Getting up at night, a weaker stream, the feeling that your bladder never fully empties. For many men over 50 this is an enlarged prostate, and it is not cancer. Here is what BPH is, what causes it, when to see a doctor, and what the research says about treatments and supplements.
Note: This is an educational guide, not medical advice. It does not sell anything, but it links to our other reviews, some of which contain affiliate links. Full disclosure & medical disclaimer
The short answer:
• BPH (benign prostatic hyperplasia) is a non-cancerous enlargement of the prostate. It is the most common prostate problem in men over 50.
• It squeezes the urethra, so the usual signs are urinary: frequent or urgent urination, trips to the bathroom at night, a weak or interrupted stream, and dribbling.
• See a doctor for any new urinary symptoms. Prostate cancer and other conditions can cause the same ones, and only an exam and tests can tell them apart.
• Prescription medicines and procedures have the strongest evidence. For herbal supplements the evidence is limited, and for saw palmetto, NCCIH says it is probably not helpful.
What Is BPH (an Enlarged Prostate)?
The prostate is a gland below the bladder that surrounds the urethra, the tube that carries urine out of the body. When the gland grows, it can press on the urethra and make it harder for the bladder to empty. That is BPH. The name means “benign” (not cancer), “prostatic” (of the prostate) and “hyperplasia” (growth of cells).
BPH becomes more common with age. The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) reports that about 5% to 6% of men aged 40 to 64 have it, and about 29% to 33% of men 65 and older. It rarely causes symptoms before age 40.
Common Symptoms
- Frequent or urgent need to urinate
- Waking at night to urinate (nocturia)
- Trouble starting to urinate
- A weak stream, or one that stops and starts
- Dribbling at the end of urination
- Feeling that the bladder is not fully empty
Symptoms usually worsen slowly, though they can stay the same or improve. Prostate size does not reliably predict how bad symptoms are: some men with a very enlarged prostate have few symptoms, and some with a mildly enlarged one have many (Mayo Clinic, NIDDK).
Is an Enlarged Prostate Cancer?
No. BPH is not cancer, and Mayo Clinic notes that it does not appear to increase the risk of prostate cancer. But the two can cause the same urinary symptoms, and a man can have both. That is the main reason not to guess: a doctor can check with a physical exam and, if needed, a PSA blood test.
What Causes It, and Who Is at Risk?
The exact cause is not known. Aging and the changes in sex hormones that come with it are suspected. According to NIDDK and Mayo Clinic, risk is higher with:
- Age over 40
- A family history of prostate problems
- Type 2 diabetes or heart and blood vessel disease
- Obesity and a lack of physical activity
- Chronic kidney disease or erectile dysfunction
Some common medicines can make urinary symptoms worse, including decongestants, antihistamines, tranquilizers, antidepressants and diuretics (NIDDK). If you take any of these, ask your doctor or pharmacist before changing anything, and do not stop a prescribed medicine on your own.
When to See a Doctor
- cannot urinate at all
- have painful, urgent urination with fever and chills
- see blood in your urine
- have severe pain in your lower abdomen or when urinating
For anything milder, still book a visit. Mayo Clinic advises discussing any urinary symptoms with a health care provider, even if they seem minor, because untreated BPH can lead to urinary tract infections, bladder stones, bladder damage and, in serious cases, kidney damage. Other conditions, including prostate cancer, can cause similar symptoms, so a checkup is the first step either way.
How BPH Is Diagnosed
NIDDK describes a typical work-up as:
- A review of your symptoms, fluid intake, medicines and family history
- A physical exam, including a digital rectal exam
- Urine tests and, when needed, a PSA blood test
- For some men, a referral to a urologist for further tests such as urodynamic tests, cystoscopy or ultrasound
What Doctors Offer: Treatments With the Strongest Evidence
| Approach | What it is | Notes (NIDDK) |
|---|---|---|
| Watchful waiting and lifestyle | Yearly checkups plus limiting fluids in the evening, cutting back alcohol and caffeine, staying active, emptying the bladder fully | For mild symptoms that do not affect quality of life |
| Alpha blockers | Prescription medicines that relax the muscles of the bladder neck and prostate | Prescription only; your doctor chooses the type |
| 5-alpha reductase inhibitors | Prescription medicines that help reduce prostate size or slow its growth | Prescription only; your doctor chooses the type |
| PDE-5 inhibitors | Prescription medicines that relax muscles around the prostate and bladder | Can relieve some urinary symptoms |
| Combination therapy | An alpha blocker with a 5-alpha reductase inhibitor | May work better than either one alone |
| Minimally invasive procedures | For example, water vapor therapy or a prostatic urethral lift | An option when medicines are not enough or not tolerated |
| Surgery | Several techniques, including laser and transurethral resection | For severe symptoms or complications; about 10% of patients may need further surgery within 20 years |
Which option fits depends on your symptoms, other health conditions and the medicines you already take. That is a conversation for your doctor, not for a website.
