Does saw palmetto work for BPH?

High-quality trials show no benefit beyond placebo. We do not recommend it as primary therapy.

Will finasteride affect my PSA?

Yes. Double the measured PSA after 6+ months on finasteride or dutasteride for screening interpretation.

BPH

BPH Medical vs. Surgical Treatment: When to Step Up

Most men with BPH start with an alpha-blocker (rapid symptom relief) and add a 5-alpha-reductase inhibitor when the prostate is enlarged (>40 g). Procedures — UroLift, Rezūm water vapor therapy, prostatic artery embolization, TURP, or HoLEP — are considered when medications fail, side effects are unacceptable, or there is retention, recurrent UTI, bladder stones, or kidney impact.

Medically reviewed by Dr. Angelo Gousse, MD — board-certified urologist (Florida).

Medication strategy

Alpha-blockers (tamsulosin, alfuzosin) work within days. 5-ARIs (finasteride, dutasteride) shrink the prostate over 6–12 months and reduce progression and surgery risk in larger prostates. Combination therapy outperforms monotherapy.

Procedural options

Minimally invasive options preserve ejaculation in most patients — UroLift (mechanical retraction), Rezūm (steam ablation). HoLEP is the gold standard for very large prostates. Choice depends on prostate size, anatomy, and patient priorities.

Frequently asked questions

Does saw palmetto work for BPH?: High-quality trials show no benefit beyond placebo. We do not recommend it as primary therapy.
Will finasteride affect my PSA?: Yes. Double the measured PSA after 6+ months on finasteride or dutasteride for screening interpretation.