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How is an enlarged prostate treated?

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There are three main types of treatment for an enlarged prostate:

  • lifestyle changes
  • medicines
  • surgery.

If tests show you have an enlarged prostate, your doctor or specialist nurse will look at your test results and medical history to see which treatments might be suitable. They will explain your treatment options and help you decide what’s right for you. It’s important to see how you feel about each treatment before making a decision.

Depending on the treatment you choose, you may have regular check-ups with your GP, or with a specialist at the hospital. They may repeat some tests to see how well your treatment is working. If your symptoms don’t improve or your treatment is causing side effects, you may be able to try a different treatment.

Lifestyle changes

If your enlarged prostate isn’t causing problems, you may decide to wait and see if your symptoms get worse before having treatment. An enlarged prostate usually develops slowly, and your symptoms may never get any worse.

There are simple changes you can make to your lifestyle that might help your symptoms.

Drink less alcohol, caffeine, artificial sweeteners and fizzy drinks - These can irritate the bladder and make urinary symptoms worse.

Drink less in the evening - Try to drink less in the late afternoon and evening, so you’re less likely to get up in the night. But make sure you drink enough during the day – 1.5 to 2 litres (3 to 4 pints) a day.

Empty your bladder before leaving the house - Remember to use the toilet before long journeys, and find out where there are public toilets before leaving home.

Double voiding - After you urinate, wait a few minutes and then try to go again. This can help to empty your bladder properly. But take care not to strain or push.

Check your medicines - Ask your doctor whether any medicines you take, such as anti-depressants or decongestants (medicines for a blocked nose), may be making your urinary symptoms worse.

Eat more fruit and fibre - This will help you avoid constipation (difficulty emptying your bowels), which can put pressure on the bladder and make urinary symptoms worse.

Keep a healthy weight - If you’re overweight, this can make your symptoms worse. Talk to your doctor if you’re worried about your weight. They can help you think about ways to lose weight healthily.

Exercise regularly - Regular exercise may help your symptoms. If you’re not usually very active, speak to your doctor before starting any kind of exercise plan. They can talk with you about exercising safely.

Bladder retraining - This technique can help you hold on for longer when you need to urinate. Ask your doctor or specialist nurse for more information.

Urethral massage - You might hear this called urethral milking. After you urinate, press gently upwards at the base of your scrotum (the skin around your testicles) with your fingertips. You should be able to feel your urethra. Keep pressing gently as you move your fingers forward from the base of your penis to the tip. This will squeeze out any urine that’s left in your urethra and prevent dribbling. Ask your doctor or specialist nurse for more information.

Absorbent pads or urinary sheaths - Absorbent pads and pants can be worn inside your underwear, or instead of underwear. They soak up any leaks. Urinary sheaths look like condoms with a tube attached to the end, which drains urine into a bag. The sheath fits tightly over your penis and you can strap the bag to your leg, under your clothes. Ask your doctor or specialist nurse for more information.

Medicines

If lifestyle changes don’t control your symptoms, medicines may be an option. Make sure you tell your doctor about any medicines or herbal remedies you already use, in case they interfere with medicines for an enlarged prostate.

The main types of medicine for an enlarged prostate are:

You might be given both types of medicine – this is known as a combination treatment.

You’ll have regular check-ups to talk about your symptoms and any side effects you might be getting.These check-ups may be with your GP or with a urologist or specialist nurse at the hospital.

  • Alpha-blockers  

    These are tablets that relax the muscles in the prostate and around the opening of the bladder, making it easier to urinate.They don’t cure an enlarged prostate but they can help to relieve symptoms.

    Alpha-blockers are usually the first type of medicine you will be offered, unless your prostate is very large. Symptoms may start to improve within a few hours or days, but you may need to take alpha-blockers for a few weeks before they work fully.Around 3 in every 5 men who take alpha-blockers find their symptoms improve within the first month of treatment.

    If your symptoms haven’t improved after about four to six weeks, your doctor may suggest trying a higher dose or a different treatment. For most men, alpha-blockers continue to work for several years.

    There are several alpha-blocker medicines available. They all work in the same way and are equally effective at managing symptoms of an enlarged prostate. The most common alpha-blockers are called:

    • tamsulosin (Flomaxtra®, Diffundox®, Flomax Relief®, Pinexel®, Stronazon®)
    • alfuzosin (Xatral®, Besavar®)
    • doxazosin (Cardura®, Doxadura®)
    • terazosin (Hytrin®).

    Like any medicine, alpha-blockers can cause side effects. These affect each man differently, and you may not get all of the possible side effects. Side effects usually stop if you stop taking the medicine. Possible side effects include:

    • feeling dizzy or sick (nausea) or having a headache when you stand up – this usually stops after the first few doses
    • tiredness or fatigue
    • a blocked nose
    • problems getting or keeping an erection (erectile dysfunction) – this affects around 3 in every 100 men (3 per cent)
    • dry orgasm (where you release little or no semen when you orgasm) – this affects around 2 in every 100 men (2 per cent).

