Enlarged Prostate (BPH) Symptoms & Treatment | Dr. Theodore Cisu

The short answer: An enlarged prostate, or benign prostatic hyperplasia (BPH), is a non-cancerous growth of the prostate that becomes very common as men get older. It can press on the urine channel and cause a weak stream, frequent urination and getting up at night. Treatment ranges from simple habit changes and medication to office procedures and surgery. The right choice depends on how much your symptoms bother you, the size and shape of your prostate, and what matters most to you.

Written by Theodore Cisu, MD, board-certified urologist. Based on the American Urological Association (AUA) guideline on the management of lower urinary tract symptoms attributed to BPH (2026). Last reviewed November 2026.

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What is an enlarged prostate (BPH)?

The prostate is a small gland that sits just below the bladder. The urethra, the tube that carries urine out of the body, runs right through the middle of it. As men age, the prostate often grows. BPH stands for benign prostatic hyperplasia. "Benign" means it isn't cancer, and BPH doesn't turn into prostate cancer.

As the prostate grows, it can narrow the urethra. The bladder then has to work harder to push urine out, and over time the bladder itself can change. That's why doctors often talk about "lower urinary tract symptoms," or LUTS. Your symptoms may come from the prostate, the bladder, or both. The 2026 AUA guideline points out that these symptoms often have more than one cause, and that protecting the health of your bladder is part of good care.

Symptoms of an enlarged prostate

• A weak or slow urine stream
• Trouble getting started
• A stream that stops and starts
• Straining to empty
• Feeling like your bladder isn't fully empty
• Dribbling at the end
• Urinating often during the day
• Waking up at night to urinate (nocturia)
• Sudden, strong urges to go, sometimes with leaking

Prostate size doesn't always match how bothersome symptoms are.

What causes BPH?

Prostate growth is a normal part of aging and is driven partly by male hormones. Family history may play a role too. Other things can make urinary symptoms worse, whatever the prostate size:

• Drinking a lot of fluid, caffeine or alcohol, especially in the evening
• Some medications, such as decongestants, antihistamines and certain diuretics
• Constipation
• Diabetes, sleep apnea and other health conditions that affect the bladder or nighttime urine production

How is BPH diagnosed?

Your first visit usually includes:

• Your history and medication list
• A symptom questionnaire. The International Prostate Symptom Score (IPSS) rates your symptoms and how much they bother you. It also helps track how well treatment works.
• A physical exam, which may include a rectal exam to feel the prostate
• A urine test to look for infection or blood
• A PSA blood test, when it makes sense for you, after talking through the pros and cons

If you're considering a procedure, your urologist will usually also check how well your bladder empties (a quick bladder scan), measure the strength of your stream, and look at the size and shape of your prostate with ultrasound, imaging or cystoscopy. Dr. Cisu performs office cystoscopy, a short look inside with a thin, flexible camera, when it's needed. More detailed bladder pressure testing is saved for cases where the cause of symptoms isn't clear.

Treatment options

Treatment is guided mainly by how much your symptoms bother you. If they're mild, watching and making a few changes can be a reasonable choice. The AUA guideline puts shared decision-making at the center: you and your urologist weigh how well each option works, how long it lasts, and its side effects.

Lifestyle changes

• Limit fluids in the 2 to 3 hours before bed
• Cut back on caffeine and alcohol
• Try "double voiding": urinate, wait a moment, then try again
• Review your medications with your doctor
• Treat constipation and stay active

Medications

• Alpha-blockers such as tamsulosin, alfuzosin and silodosin relax the muscle in the prostate and bladder neck. They often help within days to weeks. Side effects can include dizziness and changes in ejaculation. Tell your eye surgeon you take one before cataract surgery.
• 5-alpha reductase inhibitors such as finasteride and dutasteride slowly shrink an enlarged prostate over several months. Over time they can lower the chance of urinary retention or needing surgery. They lower your PSA reading, so anyone checking your PSA needs to know you take one. They can have sexual side effects.
• Daily low-dose tadalafil can ease urinary symptoms, with or without erection problems.
• Combination therapy pairs medicines that work in different ways.
• Bladder medicines can be added when urgency and frequency are the main problem.

Your urologist will usually check in about 4 to 12 weeks after you start a new treatment to see how it's working.

