Prostate Massage is Not Recommended for BPH and LUTS
Prostate massage has no established role in the treatment of BPH or LUTS and should not be recommended. The American Urological Association guidelines for both medical and surgical management of LUTS/BPH make no mention of prostate massage as a therapeutic option, effectively excluding it from evidence-based practice 1.
Evidence-Based Treatment Framework
The AUA guidelines clearly define the appropriate management pathway for LUTS/BPH, which consists of:
First-Line Approaches
- Behavioral and lifestyle modifications followed by medical therapy are the most prevalent and generally first-line approaches 1
- Alpha-adrenergic antagonists (alpha blockers) as initial medical therapy 1
- 5-alpha reductase inhibitors (5ARIs) for prostates >30cc, either alone or in combination with alpha blockers 1
- PDE5 inhibitors can be considered as initial therapy, particularly if the patient also has erectile dysfunction 1
Surgical Options for Refractory Cases
Surgery is recommended for patients with 1:
- Renal insufficiency secondary to BPH
- Refractory urinary retention secondary to BPH
- Recurrent urinary tract infections
- Recurrent bladder stones or gross hematuria due to BPH
- LUTS/BPH refractory to or unwilling to use other therapies
Why Prostate Massage is Not Included
The comprehensive AUA guidelines from 2021 (medical management) and 2018 (surgical management) represent the gold standard for LUTS/BPH treatment 1. These guidelines underwent rigorous evidence review and make no mention of prostate massage as having any therapeutic benefit for:
- Reducing prostate volume
- Relieving bladder outlet obstruction
- Improving urinary flow rates
- Alleviating storage or voiding symptoms
Clinical Pitfalls to Avoid
Do not confuse prostate massage with evidence-based treatments. While prostate massage may be used diagnostically (e.g., expressed prostatic secretions for prostatitis evaluation), it has no role in BPH/LUTS management 1.
Do not delay appropriate treatment. Men with moderate-to-severe LUTS have significant quality of life impairment, and the prevalence rises to nearly 50% by age 80 1. Effective treatments exist and should be offered promptly.
Proper Initial Evaluation
When evaluating patients with bothersome LUTS possibly attributed to BPH, clinicians should 1:
- Obtain a medical history
- Conduct a physical examination (including digital rectal exam to assess prostate size and characteristics)
- Utilize the International Prostate Symptom Score (IPSS)
- Perform urinalysis
- Consider post-void residual (PVR) measurement in select patients
Patients should be counseled on options for intervention, which include behavioral/lifestyle modifications, medical therapy, and/or referral for discussion of procedural options—not prostate massage 1.