Patient Basics: Enlarged Prostate (Benign Prostatic Hyperplasia)

An enlarged prostate, also called benign prostatic hyperplasia (BPH), is a common growth of the prostate gland that happens as men get older. It is not cancer. The larger gland can squeeze the tube that carries urine, causing a weak stream and frequent trips to the bathroom, often at night. Simple habits, medicines and minor procedures can ease the symptoms.

Key points

• More than half of men in their 60s have some prostate growth, and most men in their 80s do.
• Typical symptoms are a weak or stop-start stream, urgency, and waking at night to pee.
• BPH doesn’t turn into prostate cancer, but the two can cause similar symptoms, so get checked.
• Tamsulosin and similar medicines relax the prostate within days. Finasteride and dutasteride shrink it over months.
• Not being able to pee at all is an emergency.

What the prostate does

The prostate is a gland about the size of a walnut. It sits just below the bladder and wraps around the urethra, the tube that carries urine out of the body. It makes some of the fluid in semen. In a young man it weighs about 20 to 25 grams. It slowly grows through adult life, mostly because of changes in hormones as men age.

As it grows, the prostate can narrow the urethra. The bladder has to push harder, and over time its wall thickens and becomes more sensitive. That is why BPH can cause both a weak stream and a sudden need to go.

Enlarged prostate symptoms

• Trouble starting to pee, or having to strain
• A weak stream, or one that stops and starts
• Dribbling at the end
• Feeling that the bladder isn’t empty
• Peeing often, sometimes every hour or two
• A sudden urge that is hard to hold, and sometimes leaking
• Waking up two or more times a night to pee (nocturia)

Size doesn’t match symptoms well. A slightly larger prostate can cause a lot of trouble, while a very large one may cause little.

Left untreated, severe BPH can lead to urinary tract infections, bladder stones, blood in the urine, or sudden inability to pee (urinary retention). Rarely, urine backs up and damages the kidneys.

How doctors check for BPH

• Symptom questionnaire. A short score sheet rates how much your symptoms bother you. It helps track how well treatment works.
• Rectal exam. The doctor feels the prostate with a gloved finger to check its size and look for firm areas.
• Urine test for infection, blood or sugar.
• PSA blood test. PSA (prostate-specific antigen) can be higher with BPH and with prostate cancer. Talk with your doctor about whether this test makes sense for you.
• Bladder scan. A quick ultrasound after you pee shows how much urine is left behind.
• Other tests when needed: a urine flow test, an ultrasound to measure the prostate, or a look inside the bladder with a thin scope (cystoscopy).

Your doctor may ask you to keep a bladder diary for a few days, writing down what you drink and when you pee.

How to cut down on peeing at night

• Drink most of your fluids earlier in the day, and less in the 2 hours before bed.
• Cut back on caffeine and alcohol, especially in the evening. Both make the kidneys produce more urine.
• Pee right before bed, wait a moment, then try again (double voiding).
• If your ankles swell, raise your legs for an hour in the evening so the fluid is passed before bedtime.
• Ask whether a water pill (diuretic) can be taken in the morning instead.
• Treat constipation, which can press on the bladder.
• Avoid cold and allergy medicines with decongestants or diphenhydramine. They can make it harder to pee.

Waking at night to pee has other causes too, including diabetes, heart failure, sleep apnea and an overactive bladder. Your doctor can check for these.

Medicines for an enlarged prostate

• Alpha-blockers such as tamsulosin (Flomax), alfuzosin, silodosin, doxazosin and terazosin relax the muscle in the prostate and bladder neck. They often help within days. Side effects can include dizziness when standing up, a stuffy nose and less fluid when you ejaculate. Tell your eye surgeon you take one before cataract surgery.
• 5-alpha reductase inhibitors, finasteride and dutasteride, shrink the prostate by blocking a hormone. They take 6 months or longer to work well and suit larger glands. They can lower sex drive or cause erection problems. They also cut PSA levels by about half, so your doctor will adjust how they read your PSA.
• Both together work better than either alone for a large prostate with bothersome symptoms.
• Tadalafil, an erectile dysfunction medicine, taken daily at a low dose also eases urinary symptoms.
• Bladder medicines such as mirabegron, vibegron or oxybutynin calm urgency, often added to an alpha-blocker.

Saw palmetto and other herbal supplements haven’t worked better than a sugar pill in good studies.

Procedures and surgery

A procedure may help when medicines don’t work well enough, cause side effects, or when BPH causes retention, repeated infections, bladder stones or bleeding. Options include:

• Transurethral resection of the prostate (TURP). The surgeon passes a scope through the penis and trims away prostate tissue. It is the long-standing standard operation.
• Laser surgery to remove or vaporize the tissue, which suits very large glands and men on blood thinners.
• Prostatic urethral lift. Small implants pull the prostate tissue apart like curtains. It tends to preserve ejaculation.
• Water vapor therapy. Steam shrinks the tissue over a few months.
• Prostate artery embolization. A radiologist blocks some of the prostate’s blood supply through a thin tube in an artery.
• Open or robotic surgery for very large glands.

Each option trades off recovery time, how well it works, and the chance of side effects such as dry ejaculation (semen going back into the bladder). A urologist can help you choose.

When to see a doctor

• Any change in how you pee that bothers you or keeps getting worse
• Waking more than once or twice a night to pee
• Blood in your urine
• Pain or burning when you pee

Get emergency care if you can’t pee at all, especially with a painful, swollen lower belly. Also go if you have fever and chills with urinary symptoms.

Common questions about an enlarged prostate

Is an enlarged prostate a sign of cancer?

No. BPH is a noncancerous growth, and it doesn’t raise your chance of prostate cancer. The two are common in older men and can happen together, and early prostate cancer often causes no symptoms. That’s why your doctor may still talk with you about PSA testing.

What is a normal prostate size at age 70?

There’s no single normal number. A young man’s prostate is about 20 to 25 cc on ultrasound, roughly the same in grams. Many men in their 70s measure 30 to 50 cc or more. Some reports grade the size from 1 to 4, but symptoms matter more than size or grade when choosing treatment.

What is the best tablet for an enlarged prostate?

No one tablet is best for every man. An alpha-blocker such as tamsulosin is the most common first choice because it works quickly. Men with a large prostate often do better adding finasteride or dutasteride. Your doctor will weigh your symptoms, prostate size, blood pressure and other medicines.

Can an enlarged prostate shrink on its own?

Not usually. The prostate tends to keep growing slowly with age. Symptoms can still stay mild or even improve for years, especially with changes in drinking habits. Finasteride and dutasteride are the medicines that shrink it, by about a quarter over 6 to 12 months.

Questions to ask your doctor

• Are my symptoms from BPH or something else?
• Do I need a PSA test?
• Which medicine would you start with, and what side effects should I watch for?
• When would a procedure make sense for me?
• Could any of my other medicines be making this worse?

Learn more

• Prostate enlargement (benign prostatic hyperplasia) (National Institute of Diabetes and Digestive and Kidney Diseases)

This guide is general information and doesn’t replace advice from your own doctor. Last updated October 2026.