Benign Prostatic Hyperplasia

By their 50s, half of all men have BPH. By your 80s, it’s 90%. For men, BPH — also called benign prostatic hyperplasia or enlarged prostate — comes with the territory. BPH can trigger ongoing urinary problems, incontinence, and even chronic infections.

You can be free from the constraints and embarrassment of BPH! More than ever, it is possible to effectively treat and manage BPH. But which treatments are best for you? This guide will tell you.

You’ll know before you say “Yes.”

When treating BPH, the most important consideration is which approach best addresses your condition, your expectations, and your reservations.

In this Guide, Harvard doctors present and assess today’s treatment options. From watchful waiting to medication to surgery, the guide explains the benefits, risks, and side-effects you can anticipate from each approach.

You’ll appreciate how all things are considered — especially you. Which protocols can effectively reduce the symptoms that bother you most… which have the fewest complications… which offer you the most lasting improvement? You’ll get the answers fully and clearly.

You’ll find practical steps and proven measures. You’ll read how simple changes in behavior can ease urinary symptoms. You’ll discover two controllable risk factors. You’ll learn about medications for the “going” problem… the ”growing” problem… and a new combination pill to solve both. You’ll find the medication with the fewest sexual side effects… and one that can more successfully reduce future need for surgery.

You’ll discover advances that are erasing fears and extending relief. You’ll be briefed on a durable surgical procedure that improves urine flow for 90% of patients. You’ll read about an alternative for men taking blood thinners. The guide shines a light on today’s competing laser surgical options. You’ll learn about three outpatient procedures… the prospects for Botox BPH therapy… and the six questions to ask before any BPH surgery.

Prepared by the editors of Harvard Health Publishing in consultation with Martin Kathrins, MD, Assistant Professor of Surgery, Harvard Medical School, Chief of Benign Urology and Director of the Men’s Health Center, Brigham and Women’s Hospital. 21 Pages. (2025)

About Harvard Medical School Guides

Harvard Medical School Guides delivers compact, practical information on important health concerns. These publications are smaller in scope than our Special Health Reports, but they are written in the same clear, easy-to-understand language, and they provide the authoritative health advice you expect from Harvard Health Publishing.

Causes and effects

In BPH, cells in the prostate gland divide and multiply. That’s what causes the gland to expand in size. Research has found that prostate volume averages about 25 cubic centimeters (cc) for men in their 30s, when BPH is rare. But it’s common for the gland to get bigger with time, reaching an average of 35 to 45 cc for men in their 70s.

Prostate enlargement doesn’t always cause urinary problems. Some men have relatively large prostates without having any symptoms. On the other hand, symptoms can occur even in men with a small or average prostate.

The prostate is made up of muscle tissue and a network of tiny tubes (ducts) lined with cells that produce prostatic fluid. During ejaculation, the prostate pushes that fluid through those ducts and into the urethra, where it mixes with sperm cells from the testes and exits through the penis. BPH is the result of cell overgrowth in the muscle as well as the lining of the ducts. Experts think it has to do with age-related changes in hormone levels.

 Certain factors are linked to a higher risk of BPH. These risk factors include increasing age, a family history of BPH, higher body weight, and lack of exercise. It’s not clear whether losing weight or exercising more actually prevents BPH, but these risk factors can identify men who are the most likely to develop prostate enlargement with bothersome urinary problems. (See “Can BPH be prevented?” on page 20.)

The prostate wraps entirely around the urethra at the point where it exits the bladder.  As the prostate grows, it starts to press in on the urethra and restrict the flow of urine. As a result, it gets harder to empty your bladder. Over time, this can also lead to changes in how the bladder itself functions. In some cases, the impingement can get so extreme that you can’t urinate at all—a painful medical emergency that poses the risk of kidney damage.

• Help for BPH
• Causes and effects
• Symptoms
• Diagnosis
• Treatment: Watchful waiting
• Treatment: Medication
• Treatment: Surgery
• Can BPH be prevented?
• Resources

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