Common Treatments for Enlarged Prostate

Common Treatments For Enlarged Prostate include lifestyle, herbal, prescription, and surgical options. The type of treatment recommended will depend on the severity of symptoms and the individual. One thing that is certain, early diagnosis and treatment, or preventative measures should provide the best outcomes.

Benign prostatic hyperplasia (BPH) affects millions of men worldwide, causing urinary symptoms that can significantly impact quality of life. As the prostate gland enlarges with age, it can obstruct urine flow, leading to frequent urination, weak stream, and incomplete bladder emptying.

Advances in medical technology have expanded the options available for managing BPH. Traditional approaches like alpha-blockers and 5-alpha reductase inhibitors remain important pharmacological therapies. Newer treatments such as prostatic urethral lift and water vapor thermal therapy offer less invasive alternatives to surgery for some patients.

Choosing the right BPH treatment involves careful consideration of symptom burden, prostate size, and overall health status. A thorough evaluation by a urologist can help determine the most appropriate management strategy. Regular follow-up is essential to monitor treatment effectiveness and adjust the approach over time.

Understanding BPH

Benign prostatic hyperplasia (BPH) is a common urological condition affecting older men. It involves non-cancerous enlargement of the prostate gland, leading to urinary symptoms and potential complications if left untreated.

Definition and Epidemiology

BPH refers to the increase in size of the prostate gland in men as they age. This condition affects approximately 50% of men by age 60 and up to 90% by age 85.

The prevalence of BPH increases with age, becoming more common in men over 50. It rarely occurs in men younger than 40.

Factors that may increase the risk of BPH include family history, obesity, and certain medical conditions like diabetes and heart disease.

Pathophysiology

BPH develops in the transition zone of the prostate gland, which surrounds the urethra, the tube that carries urine from the bladder.

As the prostate enlarges, it compresses the urethra, obstructing urine flow. This leads to various lower urinary tract symptoms.

The exact cause of BPH remains unclear. Hormonal changes, particularly the balance between testosterone and estrogen, play a role in prostate growth.

Cellular proliferation and reduced cell death in the prostate tissue contribute to its enlargement.

In some cases, imaging studies like ultrasound or cystoscopy may be necessary for a comprehensive evaluation.

A cystoscopy is a procedure that allows your doctor to examine the lining of your bladder and the tube that carries urine out of your body (urethra). A hollow tube (cystoscope) equipped with a lens is inserted into your urethra and slowly advanced into your bladder.

Early diagnosis is crucial for effective management and prevention of complications such as urinary retention or kidney damage.

Non-Pharmacological Treatment

Several non-drug approaches can help manage BPH symptoms effectively. These methods focus on lifestyle changes, strengthening pelvic muscles, and using heat-based therapies to reduce prostate enlargement.

Lifestyle Modifications

Dietary changes play a crucial role in managing BPH symptoms. Reducing caffeine and alcohol intake can decrease urinary frequency and urgency. Limiting fluid consumption before bedtime helps minimize nighttime urination.

Regular exercise, particularly aerobic activities, can improve urinary symptoms and overall prostate health. Maintaining a healthy weight is also beneficial, as obesity is linked to increased BPH risk.

Bladder training techniques, such as scheduled voiding and delayed urination, can help improve bladder control. Double voiding, which involves urinating twice in succession, ensures complete bladder emptying.

Pelvic Floor Muscle Training

Kegel exercises strengthen the pelvic floor muscles, improving bladder control and reducing urinary symptoms. These exercises involve contracting and relaxing the muscles that control urine flow.

Thermal Therapies

Transurethral microwave thermotherapy (TUMT) uses microwaves to heat and destroy excess prostate tissue. This outpatient procedure typically takes 30-60 minutes and can provide relief for several years.

Transurethral needle ablation (TUNA) employs low-level radiofrequency energy to heat and destroy prostate tissue. It’s minimally invasive and can be performed under local anesthesia.

Water-induced thermotherapy (WIT) circulates heated water through a catheter to reduce prostate size. This method is less invasive than surgical options and has fewer side effects.

REZUM Water Vapor Therapy – Rezum is a minimally invasive procedure that uses steam to shrink the prostate gland and relieve symptoms. The device then releases steam that is absorbed by the prostate tissue, causing it to shrink. Rezum is typically performed on an OUTPATIENT basis and DOES NOT require any incisions or cutting of tissue.

Holmium Laser Enucleation of the Prostate (HOLEP) The holmium laser is a surgical laser that surgeons use to remove the bulky prostate tissue that’s blocking the flow of pee. HoLEP is minimally invasive and carries a low risk of complications compared to other surgeries that treat the same condition.