    Read the information leaflet that comes with your medicine for more information on side effects, or speak to your doctor, specialist nurse or pharmacist. If you are having any eye surgery, make sure you tell your eye surgeon that you are taking alpha-blockers.

  • 5-alpha-reductase inhibitors (5ARIs)  

    These medicines slowly shrink the prostate so that it stops pressing on the urethra, making it easier to urinate. They can shrink the prostate by around a quarter after 6 to 12 months of treatment. They may shrink the prostate even more if taken for longer.

    5-alpha-reductase inhibitors usually take at least six months to work fully, but they are effective at improving symptoms in the long term. Studies show that men's symptoms may continue to improve up to four years after starting treatment. 5-alpha-reductase inhibitors also help to prevent acute urine retention and the need for surgery.

    5-alpha-reductase inhibitors are usually the first type of medicine you will be offered if your prostate is very large. This is because they work particularly well in men who have a larger prostate.

    There are two 5-alpha-reductase inhibitor medicines available:

    • finasteride (Proscar®), taken as a tablet once a day
    • dutasteride (Avodart®), taken as a capsule once a day.

    5-alpha-reductase inhibitors can cause side effects. These are most common during the first year of treatment. They usually stop if you stop taking the medicine. Possible side effects include:

    • problems getting or keeping an erection – this affects 4 or 5 in every 100 men (4 or 5 per cent)
    • less desire for sex (low libido) – this affects 2 or 3 in every 100 men (2 or 3 per cent)
    • breast swelling or tenderness – this affects around 2 in every 100 men (2 per cent)
    • changes in your ejaculation, such as dry orgasms or retrograde ejaculation (where semen doesn’t come out straightaway when your orgasm, but leaves the body when you next urinate) – these changes affect around 1 in every 100 men (1 per cent).

    Read the information leaflet that comes with your medicine for more information on side effects, or speak to your doctor, specialist nurse or pharmacist.

    You should use a condom during sex if there is a chance your partner is pregnant or could become pregnant. Pregnant women and children should avoid touching broken tablets or capsules. Ask your doctor or nurse for more information.

    5-alpha-reductase inhibitors and your PSA level

    5-alpha-reductase inhibitors reduce the amount of PSA in your blood. This means the results of any PSA tests you have may not be accurate. If you have a PSA test, always tell your doctor or nurse if you are taking 5-alpha-reductase inhibitors. If your PSA level rises, your doctor should offer you further tests.

  • Other medicines  

    Your doctor may suggest other medicines to help control your symptoms, including the following.

    • Anticholinergics, such as oxybutynin, tolterodine (Detrusitol XL®) and solifenacin (Vesicare®). These can help improve symptoms such as a sudden urge to urinate, needing to urinate more often than usual, and leaking before you reach the toilet. Anticholinergics can have similar side effects to alpha-blockers. They can also cause other side effects, such as dry eyes, a dry mouth and constipation.
    • Phosphodiesterase type 5 (PDE5) inhibitor. You might be offered a PDE5 tablet called tadalafil (Cialis®). Tadalafil relaxes the muscles in the prostate and around the opening of the bladder, making it easier to urinate. Symptoms may start to improve within a few days. Tadalafil is usually only given to men with an enlarged prostate as part of a clinical trial. It can cause side effects including headaches, indigestion, back pain, and itchiness or swelling in your nose (rhinitis). These side effects are usually mild and don’t last long.
    • Mirabegron (Betmiga®). If anticholinergics aren’t working, or you can’t take anticholinergics, your doctor may recommend trying mirabegron tablets. Mirabegron is a new type of drug called a beta-3-adrenoceptor agonist. It can help if you need to urinate more often than usual or get sudden urges to urinate. Possible side effects include high blood pressure, urine infections and headaches.
    • Desmopressin. If you urinate a lot during the night, your doctor may recommend taking a desmopressin tablet before you go to bed. This causes the kidneys to produce less urine for six to eight hours. You will have regular blood tests to monitor your kidney function. Desmopressin isn’t usually an option if you’re over 65 or have heart failure.
    • Loop diuretic. This makes you urinate a lot before you go to bed, making it less likely that you’ll need to get up during the night. You take it as a capsule in the late afternoon.

  • Combination treatments  

    Some men find that taking more than one type of medicine works better than taking a single medicine on its own. This is known as combination treatment. You might be given separate tablets, or you might be given a single tablet containing both medicines to take each day.

