Prostate bph treatment

What Is BPH?

Articles On Prostate Enlargement / BPH

Prostate Enlargement / BPH

Prostate Enlargement / BPH

You can do a lot to take care of yourself and give your body what it needs. Still, as you get older, your body changes in ways you can’t always control. For most men, one of those changes is that the prostate gets bigger.

It’s a natural part of aging, but at some point, it can lead to a condition called BPH, or benign prostatic hyperplasia.

Your prostate surrounds part of your urethra, the tube that carries urine and semen out of your penis. When you have BPH, your prostate is larger than usual, which squeezes the urethra. This can cause a weak stream when you pee and cause you to wake up a lot at night to go to the bathroom along with other bothersome urinary symptoms.

BPH isn’t prostate cancer and doesn’t make you more likely to get it.

It’s a common condition, especially in older men, and there are a lot of treatments for it, from lifestyle changes to medication to surgery. Your doctor can help you choose the best care based on your age, health, and how the condition affects you.

What Causes BPH?

Doctors aren’t sure exactly what makes this happen. Some think it may have to do with normal hormonal changes as you age, but it’s not clear.

Early in puberty, your prostate actually doubles in size. Later in life, around age 25, it starts to grow again. For most men, this growth happens for the rest of their lives. For some, it causes BPH.

As the prostate gets larger, it starts to pinch the urethra. This causes symptoms that affect your urine flow, such as:

• Dribbling when you finish
• A hard time getting started
• A weak stream, or you pee in stops and starts

When your urethra is squeezed, it also means your bladder has to work harder to push urine out. Over time, the bladder muscles get weak, which makes it harder for it to empty. This can lead to:

• Feeling like you still have to pee even after you just went
• Having to go too often — eight or more times a day
• Incontinence (when you don’t have control over when you pee)
• An urgent need to pee, all of a sudden
• You wake up several times a night to pee

A larger prostate doesn’t mean you’ll have more or worse symptoms. It’s different for each person. In fact, some men with very large prostates have few, if any, issues.

Diagnosis and Tests

Your doctor will first talk to you about your personal and family medical history. You might also fill out a survey, answering questions about your symptoms and how they affect you daily.

Next, your doctor will do a physical exam. This may include a digital rectal exam. During this, he puts on a glove and gently inserts one finger into your rectum to check the size and shape of your prostate.

Basic tests: Your doctor may start with one or more of these:

• Blood tests to check for kidney problems
• Urine tests to look for infection or other problems that could be causing your symptoms
• PSA (prostate-specific antigen) blood test. High PSA levels may be a sign of a larger-than-usual prostate. A doctor can also order it as screening for prostate cancer.

Advanced tests: Based on the results of those tests, your doctor may order additional tests to rule out other problems or to see more clearly what’s happening. These might include:

• Different types of ultrasound to measure your prostate and see if it looks healthy.
• A bladder ultrasound to see how well you empty your bladder.
• Biopsy to rule out cancer.
• Urine flow test to measure how strong your stream is and how much pee you make.
• Urodynamics testing to evaluate your bladder function.

Treatments

How your doctor handles your case varies based on your age, health, the size of your prostate, and how BPH affects you. If your symptoms don’t bother you too much, you can put off treatment and see how it goes.

Lifestyle changes: You may want to start with things you can control. For example, you can:

• Do exercises to strengthen your pelvic floor muscles
• Lower the amount of fluids you drink, especially before you go out or go to bed
• Drink less caffeine and alcohol

Medicine: For mild to moderate BPH, your doctor might suggest medicine. Some medications work by relaxing the muscles in your prostate and bladder. Others help shrink your prostate. For some men, it takes a mix of medicines to get the best results.

Procedures: If lifestyle changes and medications don’t work, your doctor has a number of ways to remove part or all of your prostate. Many of these are called “minimally invasive,” meaning they’re easier on you than regular surgery. They use probes or scopes and don’t require large cuts in your body.

Examples of a minimally invasive procedures are TUMT, TUNA, or Rezūm which use a varied form of energy to destroy part of the prostate.

