Uomo maturo a colazione, guida alla prostata ingrossata

Enlarged prostate (benign prostatic hyperplasia): what are the urinary symptoms, causes, and treatments?

Oct 19, 2026

Oct 16, 2026 · @GPNutraceuticals

Enlarged prostate, medically known as benign prostatic hyperplasia (BPH), is an increase in prostate size that is not cancer and does not turn into cancer, but can make urination difficult: a weak urine stream, needing to go to the bathroom often, and getting up several times during the night. If symptoms are mild, it’s often enough to monitor them and change a few habits; when they are bothersome, effective medications are available, as well as minimally invasive procedures for more significant cases. It is one of the most common conditions in men over 50 and becomes more common with age. Evidence for supplements is weak: the latest Cochrane review found no meaningful benefit from saw palmetto alone.

In this guide, learn about the causes, symptoms, and warning signs; when to see a urologist; how diagnosis is made; recommended treatments according to guidelines; and what studies say about saw palmetto, pumpkin seeds, nettle, and other herbal remedies.

Reading time: 11 minutes

Last updated: October 2026

Scientific review: GP Nutraceuticals Team

Main sources: EAU and AUA guidelines on male lower urinary tract symptoms, Cochrane review of saw palmetto, EMA monograph on nettle root, GRANU study on pumpkin seeds

What is benign prostatic hyperplasia?

The prostate is a gland about the size of a chestnut, located below the bladder and surrounding the first part of the urethra, the tube that carries urine out of the body. It produces some of the seminal fluid. As men age, under the influence of male hormones, its central part tends to grow and may squeeze the urethra like a clamp: urine flows less easily, and the bladder muscles, which have to push harder, become more irritable over time.

Prostate size doesn’t tell the whole story: a very large prostate may cause few symptoms, while a slightly enlarged one may cause many. That’s why doctors talk about lower urinary tract symptoms and assess how much they affect daily life to measure their severity.

Inflamed or enlarged prostate? The differences between BPH, prostatitis, and cancer

Benign prostatic hyperplasia, also called benign prostatic enlargement: a non-cancerous enlargement of the prostate associated with age, which mainly causes urinary symptoms.
Prostate cancer: in the early stages, it often causes no symptoms and is suspected based on a blood test or an examination. It is not caused by an enlarged prostate, but the two conditions can occur together, so any symptoms should be assessed by a doctor.
Prostatitis: inflammation, sometimes caused by infection, that also affects younger men and causes lower abdominal or perineal pain, burning and sometimes fever.

In brief: the 5 key points

The guide's central message in five points: BPH is common, is not cancer, and is treated step by step.

It is a benign enlargement, very common after age 50, that can make urination difficult.
Typical symptoms include a weak stream, frequent urination, urgency and waking at night to urinate.
Inability to urinate, visible blood in the urine or fever require immediate medical attention.
For mild symptoms, monitoring and healthy habits may be enough; there are also effective medicines and minimally invasive procedures.
Evidence for supplements is weak: saw palmetto alone has not shown significant benefits in the most rigorous studies.

What you'll find in this guide

The guide starts with a definition, covers causes, symptoms and diagnosis, and ends with treatments, supplements and frequently asked questions.

Causes and risk factors.
Symptoms and warning signs.
When to see a doctor and how diagnosis is made.
Watchful waiting, medicines and procedures according to the guidelines.
What studies say about supplements.
Frequently asked questions.

This guide is for informational and educational purposes only and does not replace the advice of a doctor or other qualified healthcare professionals.

What causes an enlarged prostate?

Prostate enlargement is mainly linked to age and male hormones. Here, testosterone is converted by an enzyme called 5-alpha-reductase into dihydrotestosterone (DHT), which stimulates cell growth. Over the years, this stimulus, together with changes in the balance between hormones and mild chronic inflammation, causes prostate tissue to increase and therefore enlarges the prostate gland. Some of the medicines used to treat it act on this mechanism.

