Is surgery necessary for an enlarged prostate? When can you avoid it, and when should you consider surgery?

When told by a doctor that "your prostate is enlarged, and you may consider surgery," many people's first reaction is: has it really come to this point?

Let's start with the conclusion: not necessarily. Most cases of benign prostatic hyperplasia (BPH) do not require surgery; starting with medication and regular follow-ups is the standard medical recommendation. However, there are several situations where there are clear and valid reasons to undergo surgery.

This article will clarify the boundary between "can hold off on surgery for now" and "should seriously consider surgery," so you can be mentally prepared when discussing with your doctor.

Why does an "enlarged prostate" not equal "needing surgery"?

Because the size of the prostate does not necessarily correlate directly with the severity of the symptoms.

Some people have a very large prostate but only mild symptoms, while others have a prostate that isn't particularly large but experience a severe sensation of obstruction at the bladder outlet. Clinically, the intensity of treatment is decided by how the symptoms affect your quality of life, your response to medication, and whether complications have arisen, rather than just looking at data from various examinations. Therefore, the answer to the question "do I absolutely need surgery?" still depends on your own symptoms.

If you are not yet sure whether your condition is BPH, please first read "What are the symptoms of BPH? When to seek medical attention, and which warning signs can't wait."

In what situations can we hold off on surgery for now?

If your symptoms are mild to moderate, you respond to medication, and you do not have any of the warning signs mentioned in the next section, holding off on surgery for now is an acceptable choice.

The standard approach at this stage is lifestyle adjustments combined with medication therapy, along with regular follow-up visits. The follow-up items are actually very specific: changes or improvements in symptoms, post-void residual urine volume, kidney function indices, and whether there are recurrent infections. As long as these factors gradually stabilize, it is not uncommon for patients to live in harmony with an enlarged prostate for many years.

A reminder here is that medication may need to be taken long-term, and some medications have side effects such as dizziness (postural hypotension) or ejaculatory issues. If you have related concerns, please discuss with your doctor to adjust your treatment, and do not stop taking the medication on your own.

Are there treatments for BPH that do not go through the urethra?

Yes. Most common surgeries for BPH, such as transurethral resection of the prostate (TURP) or laser surgery, are performed by entering through the urethra; on the other hand, there is a treatment performed through the arterial blood vessels called prostate artery embolization (PAE), which does not involve the urethra at all.

In PAE, the physician inserts a microcatheter through an artery in the wrist or groin, and under the guidance of angiographic imaging, selectively embolizes the arteries supplying the prostate. This gradually reduces the volume of the prostate gland, thereby improving urinary symptoms. Because it does not go through the urethra and no tissue is resected, instruments do not pass through the penis or touch the external genitalia during the procedure. Patients who are anxious about instruments entering the urethral opening, prefer not to have treatments touching intimate areas, worry about retrograde ejaculation and other surgery-related impacts, or face higher anesthesia risks, can consider PAE as another option to discuss with their doctor.

There is another anxiety that is rarely voiced out loud. Transurethral surgery usually requires spinal or general anesthesia. Some people feel uneasy at the thought of being asleep, or having no sensation in their lower body, while instruments are being inserted into their private parts, or the thought of their genitals bleeding.
PAE uses local anesthesia, allowing you to remain fully conscious throughout the procedure. The instruments enter through the artery in the wrist or groin and do not pass through the urethra; if you have any sensations or questions during the process, you can communicate directly with the doctor at that moment.

However, PAE is not suitable for everyone, nor is it a simple replacement for surgery. Prostate volume, vascular conditions, and symptom severity will all affect whether it is suitable, and in some situations, surgery remains the better option. If you want to compare the differences between transurethral surgery, laser surgery, and PAE in detail, you can refer to the comprehensive comparison of various treatment methods on our website, or have a doctor evaluate and explain your options.

In what situations is surgery recommended?

There are five situations where considering surgical treatment is well-justified.

1. Recurrent acute urinary retention: completely unable to urinate, having a catheter inserted, and still being unable to urinate after it is removed.
2. Long-term obstruction that has already affected kidney function.
3. Recurrent hematuria (blood in the urine).
4. Recurrent urinary tract infections, or the formation of bladder stones.
5. Symptoms that continue to severely affect sleep and daily life despite regular medication.

If you fall into these categories, please discuss your options seriously with your doctor and do not keep delaying. At this point, the focus is no longer on "whether you want to have surgery," but that the symptoms themselves are causing harm.

If I really do not want surgery, are there other options in between?

Between "medication has limited effect" and "transurethral surgery," there is prostate artery embolization (PAE), which does not go through the urethra. This procedure uses a microcatheter via an artery to embolize the blood vessels supplying the prostate, gradually shrinking its volume.

PAE is one of the options, but it is not suitable for everyone.
The volume, shape, and vascular conditions of the prostate will affect whether you are a suitable candidate for this minimally invasive treatment, which requires a urological evaluation combined with imaging examinations to determine.
If you would like to understand the procedure and eligibility criteria for prostate artery embolization itself, please refer to "PAE Prostate Embolization Treatment Guide"; to choose between surgery and PAE, see the complete comparison in "PAE Prostate Embolization vs. Other Surgical Methods Comparison".

Even if the prostate is very large, it does not mean that traditional surgery is the only treatment left. United Daily News (UDN) Health once reported a case of minimally invasive catheter treatment evaluated by Dr. Jiun-Yu Lin for a 90-year-old patient with a prostate over 300 grams and recurrent urinary retention. Whether a large prostate is suitable for PAE still requires further confirmation of pelvic vascular conditions.

What information is most efficient to prepare before discussing with a doctor?

It is recommended to prepare five pieces of information: how long the symptoms have lasted, how many times you wake up at night to urinate, your score if you have taken the International Prostate Symptom Score (IPSS), your current medication list and how long you have been taking them, and whether you have experienced inability to urinate, hematuria, or infections.

These five answers directly determine whether you fall on the side of "can hold off on surgery for now" or "should consider surgery," allowing your time in the consultation room to be spent discussing options rather than reconstructing your medical history.

What if you would like to be evaluated?

First, a reminder about something that cannot wait: if you are currently completely unable to urinate, please go directly to a medical facility or the emergency room; do not wait for an outpatient appointment.

For other situations, you can first complete a preliminary assessment via LINE to arrange an appointment for the Saturday Men's Special Clinic. Please bring your past examination reports and medication list to your consultation, so you and the doctor can evaluate your condition based on the boundaries outlined in this article.

See-Medical Clinic is located at 2F-1, No. 40, Sec. 2, Heping E. Rd., Da'an Dist., Taipei City. Visits are by appointment only. Phone: (02) 2366-0186.

Author: Dr. Jiun-Yu Lin

Last Updated: August 27, 2026

Disclaimer: This article is for health education purposes only and cannot replace a doctor's diagnosis and treatment advice. The suitability of any treatment must be evaluated and decided by a doctor.

Prostatic Artery Embolization (PAE) International Literature References:
Mouli S, Dolmatch BL, Gunn AJ, et al. Society of Interventional Radiology (SIR) 2026 practice guidance document for prostatic artery embolization. J Vasc Interv Radiol. 2026;108771. doi:10.1016/j.jvir.2026.108771 Sapoval M, Thiounn N, Descazeaud A, et al. Prostatic artery embolisation versus medical treatment in patients with benign prostatic hyperplasia (PARTEM): a randomised, multicentre, open-label, phase 3 superiority trial. Lancet Reg Health Eur. 2023;31:100672. doi:10.1016/j.lanepe.2023.100672