Enlarged prostate (BPH): every treatment, least invasive first

Medically reviewed by David Shusterman, MD, board-certified urologist, NYMD Center, New York · Reviewed October 2026 · General information, not medical advice.

Benign prostatic hyperplasia (BPH) is non-cancerous growth of the prostate. Most men develop some of it with age. As the gland enlarges it squeezes the urethra, causing a weak stream, getting up at night, urgency, and the feeling of not emptying. BPH does not turn into cancer, but untreated obstruction can strain the bladder over time.

Start with the right workup

A good evaluation includes a symptom score, a urine test, a flow test and a bladder scan to measure what's left after you void, and usually an ultrasound to measure prostate size. Size matters, because it decides which procedures will work. A PSA blood test is often added to look for cancer separately.

Medication

Alpha-blockers (such as tamsulosin) relax the prostate and bladder neck within days. 5-alpha-reductase inhibitors (finasteride, dutasteride) slowly shrink the gland over months. Both work, but both are lifelong, and side effects such as dizziness, ejaculatory changes and lower libido lead many men to stop.

Minimally invasive procedures

Prostate artery embolization (PAE) is the least invasive procedure for BPH. An interventional radiologist goes in through a pinhole in the wrist or groin and blocks the small arteries feeding the prostate, so the gland shrinks. There is no cut, nothing passes through the urethra, there is usually no catheter afterward, and sexual function is generally preserved. It works for large prostates, where some other options don't. Because urologists don't perform it themselves, many patients are never told about it. Ask directly.

Rezūm (water vapor therapy) is done in the office through a scope. Steam destroys excess prostate tissue, which the body absorbs over weeks. Expect a catheter for a few days and a few weeks of irritation before improvement.

UroLift (prostatic urethral lift) places small implants that hold the prostate lobes apart. It suits smaller prostates without a large middle lobe. Some patients need retreatment within a few years.

iTind and Optilume BPH are newer devices: a temporary nitinol implant and a drug-coated balloon. Both are offered at selected practices.

Surgery

TURP (transurethral resection), laser procedures (HoLEP, GreenLight) and Aquablation remove tissue from inside the prostate. They are effective but considerably more invasive. They usually mean the hospital or a surgery center, anesthesia, a catheter afterward, and a high rate of retrograde ejaculation. For very large glands, simple prostatectomy (often robotic) is an option. These are reasonable choices for some men, but you should hear about the less invasive options first, along with how the recoveries compare.

Questions to ask

How big is my prostate, and which procedures fit that size?
Am I a candidate for PAE? If you don't perform it, will you refer me to someone who does?
Will I need a catheter, and for how long?
What happens to ejaculation and erections with each option?

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