Benign prostatic hyperplasia: risk factors

The condition is more common or causes more problems in people who:

is over 50;
has close relatives with the same condition;
is overweight, has diabetes or metabolic syndrome;
is physically inactive.

Some medicines, such as nasal decongestants and certain antihistamines, can worsen urinary symptoms in people who already have BPH. Sexual activity, on the other hand, does not cause prostate enlargement.

What are the symptoms of an enlarged prostate?

Symptoms usually develop gradually over months or years and fall into two groups.

Obstructive symptoms, related to difficulty passing urine:

weak or interrupted stream;
hesitation before urine starts flowing;
needing to strain to urinate;
dribbling at the end of urination and a feeling that the bladder hasn't emptied completely.

Irritative symptoms, related to increased sensitivity:

frequent need to urinate, even during the day;
nocturia, meaning waking up once or more during the night to urinate;
urgency, sometimes with small leaks.

Waking up at night and urgency are often the symptoms that have the greatest impact on quality of life.

Warning signs and complications: when urine won't pass

Over time, hyperplasia can lead to complications. Contact your doctor or go to the emergency room immediately if you experience:

inability to urinate with a tight, painful lower abdomen (acute urinary retention);
blood in the urine;
fever, chills, or intense burning, which may be signs of infection;
flank pain or a decrease in the amount of urine.

Urologist visit and tests: when should you see a doctor?

When should you see a doctor about an enlarged prostate?

It's a good idea to talk to your family doctor, who can refer you to a urologist, as soon as symptoms appear or change, even if they're mild. This helps confirm that the condition is benign prostatic hyperplasia and not something else, and determine whether and how to treat it. Many men put it off out of embarrassment or because they think it's a normal part of aging, but an early assessment can help prevent more serious problems. Don't wait if you have any of the warning signs described above.

How is BPH diagnosed? Blood tests and prostate ultrasound

According to the guidelines of the European Association of Urology (EAU) and the American Urological Association (AUA), the assessment includes:

consultation and IPSS questionnaire: seven questions about urinary symptoms, scored from 0 to 35, that classifies symptoms as mild (0-7), moderate (8-19), or severe (20-35), and also helps track progress;
digital rectal examination: the doctor uses a finger to assess the organ's size, consistency, and regularity;
urine test: to check for bacteria, blood, or glucose;
PSA: a blood test that, after discussing its benefits and limitations with your doctor, helps estimate prostate volume and detect possible signs of cancer;
uroflowmetry: you urinate into a device that measures urine flow and stream strength;
post-void residual: ultrasound is used to measure how much urine remains after urinating;
voiding diary: especially useful when the main problem is waking up at night.

In some cases, a transrectal prostate ultrasound, a creatinine test to assess kidney function, or more in-depth tests before surgery may also be recommended.

How is an enlarged prostate treated?

The choice depends on how bothersome the symptoms are, prostate size, and any related problems. The goal is to reduce symptoms: EAU and AUA guidelines recommend a stepwise approach.

Mild urinary symptoms: watchful waiting and lifestyle

If symptoms are mild and do not interfere with daily life, you may avoid medication and have regular checkups while adopting some helpful habits:

drink less in the 2-3 hours before bedtime, without reducing fluids during the rest of the day;
limit coffee, alcohol, and carbonated drinks, especially in the evening;
urinate twice in a row, a few minutes apart, to empty the bladder more completely;
practice waiting a little longer when the urge to urinate comes;
manage constipation, maintain a healthy weight, and exercise, which can improve symptoms;
review with the doctor any medications that may worsen symptoms.

Medications: which ones are used and when

When symptoms are bothersome, a doctor may prescribe medication:

alpha blockers (such as tamsulosin, silodosin, alfuzosin): they relax the prostate and bladder neck muscles and improve urine flow within a few days. They may cause dizziness, low blood pressure, and ejaculation problems;
5-alpha-reductase inhibitors (finasteride, dutasteride): they reduce prostate size and the risk of urinary retention and surgery, but the effect takes 6-12 months to appear. They are used when the prostate is greatly enlarged; they may reduce libido and erectile function and halve the level of the prostate marker in the blood, which should be mentioned to anyone interpreting the test results;
combination therapy with both medications when the prostate is larger and symptoms are moderate or severe;
low-dose tadalafil, especially useful if erectile dysfunction is also present;
medications for overactive bladder or nighttime awakenings when these symptoms and urgency are predominant, always after checking the amount of urine left after urination.

