Do not use this for urgent symptoms. If you cannot empty your bladder, have urinary symptoms accompanied by a fever or back pain, or see significant blood in your urine, seek emergency medical attention.

Understand Prostate Volume (cc vs. grams)

Prostate size is calculated using dimensions from an ultrasound or MRI and is reported in cubic centimeters (cc) or grams (which are equivalent in prostate tissue). A normal prostate is about 20 to 25 cc. Moderate enlargement is 40 to 80 cc, while massive prostates can exceed 100 to 150 cc. Prostate size dictates which procedures are technically feasible—for instance, Rezum or UroLift are typically performed on prostates under 80–100cc, while HoLEP and PAE are highly effective for massive prostates.

Questions to ask

  • What is my exact prostate volume in cc or grams on my most recent imaging?
  • Does my prostate size exclude me from less-invasive office procedures like Rezum, UroLift, or iTind?
  • If my prostate is very large (e.g. over 80cc or 100cc), are we looking primarily at simple prostatectomy, HoLEP, or prostate artery embolization (PAE)?

Identify Median Lobe and Intravesical Protrusion (IPP)

The prostate has three lobes: two lateral lobes and a middle (median) lobe. In some men, the median lobe grows upward into the bladder cavity—a finding called Intravesical Protrusion (IPP). This projection can act like a ball-valve, physically sealing the bladder opening when you try to urinate. The presence of a median lobe or high-grade IPP requires specific procedures designed to address this tissue block (like Rezum, HoLEP, or certain surgeries) and may make other implants less effective.

Questions to ask

  • Does my imaging show median lobe enlargement or intravesical prostatic protrusion (IPP)?
  • If IPP is present, how many millimeters does it project into my bladder, and does it rule out lateral-lobe-only procedures?
  • Which treatment is most reliable for resolving a ball-valve obstruction caused by a median lobe?

Measure Bladder Strain (PVR & Qmax)

Your bladder's response to the obstruction is just as important as the prostate's size. Clinicians check your urine flow rate (Qmax, normal is over 15 mL/s) and use an ultrasound immediately after you urinate to check your Post-Void Residual (PVR) volume—how much urine is left behind. A normal PVR is under 50 mL; residual urine over 100–200 mL indicates bladder muscle strain and increases the risk of urinary tract infections, bladder stones, and kidney damage.

Questions to ask

  • What is my post-void residual (PVR) volume, and is it high enough to threaten my bladder or kidney health?
  • Does my imaging show signs of bladder wall thickening, pocket formation (diverticula), or trabeculation from straining?
  • If my bladder has become weak or stretched, will my symptoms improve fully after we open the prostate obstruction?

Clarify the PSA (Prostate-Specific Antigen) Context

PSA is a protein produced by prostate cells. A elevated PSA level can indicate prostate cancer, but it is also highly elevated by BPH (larger prostates make more PSA), urinary retention, urinary tract infections, or recent medical instruments. It is vital to separate BPH symptom management from prostate cancer screening, ensuring that an elevated PSA is fully evaluated (using digital rectal exams, repeat labs, or a prostate MRI) before BPH treatments are performed.

Questions to ask

  • What is my baseline PSA level, and how does it relate to my overall prostate volume and age?
  • Could my recent urinary retention, infection, or medication (like finasteride) be affecting how we interpret my PSA numbers?
  • Do we need a prostate MRI or biopsy to rule out prostate cancer before we perform any procedures or surgeries for my BPH symptoms?

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Sources

AUA BPH Guidelines · Cleveland Clinic BPH overview · Radiopaedia Prostate Volume Calculations