Other surgical procedures include:

• Laser therapy to remove part of your prostate
• Transurethral resection of the prostate, or TURP, in which the doctor uses a scope and cuts out pieces of the gland with a wire loop

In some cases, your doctor may also suggest a traditional, open surgery or a robotic procedure to remove your prostate.

Any Complications?

BPH doesn’t lead to prostate cancer or make you more likely to get it.

It rarely leads to other conditions, but it can, and a couple of them are serious. For example, BPH can lead to kidney damage or, worst-case, cause a problem where you can’t pee at all.

It may also cause:

• Bladder damage
• Bladder stones
• Urinary tract infections
• Blood in your urine

NIH, National Institute of Diabetes and Digestive and Kidney Diseases: “Prostate Enlargement: Benign Prostatic Hyperplasia.”

Mayo Clinic: “Benign Prostatic Hyperplasia (BPH).”

Prostate Cancer Foundation: “Benign Prostatic Hyperplasia (BPH).”

UCLA Health: “Conditions Treated.”

Johns Hopkins Medicine: “Benign Prostatic Hyperplasia.”

Radiological Society of North America: “Benign Prostatic Hyperplasia (BPH).”

Traditional Treatment Methods for Enlarged Prostate

If trips to the restroom require sudden dashes or are marked by difficulty urinating, your prostate may be enlarged. You’re not alone — the Urology Care Foundation estimates that 50 percent of men in their 50s have an enlarged prostate. The prostate is the gland that produces the fluid that carries sperm. It grows larger with age. An enlarged prostate, or benign prostatic hyperplasia (BPH), can block the urethra from transporting urine from the bladder and out of the penis.

Keep reading to learn about traditional treatments for BPH.

Don’t resign yourself to living with BPH. Addressing your symptoms now can help you avoid problems later. Untreated BPH may lead to urinary tract infections, acute urinary retention (you can’t go at all), and kidney and bladder stones. In severe cases it can lead to kidney damage.

Treatment options include medications and surgery. You and your doctor will consider several factors when you evaluate these choices. These factors include:

• how much your symptoms interfere with your life
• the size of your prostate
• your age
• your overall health
• any other medical conditions

This class of medications works by relaxing the bladder neck muscles and the muscle fibers in the prostate. The muscle relaxation makes it easier to urinate. You can expect an increase in urine flow and a less frequent need to urinate within a day or two if you take an alpha blocker for BPH. Alpha blockers include:

This type of medication reduces the size of the prostate gland by blocking hormones that spur the growth of your prostate gland. Dutasteride (Avodart) and finasteride (Proscar) are two types of 5-alpha reductase inhibitors. You’ll generally have to wait three to six months for symptom relief with 5-alpha reductase inhibitors.

Taking a combination of an alpha blocker and a 5-alpha reductase inhibitor provides greater symptom relief than taking either one of these drugs alone, according to an article in Current Drug Targets. Combination therapy is often recommended when an alpha blocker or 5-alpha reductase inhibitor isn’t working on its own. Common combinations that doctors prescribe are finasteride and doxazosin or dutasteride and tamsulosin (Jalyn). The dutasteride and tamsulosin combination comes as two drugs combined into a single tablet.

There are minimally invasive surgery options when drug therapy isn’t enough to relieve BPH symptoms. These procedures include transurethral microwave thermotherapy (TUMT). Microwaves destroy prostate tissue with heat during this outpatient procedure.

TUMT will not cure BPH. The procedure does cut down urinary frequency, makes it easier to urinate, and reduces weak flow. It doesn’t solve the problem of incomplete emptying of the bladder.

TUNA stands for transurethral needle ablation. High-frequency radio waves, delivered through twin needles, burn a specific region of the prostate in this procedure. TUNA results in better urine flow and relieves BPH symptoms with fewer complications than invasive surgery.

This outpatient procedure can cause a burning sensation. The sensation can be managed by using an anesthetic to block the nerves in and around the prostate.

Hot water is delivered through a catheter to a treatment balloon that sits in the center of the prostate in water-induced thermotherapy. This computer-controlled procedure heats a defined area of the prostate while neighboring tissues are protected. The heat destroys the problematic tissue. The tissue is then either excreted through urine or reabsorbed in the body.