These thermal therapies often result in improved urinary flow and reduced symptoms. Recovery time is generally shorter compared to traditional surgical procedures.

Pharmacological Therapy

The following is a discussion about medications to help urinary flow and potentially reduce the size of the prostate. None of these medications should be taken lightly, you must consult your doctor before starting any course of medication.

Medication is a common first-line treatment for benign prostatic hyperplasia (BPH). Several drug classes are used to alleviate symptoms and improve the quality of life for men with this condition.

Alpha Blockers

Alpha blockers relax smooth muscle in the prostate and bladder neck. This action improves urine flow and reduces BPH symptoms. Common alpha-blockers include tamsulosin, alfuzosin, and silodosin.

These medications typically work quickly, often within a few days to weeks. Side effects may include dizziness, headache, and retrograde ejaculation.

Alpha-blockers are particularly effective for men with moderate to severe BPH symptoms. They do not reduce prostate size or prevent further growth.

5-Alpha-Reductase Inhibitors

5-alpha-reductase inhibitors (5-ARIs) block the conversion of testosterone to dihydrotestosterone, a hormone that promotes prostate growth. Finasteride and dutasteride are the main drugs in this class.

These medications can shrink the prostate by 20-30% over 6-12 months. They are most effective in men with larger prostates (>40 mL).

5-ARIs may reduce the risk of acute urinary retention and the need for surgery. Side effects can include decreased libido and erectile dysfunction.

Regular PSA testing is important for men on 5-ARIs, as these drugs lower PSA levels.

Phosphodiesterase-5 Inhibitors

Phosphodiesterase-5 (PDE5) inhibitors, such as sildenafil (Viagra), tadalafil (Cialis), and vardenafil (Levitra), are approved for treating both BPH and erectile dysfunction. These drugs relax smooth muscle in the lower urinary tract and improve blood flow.

PDE5 inhibitors can significantly improve urinary symptoms and sexual function. They work relatively quickly, often within a week.

Common side effects include headache, flushing, and nasal congestion. These medications are not recommended for men taking nitrates for heart disease.

Combination Therapy

Combining different classes of BPH medications can provide enhanced symptom relief. Alpha-blockers with 5-ARIs are a common combination, especially for men with larger prostates and moderate to severe symptoms.

This approach can offer more comprehensive treatment by addressing both prostate size and muscle tension. It may also reduce the long-term risk of BPH progression.

Combination therapy can increase the likelihood of side effects. Careful monitoring by a healthcare provider is essential to balance benefits and risks.

Minimally Invasive Procedures

Several minimally invasive procedures offer alternatives to traditional surgery for treating benign prostatic hyperplasia (BPH). These techniques aim to reduce prostate size or relieve urinary symptoms with less risk and shorter recovery times than open surgery.

Note: these treatments work effectively, but may require retreatment after a few years if the BPH condition remains.

Optilume BPH Turbo treatment for Prostate

This is the newest treatment available for BPH it has been developed by Urotronic Inc. in Minnesota based medical device company. The Optilume uses a drug and a consisting of a drug-coated (paclitaxel) balloon system.

Optilume is an outpatient procedure with minimal side-effects.

The Optilume BPH TURBO prostate procedure involves inserting a medication-coated balloon into the prostate urethral space, which gently reshapes the anterior prostatic urethra to create a wider passage, known as an anterior commissurotomy (crack in the upper portion of the prostate), in just 10 minutes.

Transurethral Microwave Thermotherapy TUMT

Transurethral microwave thermotherapy (TUMT) uses microwave energy to heat and destroy excess prostate tissue. A thin antenna is inserted through the urethra to deliver targeted microwaves to the prostate.

The procedure takes about 30-60 minutes and can be performed under local anesthesia. Patients typically go home the same day.

TUMT can improve urinary flow and reduce BPH symptoms in many men. However, the effects may not be as pronounced or long-lasting as other treatments.

Side effects may include temporary difficulty urinating, urinary tract infections, or erectile dysfunction in some cases. The procedure may need to be repeated after a few years.

Transurethral Needle Ablation TUNA

Transurethral needle ablation (TUNA) uses radiofrequency energy to heat and destroy targeted areas of prostate tissue. Small needles are inserted into the prostate through the urethra to deliver the energy.

The procedure usually takes 30-60 minutes under local anesthesia. Most patients return home the same day.

TUNA can improve urine flow and reduce BPH symptoms for many men. It tends to have fewer side effects than some other procedures.

Potential side effects include temporary urinary retention, blood in urine, or urinary tract infections. Some men may need retreatment after a few years.

Prostatic Urethral Lift

The prostatic urethral lift procedure uses small implants to lift and hold enlarged prostate tissue away from the urethra. This helps open the urethral passage to improve urine flow.

