You’ve noticed the symptoms: getting up multiple times each night to urinate, a weak stream, the frustrating feeling that your bladder never fully empties. Your doctor mentions an enlarged prostate, and you’re wondering—will this go away on its own? Can your prostate shrink back to normal without treatment?
It’s a question nearly every man with benign prostatic hyperplasia (BPH) asks. The answer isn’t what most hope to hear, but understanding the reality of prostate growth—and your treatment timeline options—empowers you to make the right decision for your health.
The Uncomfortable Truth About Prostate Growth
Here’s what you need to know: an enlarged prostate will not shrink on its own. In fact, the opposite is true. Without intervention, your prostate will likely continue growing throughout your lifetime.
The prostate gland grows in two main phases. The first occurs during puberty, when the prostate doubles in size. Then, around age 25, the prostate begins growing again—and this growth continues for the rest of your life. This persistent growth is simply part of male aging, driven by hormones, particularly dihydrotestosterone (DHT).
By age 60, approximately 50% of men have an enlarged prostate. By age 85, that number climbs to 90%. For most men, the question isn’t if their prostate will enlarge, but when—and how much it will affect their quality of life.
Why Waiting Can Make Things Worse
Some men adopt a “wait and see” approach, hoping their symptoms will improve or at least stay manageable. This strategy, called watchful waiting, has its place for men with very mild symptoms. However, it’s important to understand what you’re waiting for.
Without treatment, BPH typically follows a progressive course. Your symptoms will likely worsen over time as the prostate continues to grow. What starts as a minor inconvenience—an extra bathroom trip at night—can evolve into:
- Chronic urinary retention and incomplete bladder emptying
- Recurrent urinary tract infections
- Bladder stones
- Bladder damage from prolonged stretching
- Kidney damage from backup of urineComplete urinary blockage requiring emergency
- catheterization
These complications don’t happen overnight, and they don’t happen to everyone. But the risk increases the longer an enlarged prostate goes untreated. Once bladder or kidney damage occurs, treating the prostate may not fully reverse the damage.
When Watchful Waiting Makes Sense
That said, not every man with an enlarged prostate needs immediate treatment. Watchful waiting is appropriate if:
- Your symptoms are very mild and don’t significantly impact your quality of life
- You’re willing to make lifestyle modifications and monitor symptoms closely
- You have regular follow-up appointments to track prostate growth and symptom progression
- You understand the risks and know when to seek treatment
During watchful waiting, your doctor will monitor your prostate size, symptom severity, urine flow rate, and post-void residual (how much urine remains in your bladder after urinating). If any of these worsen significantly, it’s time to consider treatment.
Understanding Treatment Timelines: How Long Until Relief?
If you decide to pursue treatment—and most men with moderate to severe symptoms eventually do—understanding how quickly different options work helps set realistic expectations.
Medication Timeline: Months of Patience Required
If you start with medications, you’ll need patience. Alpha blockers like tamsulosin can improve urine flow within days to weeks, but they don’t actually shrink the prostate. They simply relax the muscles around it.
For actual prostate shrinkage, you’ll need a 5-alpha reductase inhibitor like finasteride or dutasteride. These medications block the hormone that causes prostate growth, but they work slowly:
- 1-3 months: Minimal change; many men see no improvement yet
- 3-6 months: Beginning to notice symptom improvement
- 6-12 months: Maximum prostate shrinkage achieved (typically 20-30% reduction)
- Ongoing: Must continue medication indefinitely to maintain results
This timeline frustrates many men. You’re taking a pill every day, possibly dealing with side effects like reduced libido or erectile dysfunction, and waiting half a year or more to feel significantly better. During this time, your prostate hasn’t stopped growing—the medication is simply trying to outpace the natural growth.
If you stop taking these medications, your prostate will resume growing. The shrinkage isn’t permanent; it’s maintenance therapy.
Minimally Invasive Procedures: Weeks to Months
Newer, minimally invasive treatments offer faster relief than medications while avoiding the risks of major surgery.
Prostate Artery Embolization (PAE) has emerged as an attractive option for many men. The timeline looks like this:
- Day 1-2: The outpatient procedure is completed; you go home the same day
- First week: Mild discomfort as the prostate adjusts to reduced blood supply; limited activity recommended
- 2-4 weeks: Noticeable symptom improvement begins
- 1-3 months: Continued improvement as the prostate progressively shrinks
- 6-12 months: Maximum prostate shrinkage achieved (20-40% reduction)
- Long-term: Results last for years; the prostate is permanently smaller
What makes PAE appealing is the balance of effectiveness and convenience. You’re not taking daily medication indefinitely, you avoid genital surgery, and most men preserve sexual function. The recovery is measured in days, not weeks, and symptom relief comes much faster than with medications.