UroLift (prostatic urethral lift)

Small implants hold the enlarged prostate tissue out of the way, like tiebacks on a curtain. Nothing is cut or heated. It's a fit for many men with a small to moderate-sized prostate and no blocking middle lobe. It's designed to protect erections and ejaculation. Some men need another treatment down the road.

Rezum (water vapor therapy)

Rezum uses small doses of steam to treat the extra prostate tissue, which the body then gradually clears. Symptoms improve over the following weeks to months, and some men need a catheter for a short time afterward. It's an option for many small to moderate-sized prostates and for men who want to protect sexual function.

TURP (transurethral resection of the prostate)

TURP is a long-standing standard. Using a scope passed through the urethra, the surgeon removes the tissue blocking the channel. There are no incisions. It works well for many men. A common side effect is "dry" orgasm, where semen goes back into the bladder.

Laser vaporization of the prostate

A laser removes the blocking tissue from the inside, also with no incisions. Laser approaches may suit men at higher risk of bleeding, including some who take blood thinners. Dry orgasm is common afterward.

Robotic simple prostatectomy

For a large or very large prostate, the inner part of the gland that blocks urine flow can be removed through small incisions with robotic surgery. It requires a short hospital stay and a catheter for a period of time afterward.

Other options

Your urologist can also discuss options such as robotic waterjet treatment (Aquablation), laser enucleation (HoLEP), and prostate artery embolization, which is done by an interventional radiologist. When one of these fits you best, Dr. Cisu can coordinate a referral.

Will treatment affect my sex life?

It can. Some medicines and many procedures affect ejaculation, and a few affect erections. If keeping your sexual function matters to you, say so early. Several options, including UroLift and Rezum, are designed with that in mind.

When to see a urologist

• Your symptoms bother you or disrupt your sleep
• Medication isn't helping or causes side effects you don't want
• You see blood in your urine
• You have repeat urinary infections or bladder stones
• Your PSA is elevated or your prostate exam was abnormal
• A doctor has told you your bladder isn't emptying well or your kidney function has changed

When it's an emergency

Go to the emergency room if you can't urinate at all and your lower belly is full and painful. This is called urinary retention. Cold medicines, some pain medicines and anesthesia can trigger it. A catheter brings quick relief. Seek care right away for fever or chills with urinary symptoms too.

Seeing Dr. Cisu for an enlarged prostate

Dr. Theodore Cisu cares for men with BPH at his clinics in Charlottesville and Fishersville. You can start with a telehealth visit from anywhere in Virginia. Our office can request your records, imaging and lab results ahead of time so Dr. Cisu reviews them before you talk. Second opinions are welcome, and no referral is needed. Book a visit.

Frequently asked questions

Does an enlarged prostate mean I have cancer?

No. BPH is a non-cancerous condition and doesn't turn into cancer. The two can exist at the same time, though, so prostate cancer screening is a separate conversation with your doctor.

Will BPH go away on its own?

The prostate doesn't usually shrink on its own. Symptoms can stay stable for years, improve with simple changes, or slowly get worse. Regular check-ins help you decide when treatment makes sense.

Which BPH treatment protects ejaculation?

UroLift and Rezum were designed with sexual function in mind, and daily tadalafil doesn't affect ejaculation. TURP and laser procedures commonly cause dry orgasm. Your urologist can walk you through the trade-offs for your situation.

Does prostate size matter for choosing a procedure?

Yes. Some procedures work best for small to moderate prostates, while larger glands may do better with laser treatment or robotic simple prostatectomy. The shape of the prostate, including whether there's a middle lobe, matters too.

Can I have a procedure if I take blood thinners?

Often, yes. Some approaches carry less bleeding risk than others. Don't stop a blood thinner on your own. Your urologist will plan with your prescribing doctor.

Sources

• American Urological Association. AUA releases the Management of LUTS Attributed to BPH Guideline (2026).
• Management of Lower Urinary Tract Symptoms Attributed to Benign Prostatic Hyperplasia: AUA Guideline (2026) Part III: Procedural/Surgical Management. The Journal of Urology.

This article is for general education and isn't a substitute for medical advice. If you can't urinate at all, or you have fever or chills with urinary symptoms, go to the nearest emergency room.