Tiny devices are inserted through the urethra to place the implants. The procedure takes about an hour under local anesthesia.

Most men experience symptom improvement within two weeks. The treatment preserves sexual function better than some other options.

Potential side effects include temporary pain or burning during urination, blood in urine, or urinary tract infection. Some men may need additional implants later.

Embolization of the Prostatic Artery PAE

Prostatic artery embolization (PAE) blocks blood flow to parts of the prostate, causing it to shrink. A catheter is inserted through an artery in the leg or wrist to reach the prostate arteries.

Tiny particles are injected to block selected arteries. The procedure takes 1-4 hours under local anesthesia.

PAE can reduce prostate size and improve urinary symptoms in many men. It has a lower risk of sexual side effects than some other treatments.

Potential side effects include temporary pelvic pain, blood in urine, or urinary retention. Some men may need retreatment after a few years.

Surgical Interventions

Surgical treatments for BPH offer effective relief for men with severe symptoms or those who haven’t responded to medication.

Nobody really wants to have surgery, however there may come a time when surgery is better than living with the condition.

These procedures aim to remove or reduce prostate tissue to improve urine flow.

Transurethral Resection of the Prostate TURP

TURP is the most common surgical procedure for BPH. A surgeon inserts a resectoscope through the urethra to remove excess prostate tissue. This operation typically lasts 60-90 minutes and requires a short hospital stay.

TURP can significantly improve urinary symptoms and flow rate. Most men experience relief within days or weeks post-surgery.

Potential side effects include temporary urinary incontinence and retrograde ejaculation. Full recovery usually takes 4-6 weeks.

Open Prostatectomy

Open prostatectomy is reserved for men with very large prostates. The surgeon makes an incision in the lower abdomen to remove the inner part of the prostate.

This procedure offers long-lasting symptom relief but involves longer recovery times than other surgical options. It typically requires a 3-5 day hospital stay.

Complications may include bleeding, infection, and urinary incontinence. Despite these risks, open prostatectomy can provide significant improvement in urinary function for men with severe BPH.

Laser Therapies

Laser therapies use concentrated light to remove excess prostate tissue. Two common types are:

1. Holmium laser enucleation of the prostate (HoLEP)
2. Photoselective vaporization of the prostate (PVP)

These procedures often result in less bleeding and shorter hospital stays compared to TURP. They can be effective for prostates of various sizes.

Holmium Laser Surgery is a minimally invasive procedure that uses a laser beam to remove the tissue from your prostate that’s blocking the flow of pee. HoLEP has been available since the 1990s as a more effective and potentially less costly surgery for urinary obstruction due to BPH. HoLEP offers faster recovery times and requires no incisions (cuts). There is an excellent article by the Cleveland Clinic on HoLEP .

Recovery time is typically shorter than with traditional surgery. Most men return to normal activities within 2-3 weeks.

Photoselective Vaporization of the Prostate (PVP) removes excess prostate tissue using a patented high-power green light laser. The laser vaporizes and precisely removes the enlarged prostate tissue in a virtually bloodless procedure. Because PVP therapy does not cut, or scrape tissue, patients on blood thinner therapies, such as aspirin or warfarin, can be treated.

PVP removes the excess tissue so urinary symptoms are rapidly relieved, accompanied by an improvement in the flow of urine. Most patients are released within a day, and in many cases without a catheter. Recovery time is short and comfortable, and side effects are minimal. For more information see the article by the Mayo Clinic.

Recovery time is very short, most men can resume normal activity within 2 or 3 days.

Transurethral Incision TUIP

Transurethral incision of the prostate (TUIP) involves making small cuts in the prostate and bladder neck to widen the urethra. This procedure is suitable for men with smaller prostates.

TUIP is less invasive than TURP and often performed as an outpatient procedure. It carries a lower risk of retrograde ejaculation compared to other surgical options.

Recovery is usually quick, with most men returning to normal activities within a week. Symptom improvement may be less dramatic than with other surgeries but still significant for many patients.

Robotic-Assisted Prostatectomy

Robotic-assisted simple prostatectomy is a newer technique for treating very large prostates. It combines the effectiveness of open surgery with the precision of robotic technology.

The surgeon controls robotic arms to remove prostate tissue through small incisions. This approach offers enhanced visualization and dexterity during the procedure.

Benefits include less blood loss, shorter hospital stays, and faster recovery compared to traditional open surgery. However, it requires specialized equipment and surgeon expertise.

Long-term outcomes are still being studied, but early results show promising symptom relief and quality of life improvements for men with severe BPH.

Emerging Treatments and Research

Researchers are exploring innovative approaches to treat benign prostatic hyperplasia (BPH). These new methods aim to provide more effective and less invasive options for patients.

