Treatment Options For Benign Prostatic Hyperplasia - Enlarged Prostate

Benign Prostatic Hyperplasia, or BPH, is the medical term for enlargement of the prostate, a male reproductive gland which produces the milky liquid that is added to sperm during ejaculation. Lying at the neck of the bladder and in front of the rectum, the prostate surrounds the urethra, a tubular structure that carries urine and semen out through the opening of the penis.

Although the exact cause for prostate enlargement is unknown, it occurs in almost all men as they grow older. According to the American Urological Association, over 50% of men have BPH by the age of 60, increasing to over 90% by age 85. It does not increase your risk of developing prostate cancer. However, the enlarging prostate may put pressure on the urethra, leading to urinary and bladder problems.

Symptoms

Less than half of all men with BPH have symptoms, which include:

  • Dribbling at the end of urination
  • Inability to urinate
  • Incomplete emptying of the bladder
  • Uncontrollable urination
  • Getting up to urinate two or more times during the night
  • Painful urination or blood in the urine (may indicate infection)
  • Difficulty starting a urinary stream
  • Straining to urinate
  • Sudden, urgent need to urinate
  • Weak urine stream

Diagnosis

If you are having the type of symptoms described above, your doctor will most likely perform a digital rectal exam to determine if your prostate is enlarged. To rule out the possibility of cancer as a cause for your symptoms, a PSA blood test may be ordered. PSA is a protein produced by the prostate cells, and elevated levels in the blood may indicate the presence of cancer. This is the same test that is recommended yearly for men over 50 as a screening tool. You may be referred to a urologist for further diagnostic tests to confirm a diagnosis of BPH.

Medications

Medication is typically the first line of treatment for BPH. There are two types of medication which are used to help relieve the symptoms of an enlarged prostate:

  • Alpha blockers - These drugs relax the muscles in the bladder neck and prostate, making it easier to urinate. Hytrin, Cardura, Flomax, Uroxatrol, and Rapaflo are the alpha blockers which are used to treat BPH, and they generally begin to work within a few days.
  • 5 alpha reductase inhibitors - Proscar and Avodart are both drugs which shrink the prostate by blocking male hormones that cause prostate growth. It can take 6-12 months for these drugs to be effective.

Taking an alpha blocker and a 5 alpha reductase inhibitor at the same time is usually more effective than taking either type by itself.

Other Treatment Options

There are several different types of surgery for an enlarged prostate if medication is not effective for you. There are risks and possible complications from any surgical procedure; make sure you are given a thorough explanation of the options recommended, as well as the opportunity to ask questions.

Minimally invasive surgery

Laser and microwave surgeries are minimally invasive therapies used to reduce the size of the prostate and correct the blockage of urine flow. These types of surgery are usually done on an outpatient basis and are less likely to cause blood loss. Laser procedures typically relieve symptoms right away, whereas microwave therapy may only partially relieves symptoms and takes longer for you to notice improvement.

Standard surgical procedures

Standard surgeries for enlarged prostate include:

Transurethral resection of the prostate (TURP)

Transurethral incision of the prostate (TUIP or TIP)

Open prostatectomy

Minimally invasive surgeries have made standard surgeries less common due to a lower risk of side effects and complications, but the treatment of choice depends upon many different factors and should be decided between you and your doctor.

Comments 2 comments

Seeker7 profile image

Seeker7 5 years ago from Fife, Scotland

A very useful and interesting hub. I know my Dad was diagnosed a couple of years ago and had an awful time, having to get up several times during the night to go the bathroom! We eventually persuaded him to go to the doctor. He hadn't before incase it was a young female doctor and he didn't think he would be able to discuss his problem with her. Luckily we got round that hurdle and as soon as he was put on medication it made a huge difference to his life. Ironically, he has actually seen a young female doctor a couple of times since being prescribed medication and he thinks she is the best doctor he has ever had! So it just goes to show, that older men shouldn't be shy about discussing these problems with any doctor.

I'm sure this hub will be of great benefit not only to older men, but to the families as well who are trying to help.

Voted up!


D M Coleman profile image

D M Coleman 5 years ago Author

Thank you, seeker7. My husband took medication for several years, but his problem worsened to the point that he had to begin catheterizing 3 times a day. This past July, he had the laser procedure, with wonderful results. His problems started in his early 50's.

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