Surgery: when an operation is needed

Surgery is considered when medications are not enough or complications arise, such as urinary retention, recurrent urinary infections, bladder stones, recurrent bleeding, or kidney damage. The classic technique is transurethral resection of the prostate (TURP), performed endoscopically without external incisions; for larger prostates, laser enucleation is increasingly used. Minimally invasive techniques are also available, such as water vapor therapy or small implants that widen the urethra. These tend to preserve ejaculation but are suitable only for some patients. The urologist makes the choice based on prostate size, overall health, and the patient's preferences.

Supplements and herbal remedies: what do the studies say?

Herbal remedies for this condition are widely used, especially in Europe. The most studied is saw palmetto (Serenoa repens), followed by pumpkin seeds, nettle root, pygeum, and beta-sitosterol. There are many studies, but they are often small, short, and use different preparations, and the results depend heavily on the type of extract. None of these products has been shown to reduce the gland's volume.

Scientific evidence and regulatory claims are two different things. A permitted label claim describes a physiological function recognized by an authority and does not prove that a product treats this condition. Likewise, a favorable study alone does not authorize a claim.

What the guidelines say

The EAU guidelines allow hexane-extracted saw palmetto to be offered, with a weak recommendation, to men who want to avoid the side effects of medication, explaining that the effect may be modest. The 2021 AUA guidelines do not include herbal medicine among the recommended treatments.

Studies on individual ingredients

Ingredient	Doses used in studies	What the studies say	Quality of evidence
Saw palmetto	Usually 320 mg per day of extract	The 2023 Cochrane review (27 studies, 4,656 men) found an improvement of about 1 point on the IPSS scale compared with placebo, below the approximately 3-point threshold patients can perceive; no benefit was found even at 960 mg per day in a 72-week study. With a specific hexane-extracted product, a meta-analysis found a slightly stronger urinary stream and fewer nighttime awakenings than with placebo	High for saw palmetto overall (no meaningful benefit); moderate for the hexane extract
Pumpkin seeds	Whole seeds 10 g per day or extract 1 g per day, for 12 months	In the GRANU study, involving 1,431 men, whole seeds led to more responses than placebo (58.5% versus 47.3%), while the extract did not	Low
Nettle root	EMA-indicated doses, for example 300-700 mg per day of dry extract	The European Medicines Agency recognizes its traditional use for urinary symptoms caused by enlargement, after more serious conditions have been ruled out; combined with saw palmetto, a study of 257 men found it reduced symptoms more than placebo (6 versus 4 IPSS points). The leaves have not been studied for this condition	Low
Pygeum	75-200 mg of extract per day	In a meta-analysis of 18 short studies, fewer nighttime awakenings and a stronger urine stream compared with placebo	Low
Beta-sitosterol	60-130 mg per day	In 4 studies involving 519 men, improvement of about 5 IPSS points compared with placebo, but over short periods	Low
Scutellaria and ajuga	–	Laboratory studies only; no clinical studies in humans	Very low

In general, these products are well tolerated and have fewer sexual side effects than medicines. However, symptoms should be assessed by a doctor before using them, as they could be due to something else, including cancer.

What a supplement can claim

No ingredient has an EU-authorized health claim relating to this gland. In Italy, for plants such as saw palmetto and pumpkin seeds, the Ministry of Health allows label claims such as “supports prostate function”, which describe a physiological function and not the treatment of a disorder.

Frequently asked questions

Brief answers to the most common questions: the difference from prostatitis, cancer risk, tests and ultrasound reports, saw palmetto, sex life, how much to drink, and when surgery is needed.

