Enlarged Prostate (BPH)
The prostate is a walnut-sized gland below the bladder and surrounding the urethra. An enlarged prostate can squeeze the urethra and cause difficulty with urination. Urinary problems due to an enlarged prostate are widespread and can be seen in men as young as 30.
An enlarged prostate – also called benign prostatic hyperplasia (BPH) – is typically due to the noncancerous growth of an internal prostate area. Your risk of an enlarged prostate increases with age. More than half of all men over the age of 50 and 90% over the age of 80 have an enlarged prostate.
Enlarged Prostate Symptoms
Symptoms of prostate troubles are divided into two categories:
- Urine Obstruction: Difficulty starting the urine stream, a weak stream, and dribbling after finishing are common obstructive symptoms of an enlarged prostate.
- Urine Storage: Frequent or urgent urination, waking at night to urinate, and difficulties holding urine (loss of urine before making it to the bathroom) are types of urinary incontinence that may indicate more advanced issues with the prostate.
The above symptoms may worsen over time and cause complications that include:
- Inability to urinate (urinary retention)
- Bladder or kidney damage
- Bladder stones
- Urinary tract infections (UTIs)
An enlarged prostate is usually diagnosed after a medical exam, including a digital rectal examination and a prostate-specific antigen (PSA) blood test. Simple, in-office urinary flow tests may also be conducted; in some cases, more advanced testing may be required.
When symptoms appear, many men are concerned they may have prostate cancer. It is essential to know that BPH does not cause or worsen prostate cancer, though it can co-occur. Also, know that prostate cancer is rarely symptomatic in its early stages. Learn more about differentiating BPH from prostate cancer.
Treatment for Enlarged Prostate (BPH)
Initial treatment is geared toward behavioral modifications such as urinating on a fixed schedule and avoiding urinary irritants like caffeine. You must also limit evening beverages and urinate when you first feel the urge. Increasing your physical activity level can also help.
Herbal supplements have been marketed heavily to men with lower urinary tract symptoms or LUTS. This is especially true of a supplement known as saw palmetto, posited as a natural prostate enlargement therapy. There is little evidence to support this beyond a possible placebo effect; however, we do not necessarily discourage its use. Because the FDA does not regulate supplements and may have varying quality, we strongly caution that patients find a well-known supplement company that uses third-party testing to ensure purity. Eventually, however, herbal supplements will not offer relief – physical or psychological and the next step must be taken.
Often, men with an enlarged prostate may also need medications. There are two general categories: drugs that increase flow (alpha-blockers such as Rapaflo, Flomax, Uroxatral, Cardura, and Hytrin) and medicines that shrink the prostate (Proscar and Avodart).
Recent studies indicate that combinations of medications that work by different pathways may be more effective than a single medication to treat BPH. While drugs will work for a while, their effects eventually wear off, and patients will ultimately need to consider minimally invasive in-office or surgical therapies.
More than 65% of men with BPH will have worsening problems and may ultimately need minimally invasive in-office or surgical treatment.
IN-OFFICE AND MINIMALLY INVASIVE PROCEDURES
Minimally invasive BPH therapies are often an excellent next step in approaching an enlarged prostate that no longer responds to medication I ordered for the drug causes significant side effects.
- Rezūm™ Water Vapor Therapy is a newer procedure that uses thermal energy – steam – to shrink an enlarged prostate.
- Urolift is another heavily marketed and relatively newer BPH therapy that does not involve the mechanical elimination of excess prostatic tissue. Instead, sutures are fired into the prostatic tissue, which is pulled back from the urethra to relieve symptoms.
- Transurethral needle ablation (TUNA) uses low-energy radio frequency to destroy excess prostate tissue (such as with the Prostiva system). The TUNA is less commonly used than the treatments above.
- Transurethral microwave therapy (TUMT) uses microwave energy to generate heat and destroy prostate tissue. TUMT is no longer widely used.
LASER SURGICAL OPTIONS
- The Greenlight KTP laser prostatectomy can be a safe, effective option that uses a laser to melt away excess prostate tissue. This procedure is performed on an inpatient or outpatient basis and requires general anesthesia. Greenlight is typically indicted for relatively smaller enlarged prostates.
- Holmium laser enucleation of the prostate (HoLEP) hollows the prostate, leaving only the capsule behind. HoLEP is a good option for larger prostates that tend to bleed more.
Surgery is designed to open the prostate channel by surgically removing excess tissue. These procedures are often indicated for larger prostates and are the definitive treatment or
- The gold standard surgical procedure to treat an enlarged prostate is a transurethral resection of the prostate (TURP), which cuts away excess prostate tissue using a small electrical loop. This surgery typically involves an overnight hospital stay.
- A simple prostatectomy is an option for extremely large prostates for whom a bipolar TURP is inappropriate or indicated.
- Aquablation is a new technology that uses a robotic arm and autonomous technology to fire a water jet into the prostate and remove excess prostatic tissue.
What Is the Best BPH Treatment Option?
As you can tell, many treatment options are available today. Dr. Natale takes a stepwise approach toward treating BPH, only progressing to a more invasive option once the last has failed or no longer offers relief. Fortunately, most options above have success rates and durable or long-lasting results. As such, we discussed the possible treatment progression during your consultation and can always modify the next step based on the previous period’s results. The most critical next step is to meet with Dr. Natalie to see what options you have available after thoroughly examining the size of your prostate and the symptoms you’re experiencing.