Invasive surgery for BPH includes transurethral surgery, which doesn’t require open surgery or an external incision. According to the National Institutes of Health, transurethral resection of the prostate is the first choice of surgeries for BPH. The surgeon removes prostate tissue obstructing the urethra using a resectoscope inserted through the penis during TURP.

Another method is transurethral incision of the prostate (TUIP). During TUIP, the surgeon makes incisions in the neck of the bladder and in the prostate. This serves to widen the urethra and increase urine flow.

Laser surgery for BPH involves inserting a scope through the penis tip into the urethra. A laser passed through the scope removes prostate tissue by ablation (melting) or enucleation (cutting). The laser melts excess prostate tissue in photoselective vaporization of the prostate (PVP).

Holmium laser ablation of the prostate (HoLAP) is similar, but a different type of laser is used. The surgeon uses two instruments for Holmium laser enucleation of the prostate (HoLEP): a laser to cut and remove excess tissue and a morcellator to slice extra tissue into small segments that are removed.

Open surgery may be required in complicated cases of a very enlarged prostate, bladder damage, or other problems. In open simple prostatectomy, the surgeon makes an incision below the navel or several small incisions in the abdomen via laparoscopy. Unlike prostatectomy for prostate cancer when the entire prostate gland is removed, in open simple prostatectomy the surgeon removes only the portion of the prostate blocking urine flow.

Not all men with BPH need medication or surgery. These steps may help you manage mild symptoms:

• Do pelvic-strengthening exercises.
• Stay active.
• Decrease alcohol and caffeine intake.
• Space out how much you drink rather than drinking a lot at once.
• Urinate when the urge strikes — don’t wait.
• Avoid decongestants and antihistamines.

Talk with your doctor about the treatment approach that best suits your needs.

What’s the Best Approach to Treating BPH?

Articles On Prostate Enlargement / BPH Treatments

Prostate Enlargement / BPH Treatments

Prostate Enlargement / BPH Treatments

There’s no one-size-fits-all approach when you have an enlarged prostate and you’re trying to decide what to do next.

Each person reacts in his own way to the symptoms of benign prostatic hyperplasia (BPH), a common condition for men as they age.

You can talk about your symptoms with your doctor, and together you can decide on the best way for you to handle your case. Your options may include:

Watchful Waiting

If your symptoms don’t bother you much and you haven’t gotten any complications, you may choose to just have you and your doctor keep a regular eye on things.

This means seeing your doctor once a year — or sooner if your symptoms change.

Some things to watch include:

• Needing to pee a lot
• The sensation that your bladder is full, even after you’ve just gone
• An urgent need to go out of the blue
• A weak stream or dribbling at the end
• Trouble starting
• Having to stop and start peeing several times
• Urine leakage

Reasons to consider watchful waiting for an enlarged prostate:

• Your symptoms are mild.
• You don’t want the side effects of medications.
• It’s less costly than medical or surgical treatments.
• Some men with mild BPH symptoms find they get better without treatment.

If you choose watchful waiting, there are a couple of things you can do to ease things:

• Make simple changes in your habits. Drinking fewer liquids before bedtime. Drink less caffeine and alcohol generally.
• Avoid some over-the-counter medications. Take a pass on cold and sinus medicines that have decongestants or certain antihistamines, such as diphenhydramine (Benadryl), that can make a prostate problem worse. Read labels on these products before you buy them.

Should I Go With a Treatment?

If your symptoms become worse, it’s time to talk to your doctor about an active treatment. Some things to ask yourself and your doctor about each option:

• How much will my condition improve?
• How long will the effects last?
• Is there a chance that the treatment will cause problems?

From there, you can talk with him about medications, supplements or surgery.

Prescription Medications

These may give you relief. Some reasons to consider going on medication for an enlarged prostate include:

• You have moderate symptoms that aren’t getting better or might be getting worse.
• You’ve tried making lifestyle changes, such as drinking fewer liquids, with no results.
• You are at risk for complications related to BPH, such as not being able to empty your bladder.