Rezūm Water Vapor Therapy follows a similar timeline:
- Day 1: Five-minute procedure completed
- First 2-4 weeks: Urinary symptoms may temporarily worsen as tissue dies and is absorbed
- 2 weeks to 3 months: Gradual symptom improvement
- 3-6 months: Maximum benefit achieved
UroLift provides the fastest relief among minimally invasive options:
- Day 1: Procedure completed
- Immediately to 2 weeks: Noticeable symptom improvement
- Ongoing: Effects maintained long-term
However, UroLift doesn’t actually shrink the prostate—it mechanically holds the tissue away from the urethra. It works best for smaller prostates without a middle lobe.
Surgical Timeline: Immediate Results, Longer Recovery
Traditional surgical approaches like TURP (transurethral resection of the prostate) or simple prostatectomy offer immediate prostate reduction, but with a longer recovery period:
- Day 1: Surgery performed; hospital stay of 1-3 days
- Week 1-2: Catheter in place; significant discomfort
- 2-6 weeks: Gradual recovery; restrictions on activity and lifting
- 6-12 weeks: Return to normal activities
- 3-6 months: Sexual function stabilizes (retrograde ejaculation common; erectile dysfunction possible)
Once healed, the improvement in urine flow is immediate and dramatic. However, the recovery process is the longest of any treatment option, and the risk of permanent sexual side effects is highest.
Comparing the “Do Nothing” Timeline
Let’s put this in perspective. If you choose not to treat your enlarged prostate:
- Year 1-2: Symptoms gradually worsen; more nighttime bathroom trips, weaker stream
- Year 3-5: Quality of life significantly impacted; avoiding long trips, planning routes around bathrooms
- Year 5-10: Possible complications like urinary retention, infections, bladder stones
- Year 10+: Severe prostate enlargement can cause urinary obstruction with possible bladder and kidney damage
This progression varies widely—some men experience rapid worsening while others plateau for years. But the trend is clear: without treatment, things don’t get better.
Making the Timeline Decision: What Matters Most?
Choosing when and how to treat your enlarged prostate depends on what matters most to you:
If you prioritize minimal disruption to your life: Minimally invasive procedures like PAE offer a middle ground. You’ll wait weeks rather than months for improvement, without the extended recovery of surgery.
If you want the absolute fastest relief: Surgical options provide immediate results once you’ve healed, though recovery takes longer than the procedures themselves.
If you’re willing to wait for a non-invasive approach: Medications work, but you’ll need patience and must continue taking them indefinitely.
If your symptoms are mild: Lifestyle modifications combined with watchful waiting may buy you time, but stay vigilant for worsening symptoms.
The Cost of Waiting Too Long
Here’s what many men don’t realize: the longer you wait, the more your bladder adapts to working harder. Over time, the bladder muscle thickens and becomes less elastic. Eventually, it may become weak and “floppy,” unable to contract effectively even after the prostate obstruction is relieved.
This is why treating BPH earlier rather than later often leads to better outcomes. A mildly enlarged prostate at age 55 is easier to treat—and recovery is faster—than a severely enlarged prostate at age 70 that’s caused years of bladder damage.
The Bottom Line: Your Prostate Won’t Shrink on Its Own
An enlarged prostate will not resolve without intervention. The natural course is continued growth and worsening symptoms. While watchful waiting has its place for mild symptoms, most men eventually need treatment.
The good news? You have more options than ever, and treatment timelines have improved dramatically. You don’t need to choose between years of medication and major surgery. Minimally invasive procedures offer middle-ground solutions with faster relief than medications and easier recovery than surgery.
The best time to address your enlarged prostate is before it significantly impacts your quality of life or causes complications. Don’t wait until you’re desperate. Instead, consult with a urologist or interventional radiologist to discuss your timeline preferences and find the treatment approach that aligns with your goals.
Your prostate won’t shrink on its own, but with the right treatment, you can reclaim your comfort, your sleep, and your freedom from the bathroom. The only question is: how soon do you want relief?
Learn more about Prostate Artery Embolization (PAE) or request a consultation. Colorado Advanced Endovascular is based in Lakewood, Colorado, and serves Denver and the Front Range.