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"

[Globenauta]

12 hours ago, JensenZ said:

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"

Thanks for your feedback.

That was indeed the first question the Dr. asked me (if I am diabetic). I said that I have periodic annual checkups which include blood sugar test (FBS) that have always come back at around the average values of the normal range. The last one was just a couple of mouths ago. Personally, I am not sure if that's enough to rule out diabetes, but he seemed satisfied with it and didn't prescribe further tests.

 

[Sheryl]

16 hours ago, Globenauta said:

 

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.

Most common cause of prostatitis is E. Coli, which an STD panel would nto detect.

Also, depending on the type of test done, there can be false negatives esp for chlamydia.

 

So you still need to rule out prostatitis IMO. It is just not usual for mild BPH to cause the degree of urinary frequency you describe. Add to that the lack of relief from tamsulosin, and suspicion of an infection rises.

 

This doctor is  not too far from Samut Prakan  and has been recommended by other board members

https://www.sukumvithospital.com/doctorprofile.php?id=188&lang=en

 

Ideally you want toi get a prostate massage to express prostatic fluid then a culture and sensitivity

 

As for your BPH: iti s a progressive condition and it worsens with age, but how fast varies greatly. One of the 2 classes of medication used for it can help reduce prostate size/slow growth. These are the 5-alpha reductase inhibitors, such as finasteride and dutasteride. It takes 6-12 months to see the therapeutic effect of these drugs, and they do unfortunately sometimes worsen ED. When they do, sometimes this effect eases up with continued use and sometimes not.

 

The other class of drugs used for BPH are alpha antagonists, such as tamsulosin and doxazosin.  These do nto affect oprostate size but rather give symptomatic relief from blockage by relaxing the smooth muscles in the prostate and bladder neck. Unlike the first class of drugs, action is almost immediate. You already tried this class of drug without  relief.

 

Cialis is also sometimes used to relax the muscles around the bladder neck and prostate, likewise only symptomatic relief. And of course, for ED. 

 

Since the 5-alpha reducatse inhibitors do, over time, reduce the size of the prostate and slow progression of BPH, you  could ask doctor about a daily regimen of Cialis plus finasteride or dutasteride as a way of  potentially off-setting the negative effect of the latter on erectile function. May or may not work, and may or may nto be suitable i nthe context iof your overall medical history.

 

Urolift is nto widely available here, just a few places and doubt any doctor  would  do it for mild case of BPH. Like all treatments, it has potential side effects. 

 

Some people feel that saw palmetto and/or milk thistle supplements help with BPH, others don't, and there is a lack of clear evidence either way. No harm in trying.

 

But above all, I suggest you rule out potential infection as your urinary frequency is unusual from mild BPH. 

 

 

 

 

 

 

[Moonlover]

With your symptoms and age, I would consider trying a course of acupuncture. It's none invasive, pretty cheap compared with standard western treatment and importantly avoids the need for medication with their almost inevitable side affects.

 

It has a very good track record as this website indicates.

 

https://bestofchinesemedicine.com/specialties/bph-treatment/

[xylophone]

I suffered from either prostatitis or BPH for decades and was never quite clear what it was, although large and long doses of one or two antibiotics seemed to do the trick, until it/they didn't!

 

It wasn't until I got in touch with a couple of professors who were working on this very subject that I found relief with a regimen of the antibiotics they prescribed, so it was prostatitis one way or another.

 

However over this time, I was prescribed tamsulosin and others to help alleviate my symptoms and along with that I tried just about every other remedy (herbal and otherwise including Beta Sitosterol) and nothing worked, so I had a TURP done at the Epworth Hospital in Melbourne, and it has certainly not been plain sailing since that time.

 

Latterly I researched other options for BPH and came to the conclusion that if I was to have my time over again I would choose the Urolift procedure or possibly the iTind procedure, both of which are fairly non-invasive and don't actually require surgery.

 

Good luck with whatever you decide and once you go for something like a TURP, there is no turning back, so choose carefully.

 

https://youtu.be/e20Ak49YD6E?feature=shared

https://www.youtube.com/watch?v=e20Ak49YD6E&ab_channel=UroLift

https://www.prostatelasercenter.com/blog/difference-prostatitis-vs-bph/

[Lacessit]

I have an obstructive prostate.

 

Originally I was on finasteride and cardura. My GP in Australia switched me to duodart, which is a combination of dutasteride and tamsulosin.

 

Sheryl's advice of investigating whether the OP has prostatitis should be heeded.

 

The advice of my highly qualified urologist in Australia is live with BPH, take meds, and treat surgery as an absolute last resort.

[msbkk]

1 hour ago, Lacessit said:

I have an obstructive prostate.

 

Originally I was on finasteride and cardura. My GP in Australia switched me to duodart, which is a combination of dutasteride and tamsulosin.

 

Sheryl's advice of investigating whether the OP has prostatitis should be heeded.

 

The advice of my highly qualified urologist in Australia is live with BPH, take meds, and treat surgery as an absolute last resort.

It certainly depends on the case. Medications did not help me at and had the Rezum procedure in Bangkok 2 years ago. I am very satisfied with the result without any side effects.