What does it mean to have an inflamed prostate?

It usually means prostatitis: inflammation, sometimes caused by bacteria, which can also occur in young men. Unlike the symptoms of benign prostatic hyperplasia, which are mainly related to urination, prostatitis causes pain in the lower abdomen, perineum, or genitals, a burning sensation and, in acute cases, fever. Treatment depends on the cause: bacterial forms are treated with antibiotics prescribed by a doctor, while several approaches are used for chronic nonbacterial forms, from medication to pelvic floor physical therapy. In everyday language, the term is also used to mean enlargement, but these are different conditions.

Can an enlarged prostate become cancerous?

No. Benign enlargement does not turn into cancer and does not increase the risk of prostate cancer. However, both conditions are common with age and can occur together, so symptoms should always be assessed by a doctor.

Does a high PSA (prostate-specific antigen) mean prostate cancer?

Not necessarily. This value can also rise due to enlargement, prostatitis, or after strain in the area, such as a long bike ride. A doctor should interpret the result alongside an examination and, if needed, other tests. Anyone taking finasteride or dutasteride should mention it, because these medicines halve the value.

What does the prostate impression on the bladder mean?

This is a term used in ultrasound reports: it indicates that the central part of the organ has grown upward and protrudes into its interior. This is common when the prostate increases in volume and, if the protrusion is pronounced, it can obstruct emptying. On its own, it is neither a tumor nor a condition that needs treatment: the urologist assesses it alongside symptoms, urinary flow, and the amount of urine left after urination.

What should you do if your prostate is heterogeneous?

“Heterogeneous” describes an uneven appearance of tissue on ultrasound images and is common after age 50: it may be due to enlargement, small calcifications, or past inflammation. On its own, it does not indicate a tumor. It is worth showing the report to your urologist, who will interpret it alongside the examination, blood tests, and symptoms and, if needed, recommend other tests such as an MRI.

Does saw palmetto work?

The most recent Cochrane review, covering 27 studies, found no patient-relevant improvement in symptoms with saw palmetto alone. A specific hexane-extracted product showed some benefits for urinary flow and nighttime awakenings, and European guidelines consider it an option with a weak recommendation for people who want to avoid the side effects of medication.

Can an enlarged prostate affect your sex life?

Yes, to some extent. Moderate or severe urinary symptoms are more often associated with erectile dysfunction and ejaculation problems, partly because they share risk factors such as age, diabetes, and excess weight. Treatments can also have an effect: alpha blockers can reduce or eliminate ejaculation; finasteride and dutasteride can reduce libido and erectile function in some men, while tadalafil can also improve erections. If these issues are a concern, it is worth discussing them with your urologist before choosing a treatment.

Should you drink less if you need to urinate often at night?

Only in the evening. Reducing fluids in the 2-3 hours before bed and limiting alcohol and coffee can help, but drinking too little during the rest of the day is not helpful and may contribute to kidney stones. If you wake up many times at night, keeping a urination diary can help your doctor identify the cause.

Can BPH be treated without surgery?

In most cases, yes: many men do well with regular checkups and healthy habits or with medication. Surgery is needed when medication is not enough or problems such as urinary retention occur.

In summary

This is a benign and very common condition after age 50: it is not a tumor, but it can make urination difficult and disrupt sleep. It is recognized by a weak stream, frequent urination, urgency, and nighttime awakenings; if you experience urinary retention, blood, or fever, seek medical care immediately. Diagnosis is based on an examination, the IPSS questionnaire, a urine test, and, after discussing it with your doctor, a PSA test.

Treatment proceeds in stages: monitoring and healthy habits if symptoms are mild, then medication such as alpha-blockers and 5-alpha-reductase inhibitors, and surgery when needed. Evidence for supplements is weak: saw palmetto alone has not shown significant benefits, while data on some extracts and other plants are limited.

