Many men with mild symptoms don’t need any treatment other than lifestyle changes. Men with more severe symptoms may need medications or surgical procedures.

Lifestyle Changes

Small lifestyle changes can improve symptoms of BPH. These changes include:

• Avoiding or limiting fluids a few hours before bedtime or going out.
• Avoiding or limiting fluids that can worsen symptoms, including caffeine and alcohol.
• Quitting smoking or using any source of nicotine
• Double voiding. This is where a person waits a minute or two after urinating, then tries to go again, without straining or pushing.
• Avoiding medications that can make symptoms worse (for example, antihistamines (allergy drugs) and decongestants).

Medications

The two kinds of medications used to treat BPH are:

• Alpha blockers (such as tamsulosin and related medications)
• Alpha-reductase inhibitors (such as finasteride and related medications)

Alpha blockers work by relaxing the muscles in the prostate and bladder to help urine flow more easily. Alpha blockers often cause low blood pressure or dizziness, especially when standing up. A healthcare provider may recommend taking the medication at bedtime to reduce these side effects.

Alpha-reductase inhibitors work by stopping the prostate from growing, or even causing it to shrink. This medicine is more helpful in men with very enlarged prostate glands and is often used in combination with an alpha blocker. Alpha-reductase inhibitors may take up to six months to improve symptoms. Alpha-reductase inhibitors also cause PSA levels to decrease by about half.

Results are likely to be best when men use both medications over time. However, some men experience problems with sexual dysfunction with use of these medications.

Herbal Medicines

Some people use saw palmetto to improve symptoms of BPH. Research has not shown any proven benefits from this plant.

You need to tell your healthcare provider if you are taking any non-prescription medications or supplements for prostate health. Many of these products have ingredients that could harm you and interact with medications.

Surgery

If BPH symptoms aren’t relieved with medications, a healthcare provider may recommend surgery. This can remove or destroy some of the prostate to make it smaller. Your healthcare provider will help you decide which procedure is best. Some of the treatments used to treat BPH are:

• Trans-urethral resection of the prostate (TURP): Pieces of the enlarged prostate are removed through the urethra. This may be the best care for many men with BPH. However, less invasive procedures can result in fewer side effects than TURP. 
• Ablation of the prostate: Some of the prostate is destroyed with heat, light (laser), or electrical energy using special instruments through a scope in the urethra
• Prostatectomy: Surgery to remove the prostate gland

Complications from these procedures can include sexual dysfunction (inability to get an erection) and urinary incontinence (inability to control urine).

Less invasive procedures can treat BPH in men whose prostate is not too large. These include:

• Trans-urethral incision of the prostate (TUIP): Instruments are used to widen the urethra.
• Radiofrequency ablation or microwave thermotherapy: Heat is used to burn away areas of the enlarged prostate
• Prostatic lift: An implanted device is used to widen the urethral opening and implants are placed to keep it open

These less invasive surgeries cause fewer problems with sexual dysfunction. They can be done with local anesthesia and don’t require a hospital stay.

However, it might be necessary to repeat treatment if symptoms appear again.

The treatment of prostatitis depends on the cause (if known).

Medications

If the prostatitis is cause by a bacterial infection, a healthcare provider will prescribe antibiotics.

Acute bacterial prostatitis can cause very severe symptoms. Sometimes treatment involves hospitalization for intravenous (IV) antibiotics.

• Oral antibiotics often last up to six weeks to make sure the infection is fully treated.
• Antibiotics are also used to treat chronic prostatitis when the disease involves bacteria. Some men have to take antibiotics for several months, or even take low-dose antibiotics for a long time.
• Alpha blockers are sometimes used to treat symptoms of prostatitis, such as difficult or painful urination. Alpha blockers work by relaxing the muscles of the prostate and bladder, to help urine flow more easily.
• Anti-inflammatory medications may treat pain and inflammation. Non-steroidal anti-inflammatory medications (NSAIDs) should be used cautiously in older adults because they may increase blood pressure, damage kidneys, and increase risk of bleeding.

Common NSAIDs are ibuprofen, naproxen, and aspirin. Ask your healthcare provider about the best pain medication.

Herbal Medicines

Several herbal remedies are used to treat symptoms of prostatitis, including rye grass (cernilton), quercetin (found in green tea, onions, and other plants), and saw palmetto. There is no evidence that any of these treatments are effective. Be sure to tell your healthcare provider if you are taking any non-prescription medications or supplements for prostatitis. Many of these products contain multiple ingredients that could be harmful.

Other Treatments

Some treatments, including acupuncture, physical therapy, and sitz baths, may help symptoms in some men with chronic prostatitis.

Surgery

Surgery is rarely needed for prostatitis. However, it may be needed if prostatitis is due to an abnormality in the bladder or urethra that is causing long-lasting prostatitis.

The treatment for prostate cancer depends on the stage and grade of the cancer, the person’s age and life expectancy, overall health, possible side effects, and personal choices. The healthcare provider works with the person to help them decide how to treat the cancer.

Active Surveillance

Not all prostate cancer needs immediate treatment, and some never need any treatment:

• Early prostate cancer may not need treatment, especially in men who likely have less than 10 years to live. These cancers tend to grow very slowly, and most men die of other causes.
• Treating early-stage cancers doesn’t reduce death rates from prostate cancer compared to men who are not treated.
• Many men do “active surveillance.” This means that:
  • The person won’t have treatment right away. They will have their cancer monitored in case the cancer grows or spreads.
  • Monitoring may include regular prostate-specific antigen (PSA) tests, digital rectal examinations, and periodic biopsies.
  • Monitoring may be right for some men with more advanced disease if they have health problems that make cancer treatment more risky. The benefit of monitoring is avoiding harm. The risk is that the cancer may become harder to treat.

When cancer cells have grown beyond the prostate or spread to other parts of the body, treatment is designed to slow the growth of the cancer cells.

Radiation

Radiation therapy can be used to kill cancer cells. Side effects from radiation can include problems with urination, bowel movements, and erections.

Hormone therapy

Hormone therapy is treatment that reduces a person’s production of testosterone. This is the male sex hormone that helps prostate cancer cells grow. Hormone therapy can shrink the cancer and slow its growth. Side effects of hormone therapy can include hot flashes, osteoporosis, and sexual problems.

Hormone therapy is often used in combination with radiation.

Surgery

Surgery for prostate cancer involves removing the prostate gland (prostatectomy) and some of the surrounding tissue and lymph nodes that may contain cancer cells. Prostatectomy can cause inability to control urine or have erections.

Monitoring

No matter the stage of prostate cancer, a healthcare provider needs to monitor the disease to check how well the treatments are working. For prostate cancer, the most common monitoring method is the PSA test. 

If prostate cancer has spread to other organs or bones, imaging tests such as CT scans or PET scans can show where the cancer is. These tests can help a healthcare provider target treatment to manage the disease.

Click here to read the Choosing Wisely recommendations "Tests and treatments for prostate cancer: the latest advice for men"