    Alpha-blocker plus 5-alpha-reductase inhibitor

    You may be offered an alpha-blocker together with a 5-alpha-reductase inhibitor if:

    • your symptoms affect your day-to-day life, and
    • you have a very large prostate or a PSA level of more than 1.4 ng/ml.

    Alpha-blockers and 5-alpha-reductase inhibitors can both cause side effects, so you might get side effects from both medicines. Some side effects, such as less desire for sex, changes in your ejaculation and erection problems, are more common in men taking both medicines than in men who take either medicine on its own.

    Alpha-blockers can start to work within a few hours or days, while 5-alpha-reductase inhibitors usually take at least six months to work fully. This means that men on combination treatment may be able to stop taking the alpha-blocker after around nine months, without making their treatment less effective.

    Alpha-blocker plus anticholinergic

    You may be offered an alpha-blocker together with an anticholinergic, if treatment with either medicine alone isn’t working. Alpha-blockers and anticholinergics can both cause side effects, and these may be worse if you’re taking both medicines at the same time. The most common side effects in men taking both medicines include a dry mouth, constipation and indigestion.

  • Complementary therapies  

    Some men like to use herbal remedies, such as saw palmetto or red stinkwood (African plum). But studies suggest they’re unlikely to improve symptoms of an enlarged prostate. We need more research before herbal remedies can be recommended as a treatment.

    Not all herbal remedies in the UK are licensed, and the quality varies a lot. Be very careful when buying herbal remedies over the internet. Many are made outside the UK and may not be high-quality. Many companies make claims that aren’t based on proper research. There may be no real evidence that their products work, and some may even be harmful. Remember that even if a product is ‘natural’, this doesn’t mean it is safe.

    At the moment, there’s no evidence that acupuncture or homeopathy can help manage symptoms of an enlarged prostate.

    It’s important to tell your doctor about any complementary therapies you are using. Some may interfere with your enlarged prostate treatment or with other medicines you may be taking. Some herbal remedies may also affect your PSA level, making the PSA test unreliable. For more information about using herbal remedies safely, visit the MHRA website.

Surgery

Surgery may be an option if your symptoms don’t improve with lifestyle changes or medicines, or if your symptoms are severe.

Several different types of surgery can be used to treat an enlarged prostate. Common types of surgery include:

  • transurethral resection of the prostate (TURP)
  • holmium laser enucleation of the prostate (HoLEP)
  • transurethral vaporisation of the prostate (TUVP)
  • bladder neck incision
  • open (simple) prostatectomy.

Your hospital might not offer all of these types of surgery. The options available to you may also depend on the size of your prostate and any other health problems you have. Your doctor or nurse will discuss the advantages and disadvantages of each type of surgery they offer, to help you decide what is right for you.

You can read a summary of the most common types of surgery for an enlarged prostate below. Your doctor or nurse can give you more information, or you can speak to our Specialist Nurses.

  • Transurethral resection of the prostate (TURP)  

    This is an operation to remove the parts of the prostate that have grown too large and are pressing on the urethra. It is the most common type of surgery for an enlarged prostate.

    During the operation, the surgeon passes a thin tube up your penis into your urethra. They then pass an electrically-heated wire loop through the tube and use it to remove small pieces of prostate tissue.

    Read more about TURP in our online fact sheet.

  • Holmium laser enucleation of the prostate (HoLEP)  

    This is similar to TURP but uses a high-powered laser to remove the parts of the prostate that are blocking the urethra. Studies suggest that HoLEP is as effective as TURP at improving symptoms of an enlarged prostate, with similar side effects. HoLEP may be particularly useful in men with a very large prostate, as it rarely causes bleeding. You may also be less likely to need further surgery after HoLEP than after a TURP.

    HoLEP uses specialist equipment and should only be carried out by a surgeon who has had special training. This is why HoLEP is usually only available at specialist centres.

  • Transurethral vaporisation of the prostate (TUVP)  

    You may hear this called transurethral electrovaporisation of the prostate. It is similar to TURP, but parts of the prostate are destroyed with heat rather than being cut away. An electric current is passed into a small roller ball (like a computer mouse ball) or mushroom-shaped electrode. This heats up and destroys the prostate tissue blocking the urethra.

    A laser can also be used to destroy the prostate tissue. This is called photoselective vaporisation of the prostate (Greenlight laser surgery).

    Studies have shown that TUVP is as effective as TURP at improving symptoms. But some men may need more treatment in the future.

  • Bladder neck incision  

    You may hear this called transurethral incision of the prostate (TUIP). It is similar to TURP, but is simpler and has a shorter recovery time. The surgeon passes a thin tube up your penis into the urethra. They then pass an instrument up the tube and use it to make a few small cuts (usually one or two) in the opening of the bladder and in the prostate. This makes the opening of the bladder wider and allows urine to flow more easily.

