or BPH.
"BPH is a fancy way of saying the prostate is getting larger, and we don't want it to."
Dr. Toby Kohler, a Mayo Clinic urologist, says the enlarged prostate forces the urethra to narrow, causing a variety of urination problems. And as men age, the symptoms occur more frequently.
Treatment for BPH has long been medications and procedures, such as lasers or an electric loop, which burn the prostate from the inside out.
But, now, a relatively new convective water therapy treatment uses steam to make the prostate smaller.
"For nine seconds, a steam ball is produced and that kills all that prostate tissue that we don't want or that has grown out of control."
Dr. Kohler says the procedure, performed right in the doctor's office, has a very low risk for complications or sexual side effects.
"It does not carry heat outside the prostate, and it does not carry heat to areas we don't want it."
He says this next generation of BPH treatment may soon replace the need for costly medications.
For the Mayo Clinic News Network, I'm Jason Howland.
Treatment at Mayo Clinic
Mayo Clinic specialists have training in a wide range of state-of-the-art technology to treat enlarged prostates. You have access to the latest noninvasive laser treatments, including HoLEP and PVP lasers. Your Mayo Clinic specialist will explain the range of treatments available and help you choose the best approach based on your symptoms.
Explore Mayo Clinic studies testing new treatments, interventions and tests as a means to prevent, detect, treat or manage this disease.
Lifestyle and home remedies
To help control the symptoms of an enlarged prostate, try to:
- Limit beverages in the evening. Don't drink anything for an hour or two before bedtime to avoid middle-of-the-night trips to the toilet.
- Limit caffeine and alcohol. They can increase urine production, irritate the bladder and worsen symptoms.
- Limit decongestants or antihistamines. These drugs tighten the band of muscles around the urethra that control urine flow, making it harder to urinate.
- Go when you first feel the urge. Waiting too long might overstretch the bladder muscle and cause damage.
- Schedule bathroom visits. Try to urinate at regular times — such as every four to six hours during the day — to "retrain" the bladder. This can be especially useful if you have severe frequency and urgency.
- Follow a healthy diet. Obesity is associated with enlarged prostate.
- Stay active. Inactivity contributes to urine retention. Even a small amount of exercise can help reduce urinary problems caused by an enlarged prostate.
- Urinate — and then urinate again a few moments later. This practice is known as double voiding.
- Keep warm. Colder temperatures can cause urine retention and increase the urgency to urinate.
The Food and Drug Administration hasn't approved any herbal medications for treatment of an enlarged prostate.
Studies on herbal therapies as a treatment for enlarged prostate have had mixed results. One study found that saw palmetto extract was as effective as finasteride in relieving symptoms of BPH, although prostate volumes weren't reduced. But a subsequent placebo-controlled trial found no evidence that saw palmetto is better than a placebo.
Other herbal treatments — including beta-sitosterol extracts, pygeum and rye grass — have been suggested as helpful for reducing enlarged prostate symptoms. But the safety and long-term efficacy of these treatments hasn't been proved.
If you take any herbal remedies, tell your doctor. Certain herbal products might increase the risk of bleeding or interfere with other medications you're taking.
Preparing for your appointment
You might be referred directly to a doctor who specializes in urinary issues (urologist).
What you can do
- Make a list of your symptoms, including any that may seem unrelated to the reason for which you scheduled the appointment.
- Keep track of how often and when you urinate, whether you feel you're completely emptying your bladder, and how much liquid you drink.
- Make a list of your key medical information, including other conditions you might have.
- Make a list of all medications, vitamins or supplements that you're currently taking.
- Write down questions to ask your doctor.
Questions to ask your doctor
- Is an enlarged prostate or something else likely causing my symptoms?
- What kinds of tests do I need?
- What are my treatment options?
- How can I manage other health conditions along with an enlarged prostate?
- Are there any restrictions on sexual activity?
Don't hesitate to ask other questions during your appointment.
What to expect from your doctor
Your doctor is likely to ask you a number of questions. Being ready to answer them might give you more time to address any concerns. You might be asked:
- When did you first begin experiencing urinary symptoms? Have they been continuous or occasional? Have they gradually worsened over time, or did they come on suddenly?
- How often do you urinate during the day, and how often do you need to get up at night to urinate?
- Have you ever leaked urine? Do you have a frequent or urgent need to urinate?
- Is it difficult for you to begin urinating? Do you start and stop when urinating, or feel like you have to strain to urinate? Does it ever feel like you haven't completely emptied your bladder?
- Is there any burning when you urinate, pain in your bladder area or blood in your urine? Have you had urinary tract infections?
- Do you have a family history of enlarged prostate, prostate cancer or kidney stones?
- Have you ever had any trouble getting and maintaining an erection (erectile dysfunction), or other sexual problems?
- Have you ever had surgery or another procedure that involved insertion of an instrument through the tip of your penis into your urethra?
- Are you taking any blood thinners, such as aspirin, warfarin (Coumadin, Jantoven) or clopidogrel (Plavix)?
- How much caffeine do you consume? What is your fluid intake?
Sept. 28, 2018