What About Supplements?
Many men look at herbal products for urinary symptoms, and the evidence is weaker than for the treatments above. We summarize what the National Center for Complementary and Integrative Health (NCCIH) says about the most-studied ingredients:
| Ingredient | What the research shows | Evidence |
|---|---|---|
| Saw palmetto | NCCIH says it is probably not helpful for BPH symptoms. A 2023 review of 27 studies found little or no benefit when used alone, and two NIH-funded trials, including one with up to three times the usual dose, did not beat placebo. | Probably not helpful |
| Stinging nettle root | One placebo-controlled trial of 620 men (Safarinejad, 2005) reported better symptom scores and urine flow over six months. NCCIH rates the evidence as limited. | Limited |
| Pygeum (African plum) | A Cochrane review of 18 trials in 1,562 men found a standardized extract may help urinary symptoms, but the studies were small, short and varied in dose. | Limited |
| Beta-sitosterol | A six-month trial of 200 men (Berges, 1995) reported symptom improvement. A later Cochrane review on the topic has been withdrawn, so we treat the evidence as limited. | Limited |
Supplements are not regulated like prescription medicines, and they are not a replacement for a diagnosis. They can also interact with medicines or hide a problem that needs treatment. If you decide to try one, tell your doctor first.
If you are comparing products, we read the official label of each one and checked every dose against the research. See our prostate supplement comparison, or the individual reviews of TitanFlow, Prostadine and ProstaVive.
Frequently Asked Questions
Is an enlarged prostate the same as prostate cancer?
No. BPH is a non-cancerous growth of the gland. The two can cause similar urinary symptoms, so a doctor should check any new symptoms.
At what age does BPH start?
It rarely causes symptoms before 40. NIDDK reports it in about 5% to 6% of men aged 40 to 64 and in about 29% to 33% of men 65 and older.
Why do I get up at night to urinate?
An enlarged prostate is one common cause, because the bladder may not empty fully. Other conditions and some medicines (such as diuretics) can also cause it, and so can how much you drink before bed, so it is worth mentioning to your doctor.
Can BPH go away on its own?
Symptoms usually get worse slowly, but Mayo Clinic notes they may also stay the same or improve. Do not assume they will resolve: untreated BPH can lead to infections and bladder or kidney problems.
Does saw palmetto shrink an enlarged prostate?
The research does not support that. NCCIH says saw palmetto is probably not helpful for urinary symptoms from an enlarged prostate.
What can I change in my daily routine?
NIDDK lists limiting fluids before bed, cutting back on alcohol and caffeine, staying physically active and taking time to empty the bladder fully. These are supportive steps and do not replace a medical evaluation.
Sources
- NIDDK – Prostate Enlargement (Benign Prostatic Hyperplasia)
- Mayo Clinic – Benign prostatic hyperplasia (BPH)
- NCCIH – Saw Palmetto
- NCCIH Clinical Digest – BPH and Complementary Approaches
- Safarinejad MR. Urtica dioica for BPH. J Herb Pharmacother, 2005
- Berges RR et al. Randomised, placebo-controlled trial of beta-sitosterol in BPH. Lancet, 1995
- Wilt TJ et al. Pygeum africanum for BPH. Cochrane Review, 2002
The Bottom Line
An enlarged prostate is common, it is not cancer, and it is treatable. The most useful step is not a product: it is getting urinary symptoms checked, so that you and your doctor know whether it is BPH and which option fits you. If you then want to look at supplements, start with the evidence, not the marketing, and read the label before you buy.