Mild BPH symptoms, unclear treatment path — anyone in a similar situation?

[Globenauta]

Hi everyone,

I’m a 56-year-old male dealing with some mild but persistent lower urinary tract symptoms, and I’d appreciate hearing from others who’ve been through something similar.
 

For the past year or so, I’ve been experiencing:

• Increased daytime urinary frequency (sometimes every 1–2 hours),
• Early morning urgency (often waking between 4-5 am),

• Weak urine flow, especially in the morning,

• Usually 1 wake-up per night, though occasionally I sleep through.

I recently saw a urologist and had some basic tests done:

• Prostate volume on abdominal ultrasound: 26 ml (doctor says "mildly enlarged"),

• PSA: 1.01 ng/mL (previously around 0.4),

• Urine flow test: not dramatic, but mildly impaired, no flat curve, still shows a peak.
   

The doctor did a rectal exam and said my prostate felt “rather enlarged,” though he didn’t repeat that at follow-up. He suggested that a transrectal ultrasound would be more accurate, but also said it wouldn’t change management much unless I pursue intervention.
 

I did a 7-day trial of tamsulosin, and while there might have been some very minor improvement (e.g., one full night of sleep), it wasn’t dramatic. I also experienced retrograde ejaculation, which really affected my sexual experience. My doctor advised discontinuing tamsulosin, saying it likely wouldn’t give more benefit long-term.
 

I asked about Duodart, but he advised against it due to high risk of sexual side effects (I already have ED and take tadalafil 5 mg every other day).

We also briefly discussed options like Urolift, but he said it's usually for more severe symptoms (e.g., people waking up 3–4 times a night, or with serious retention). He didn’t recommend further tests like cystoscopy unless I plan to consider a procedure.
 

So in the end, his advice was basically: try to live with it for now, and come back if symptoms get worse.
 

I’m not sure if I’m doing the right thing by waiting. The symptoms are not disabling, but they are consistently frustrating and affecting my sleep and focus. I’m also uncertain how to assess “how bad is bad enough” when it comes to acting on this.
 

Has anyone else been in a similar “grey zone”?

• Did your symptoms improve over time, stay stable, or eventually require treatment?

• Has anyone regretted or benefited from doing UroLift or similar procedures relatively early?

• Did anyone find alternatives to tamsulosin that helped without sexual side effects?

Any shared experiences would be truly appreciated.

Thanks in advance.

[NickyLouie]

Lifestyle changes , are you overweight with no exercise ? 

 

Diet - you can read enough online , but stop eating crap food and sugars, alcohol and caffeine should be really scaled back along with dairy 

 

Drink green tea and take saw palmetto

 

Start doing kegel exercises 

 

 

 

 

[Sheryl]

Before going into the BPH issue, I have to wonder if you  might have an  undiasgnosed prostate infecton or urethitis.

 

Needing to per every1-2 hours seems inconsistent with your degree of BPH.

 

Might  be worth getting a second opinion during which you specifically ask about cultures. 

 

Where are you located? 

[dinsdale]

21 minutes ago, Sheryl said:

might have an  undiasgnosef prostate infecton or urethitis

Agree. 

[Magictoad]

Try the Duodart and see how it goes. I take it every day and haven't noticed anything untoward but I'm 72 with terminal cancer.

[Globenauta]

1 hour ago, Sheryl said:

Before going into the BPH issue, I have to wonder if you  might have an  undiasgnosed prostate infecton or urethitis.

 

Needing to per every1-2 hours seems inconsistent with your degree of BPH.

 

Might  be worth getting a second opinion during which you specifically ask about cultures. 

 

Where are you located? 

 

Thanks, Sheryl,
 

I actually asked the urologist during my recent appointment whether an infection could be part of the problem. He said it was theoretically possible but didn’t seem too inclined to investigate further once I mentioned I had recently done an STD panel.
 

The panel included Chlamydia, Gonorrhea, Mycoplasma, Ureaplasma, Trichomonas, HSV 1 & 2, Candida, and a few others that all came back negative. Would that be enough to rule out a prostate infection or urethritis?
 

I’m based in Samut Prakan, by the way.

Thanks again, very helpful advice.

[JensenZ]

I hear nothing about diabetes. Here's some basic information, which is worth exploring:

 

AI overview:

 

"Diabetics may need to urinate more frequently than non-diabetics, potentially multiple times a day, due to the body's attempt to eliminate excess glucose in the urine. While a normal person may urinate 4-7 times a day, a diabetic may urinate more than 10 times. This increased frequency can be a sign of diabetes or other conditions, like high blood pressure or kidney issues"