The GP Nutraceuticals nutraceutical approach

A supplement is not a treatment for prostate enlargement and does not replace a doctor's assessment or, when needed, medication. It can complement the healthy habits described in this guide, after a doctor has assessed the symptoms.

ProstaCom Ultra is a tablet dietary supplement combining dry extracts of saw palmetto (fruit, 600 mg), pumpkin seeds (150 mg), nettle leaves (100 mg), Scutellaria root (100 mg, including 95 mg of baicalin), and Ajuga reptans (50 mg, including 5 mg of teupolioside). The amounts refer to the daily dose of one tablet.

Among the permitted label claims:

saw palmetto and pumpkin seeds support prostate function;
saw palmetto, pumpkin seeds, and nettle support urinary tract function;
Scutellaria supports the body's natural defenses;
Ajuga contributes to the maintenance of healthy skin and skin appendages.

The studies described in this guide used preparations and amounts different from those in a dietary supplement (for example, 10 g per day of whole pumpkin seeds, or nettle root rather than leaves), so their results cannot be attributed to the product. The product is not recommended for women of childbearing age or boys before puberty. If you take medication for BPH or have a fever, blood in your urine, or difficulty urinating, talk to your doctor first.

Scientific sources and references

This guide is based on three types of sources: guidelines from scientific societies, institutional sources such as the European Medicines Agency, and scientific studies published in peer-reviewed journals, including systematic reviews and randomized clinical trials.

Guidelines and institutional sources

European Association of Urology. EAU Guidelines on the Management of Non-neurogenic Male LUTS. uroweb.org
Lerner LB, McVary KT, Barry MJ, et al. Management of lower urinary tract symptoms attributed to benign prostatic hyperplasia: AUA guideline part I – initial work-up and medical management. J Urol. 2021. doi.org
European Medicines Agency, Committee on Herbal Medicinal Products. European Union herbal monograph on Urtica dioica L., Urtica urens L., radix. 2025. ema.europa.eu
Commission Regulation (EU) No 432/2012 establishing a list of permitted health claims made on foods. eur-lex.europa.eu

Saw palmetto

Franco JVA, Trivisonno L, Sgarbossa NJ, et al. Serenoa repens for the treatment of lower urinary tract symptoms due to benign prostatic enlargement. Cochrane Database Syst Rev. 2023. doi.org
Barry MJ, Meleth S, Lee JY, et al. Effect of increasing doses of saw palmetto extract on lower urinary tract symptoms: a randomized trial. JAMA. 2011. PMID: 21954478
Novara G, Giannarini G, Alcaraz A, et al. Efficacy and safety of hexanic lipidosterolic extract of Serenoa repens (Permixon) in the treatment of lower urinary tract symptoms due to benign prostatic hyperplasia: systematic review and meta-analysis of randomized controlled trials. Eur Urol Focus. 2016. doi.org

Other herbal medicines

Vahlensieck W, Theurer C, Pfitzer E, et al. Effects of pumpkin seed in men with lower urinary tract symptoms due to benign prostatic hyperplasia in the one-year, randomized, placebo-controlled GRANU study. Urol Int. 2015. doi.org
Lopatkin N, Sivkov A, Walther C, et al. Long-term efficacy and safety of a combination of saw palmetto and nettle extract for lower urinary tract symptoms: a placebo-controlled, double-blind, multicenter trial. World J Urol. 2005. doi.org
Wilt T, Ishani A, MacDonald R, et al. Pygeum africanum for benign prostatic hyperplasia. Cochrane Database Syst Rev. 2002. doi.org
Wilt T, Ishani A, MacDonald R, et al. Beta-sitosterols for benign prostatic hyperplasia. Cochrane Database Syst Rev. 1999. doi.org

Update history

We update this guide when new guidelines or relevant studies are published.

Version 1.0 – October 2026

First published. Primary sources: EAU and AUA guidelines on male urinary disorders, Cochrane review on saw palmetto (2023), EMA monograph on nettle root, clinical studies on saw palmetto, pumpkin seeds, nettle, pygeum and beta-sitosterol.

Gabriele Poli