    A bladder neck incision may be suitable if you have a small prostate but still get urinary symptoms.We don’t know how effective it is in the long term. But studies suggest that bladder neck incision is as effective as TURP at improving symptoms in men with a small prostate.

  • Open (simple) prostatectomy  

    This is an operation to remove the inner part of the prostate through a cut in the abdomen (stomach area). It isn’t often used to treat an enlarged prostate, but it may be an option if your prostate is very large, or if you have other health problems such as large bladder stones. It involves a longer stay in hospital than other types of surgery for an enlarged prostate.

  • Other types of surgery  

    There are some other less common types of surgery. These include:

    • minimally invasive surgery, such as transurethral needle ablation or transurethral microwave therapy
    • transurethral vapour resection of the prostate
    • prostatic urethral lift
    • prostate artery embolisation.

    These treatments aren’t available in many UK hospitals. They’re usually only available as part of a clinical trial or through private healthcare.

  • Possible side effects of surgery  

    As with most medical treatments, there is a risk of side effects after surgery to treat an enlarged prostate. Possible side effects include the following.

    • Needing to urinate more often or urgently. This usually improves over time. Speak to your doctor or nurse if it doesn’t improve.
    • Leaking urine when you cough, sneeze, laugh or exercise. This is called stress incontinence. Ask your doctor or nurse about pelvic floor muscle exercises, which may help with leaking urine. You can also read our fact sheet, Pelvic floor muscle exercises, or call our Specialist Nurses for more information. If the exercises don’t help, there are other treatments available.
    • Blood in your urine. You may see some blood in your urine for a couple of weeks after your operation. Sometimes the urine clears and then you see a small amount of blood five to ten days after your operation. This is a normal part of the healing process.
    • Urine infection. There is a small risk of a urine infection. Visit your GP if you have a high temperature, a burning sensation when you urinate, or dark or cloudy urine with a strong smell.
    • A weak flow when you urinate. Your flow may slowly become weaker over time. This can be caused by scarring around the opening of the bladder or the urethra, which causes the urethra to become narrow. A simple operation can remove the scar tissue.
    • Retrograde ejaculation. This is when the semen doesn’t come out straightaway when you orgasm. Instead, it leaves your body when you next urinate. This can happen if the opening of your bladder is wider after surgery.
    • Problems getting or keeping an erection. Some studies have reported an increase in erection problems after surgery for an enlarged prostate. But these may be caused by other health problems. If you had good erections before the operation, you may be less likely to have problems afterwards.

    Your chances of getting each of these side effects will depend on many things, including the type of surgery you choose. Speak to your doctor or nurse for more information.

  • What if I can’t have surgery?  

    Surgery isn’t always an option – you may not be fit or well enough for an operation, or you may not like the idea of it. If surgery isn’t suitable for you and lifestyle changes and medicines haven’t worked, your doctor or nurse may suggest using a catheter. This is a thin, flexible tube used to drain urine from your bladder. The catheter may be permanent or temporary.

    A permanent catheter is passed up into the bladder through your penis, or through a small cut in your abdomen. The catheter is usually attached to a drainage bag, which you strap on to your body under your clothing. Your doctor or nurse will usually change your catheter every 12 weeks.

    A temporary catheter (self-catheterisation) is where you put a catheter in yourself when you need to urinate, rather than leaving one in all the time. Your doctor or nurse will show you how to put the catheter in and tell you how often to use it. Some men can urinate quite well without a catheter and only use it once a day to make sure they empty their bladder regularly. Other men need to use a temporary catheter several times a day.

    Urine infections are common in men who use a catheter. Your urine should usually be a pale yellow colour. If it becomes dark or cloudy with a strong smell, this could be a sign of a urine infection. Other signs of a possible infection include a fever (high temperature), a burning feeling when you urinate, and feeling unwell. Tell your doctor or nurse if you have any of these symptoms. They’ll usually give you antibiotics to treat the infection.

    You can lower your chances of getting a urine infection by keeping your catheter and the area around it clean. You may find the following tips helpful.

    • Always wash your hands with warm, soapy water before and after touching your catheter or drainage bag.
    • Wash the catheter and the area around it at least twice a day with warm water and unscented soap. Use one wash cloth for this and a different one for the rest of your body. Wipe downwards along the catheter, away from your body, and dry it carefully afterwards.
    • Drink plenty of fluids (1.5 to 2 litres, or 3 to 4 pints a day).
    • Eat plenty of foods containing fibre – such as fruit, vegetables and wholemeal bread – to avoid constipation. Constipation can stop your catheter from draining properly.

    Let your nurse know if your catheter isn’t draining properly. If urine hasn’t drained from your bladder for 2 to 3 hours, contact your GP or district nurse straight away.

References

Updated: August 2015 | Due for Review: August 2017

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