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Prostate care
Enlarged Prostate (BPH)
An enlarged prostate is one of the most common reasons men see a urologist — and one of the most treatable. We'll walk you through the full range of options, from a simple pill to in-office procedures that skip the operating room entirely.
What is BPH?
BPH is noncancerous prostate growth. It can affect sleep and quality of life, and obstruction can lead to urinary retention, infections, bladder stones or kidney problems. Symptoms deserve evaluation even though BPH is not prostate cancer.
A look at how an enlarged prostate narrows the urethra — and what treatment aims to relieve.
Symptoms to watch for
- Going more often, especially at night
- A weak or slow stream
- Trouble starting to urinate
- Dribbling at the end
- Feeling you can't fully empty
- Sudden, urgent need to go
If these sound familiar, it's worth an evaluation — not because it's an emergency, but because the earlier we look, the gentler the options tend to be.
Adapted from A Urology Consult in a Book by David Shusterman, MD. Explore the author’s books
Is the prostate actually causing the problem?
An enlarged prostate is a finding, not the whole diagnosis. A large gland may cause little difficulty, while a smaller one can block urine flow because of its shape or position. The bladder matters too: it may work harder against resistance for years, or it may become too weak to empty well. Frequency and waking at night can also have causes beyond a blocked prostate. We first try to learn what is causing the symptom, how much it bothers you, and whether the urinary system is at risk.
At a visit, we ask about the pattern of symptoms, medicines, fluid and sleep habits, prior infections or retention, and what you most want treatment to change. Urine testing can look for blood or infection. A bladder scan after urination measures what remains; a urine-flow test may help show how the stream behaves. Prostate size and shape, cystoscopy or more detailed bladder testing may be useful when the result would change the treatment choice. No single number should decide a procedure by itself.
What decision should the evaluation answer?
The first decision is whether watchful follow-up, a medicine or a procedure fits the findings and your goals. Severe bother and medical risk are different: a person may want treatment for sleep and daily life even without a dangerous test result, while another may have substantial retained urine or complications despite describing only mild bother. If an intervention is considered, ask what evidence shows that opening or shrinking the prostate would address your main symptom. Ask which findings favor the proposed option, what other reasonable options exist, and how improvement and follow-up will be measured.
Bring your medication list, prior PSA or prostate records, and any bladder or urine-flow results. We’ll check what is driving the symptoms before comparing treatment choices.
Your treatment options
There's a whole ladder of treatments for BPH, and most men never need surgery. Here's the short version — and where to go deeper.
How I actually decide: two treatments, one threshold
Medication
For milder symptoms, daily medication can relax the prostate or shrink it over time. Often the first step.
UroLift & Rezūm — in-office procedures
UroLift holds the prostate open with tiny implants, but it suits only smaller prostates, and in Dr. Shusterman's experience symptoms often return, so he now rarely recommends it. Rezūm uses steam to shrink the tissue in the office, without major surgery, and is his alternative when PAE isn't the right fit.
Prostate artery embolization (PAE)
Our urology and interventional radiology team evaluates whether PAE is appropriate for you. Dr. David Shusterman evaluates patients and coordinates aftercare; Dr. Yosef Golowa performs the embolization. Discuss expected benefits, recovery and potential risks at your consultation.
Going deeper
The full prostate treatment ladder lives at 1Prostate.
For an in-depth look at every BPH option — medication through PAE — visit our dedicated prostate center. For more on treating prostate conditions without the operating room, Modern Urologist covers minimally invasive prostate care in detail.
Visit 1Prostate Modern UrologistDon't wait for the bladder to fail
Treated late, an enlarged prostate can progress to urinary retention — the bladder no longer emptying. We prefer to treat obstruction earlier, often non-surgically, to help preserve bladder function rather than waiting for a crisis.
When to see us
Book an evaluation if symptoms are disrupting your sleep or daily routine, if they're getting worse, or if you've noticed blood in your urine or trouble urinating at all (which needs prompt attention). We'll confirm what's going on and map out the options that fit your life — at our Manhattan or Forest Hills office.
Common questions
What are the first signs of an enlarged prostate?
Common early signs include needing to urinate more often (especially at night), a weaker or slower stream, trouble starting, dribbling, and a feeling that the bladder isn't fully empty. These tend to come on gradually.
Does an enlarged prostate always need surgery?
No. Treatment depends on your symptoms, tests and preferences. Options may include monitoring, medicines and procedures; your evaluation guides the plan.
Is an enlarged prostate the same as prostate cancer?
No. BPH is a non-cancerous enlargement of the prostate. It's very common with age and unrelated to prostate cancer — though both can cause urinary symptoms, which is exactly why an evaluation matters.
Which BPH treatment is right for me?
It depends on your symptoms, prostate size, and goals. We start with an evaluation, then walk through the options together — from medication to minimally invasive procedures — at either office.
Prostate Unlocked by David Shusterman, MD. Explore the author’s books as you prepare questions for your appointment.
Sources for this information
NIDDK: BPH
Prepare for your visit with a book by Dr. David Shusterman
A Urology Consult in a Book explains symptoms, evaluation and treatment choices. Bring your questions to your clinician; the book supports that conversation.
Explore the books and care team →Get your prostate symptoms sorted.
Book an evaluation at our Manhattan or Forest Hills office — most patients are seen within the week.
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