Two types of medications are available to treat moderate BPH. Each works differently in the body, and each has its own side effects.

The two classes of drugs for an enlarged prostate are:

• Alpha blockers, which relax muscles of the prostate and neck of the bladder to relieve symptoms. Examples of alpha blocker medications include: Alfuzosin (Uroxatral), Doxazosin (Cardura), Tamsulosin (Flomax), and Terazosin (Hytrin).
• 5-alpha reductase inhibitors (5-ARIs), which help shrink the prostate and prevent additional growth. Examples of 5 ARIs include: Finasteride (Proscar) and Dutasteride (Avodart).
• Phosphodiesterase 5 inhibitors (PDE5 inhibitors): Tadalfil (Cialis), Sildenafil, (Viagra), Vardenafil (Levitra). (PDE5) inhibitors have been shown to improve prostate symptom score with increasing flow rate.

Men with very enlarged prostates may take more than one medication, called combination therapy, to reduce the need for surgery. However, men taking both might also get hit with the side effects of both drugs.

The FDA requires labels on the 5-ARIs to include a warning that they may be linked to an increased chance of high-grade (or aggressive) prostate cancer. Medications that contain 5-ARIs include: dutasteride (Avodart, Jalyn) and finasteride (Propecia, Proscar).

Supplements

They aren’t as closely regulated as medicines your doctor prescribes. That means their safety, quality, and effects can vary.

Saw palmetto is one of the best-studied and most commonly used supplements to treat BPH. Some small studies have shown benefit. However, several large studies do not show that it reduces the size of the prostate or eases urinary symptoms.
Three others are:

Talk to your doctor before you start any supplement. They may cause problems with prescription medicines, treatments, or tests you might need.

Procedures

Sometimes BPH doesn’t respond enough to lifestyle changes, medications, or supplements. If that’s true for you, there are surgical options as well.

You and your doctor look to surgery when you can’t pee at all or have:

One of your options would be what’s called “minimally invasive” surgery. In these types, doctors make much smaller cuts or are able to work with probes they insert through your penis. These types of procedures often mean faster recoveries and less pain and scarring.

Traditional, open surgery is the other option. You should talk with your doctor about what’s best for your case.

Mayo Clinic: “Benign prostatic hyperplasia: Definition” “Benign prostatic hyperplasia: Treatments and Drugs,” “Minimally invasive surgery: Definition.”

Urology Care Foundation: “What Are the Symptoms of BPH?” “Benign Prostatic Hyperplasia (BPH): Surgery,” “BPH: Minimally Invasive Surgeries,” “What is Transurethral Electroevaporation of the Prostate (TUVP)?”

UCLA Health: “Conditions Treated: BPH.”

U.S. Food & Drug Administration: “5-alpha reductase inhibitors (5-ARIs): Label Change – Increased Risk of Prostate Cancer.”

National Institutes of Health, National Center for Complementary and Integrative Health: “Saw Palmetto.”

American Urological Association: “Benign Prostatic Hyperplasia (BPH): A Patient’s Guide,” “Benign Prostatic Hyperplasia (BPH), Clinical Guidelines.”

Agency for Healthcare Policy Research.

William Jaffe, MD, professor of urology, Temple University School of Medicine, Philadelphia.

National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC): “Prostate Enlargement: Benign Prostatic Hyperplasia.”

BJU International: “High-grade prostate cancer and finasteride.”

Winchester Hospital: “Health Library: Saw Palmetto”

Casabé A, Roehrborn CG, Da Pozzo LF, et al. “Efficacy and safety of the coadministration of tadalafil once daily with finasteride for 6 months in men with lower urinary tract symptoms and prostatic enlargement secondary to benign prostatic hyperplasia.” J Urol.2014;191:727-733

Porst H, Kim ED, Casabé AR, et al. “Efficacy and safety of tadalafil once daily in the treatment of men with lower urinary tract symptoms suggestive of benign prostatic hyperplasia: results of an international randomized, double-blind, placebo-controlled trial.” Eur Urol.2011;60:1105-1113.