Stem Cell Therapy

Stem cell therapy shows promise in BPH treatment. Scientists are investigating the use of mesenchymal stem cells to regenerate prostate tissue and reduce inflammation. Early studies have demonstrated potential benefits in animal models.

Researchers are exploring various stem cell sources, including adipose tissue and bone marrow. Clinical trials are underway to assess safety and efficacy in human patients.

The therapy aims to restore normal prostate function and alleviate BPH symptoms without surgery. While still in the experimental stages, stem cell treatment could offer a breakthrough in BPH management.

Novel Drug Therapies

Pharmaceutical companies are developing new medications targeting BPH symptoms. These drugs focus on specific receptors and pathways involved in prostate growth and urinary function.

One promising approach involves selective androgen receptor modulators (SARMs). These compounds aim to reduce prostate size without affecting testosterone levels throughout the body.

Another avenue of research explores the potential of 5-alpha reductase inhibitors with fewer side effects. Scientists are also investigating combination therapies to enhance treatment efficacy.

Novel drug delivery systems, such as nanoparticles and sustained-release formulations, are being developed to improve medication effectiveness and patient compliance.

PLASMA treatment

Pulsed Laser Ablation of the Prostate (PLASMA) is an emerging minimally invasive procedure for BPH. This technique uses high-energy laser pulses to vaporize excess prostate tissue.

PLASMA treatment offers several advantages:

• Shorter procedure time
• Reduced bleeding risk
• Faster recovery compared to traditional surgeries

Early clinical studies have shown promising results in symptom relief and improved urinary flow. Patients report minimal discomfort and a quick return to normal activities.

Ongoing research aims to optimize laser parameters and treatment protocols. Long-term follow-up studies are evaluating the durability of PLASMA treatment outcomes.

Managing Treatment Side Effects

BPH treatments can cause various side effects that patients should be aware of. Common issues include urinary problems, sexual dysfunction, and general discomfort.

Urinary side effects may include frequent urination, urgency, or difficulty emptying the bladder. Patients can manage these by adjusting fluid intake and scheduling bathroom visits.

Sexual side effects like erectile dysfunction or reduced libido can occur with some medications. Open communication with healthcare providers is essential to address these concerns.

General discomfort such as fatigue or dizziness may arise. Patients should monitor their symptoms and report any persistent issues to their doctor.

Some strategies to minimize side effects include:

• Taking medications as prescribed
• Maintaining a healthy lifestyle
• Regular follow-up appointments
• Discussing alternative treatments if side effects are severe

It’s important to note that not all patients experience side effects, and many issues resolve over time as the body adjusts to treatment.

Patients should keep a symptom diary to track any changes and discuss them with their healthcare provider. This information can help guide treatment adjustments if necessary.

Long-Term Management and Follow-Up

This is the key – what are the long-term outcomes? I wrote an article about a friend of mine who researched for 9 months before having treatment for prostate cancer, simply because he wanted the best outcome. He was in his late 40s at the time of diagnosis and wanted to preserve sexual function as much as possible (don’t we all).

His research paid off and he had a successful procedure and maintains an active sex life.

Regular check-ups are essential for men with BPH. Urologists typically recommend annual visits to monitor symptom progression and treatment efficacy. These appointments often include digital rectal exams and PSA blood tests.

Patients should maintain open communication with their healthcare providers. Reporting any changes in urinary symptoms or medication side effects is crucial for optimal management.

Lifestyle modifications play a key role in long-term BPH control. Limiting fluid intake before bedtime and avoiding bladder irritants like caffeine and alcohol can help reduce symptoms.

Regular exercise, particularly pelvic floor exercises, may improve urinary control. A balanced diet rich in fruits, vegetables, and whole grains is also beneficial for prostate health.

Medication adherence is vital for those prescribed BPH drugs. Patients should take their medications as directed and not stop without consulting their doctor.

For men who have undergone surgical procedures, follow-up appointments are necessary to ensure proper healing and function. These may include post-operative tests to assess urine flow and bladder emptying.

Ongoing monitoring for potential complications is important. This includes watching for signs of urinary tract infections, bladder stones, or kidney problems.

Frequently Asked Questions

Patients considering treatments for benign prostatic hyperplasia (BPH) often have important questions about their options. Understanding the available therapies and management approaches can help guide informed decisions.

How much does all of this cost?

Prices for therapies vay due to complexity and condition of the patient and the prostate. It is impossible to accurately portray prices for everything.

However in Thailand The Bangkok Hospital does list prices for common urological procedures. Please click through and check them out for yourself.

Bangkok Hospital Urologu Surgery Packages

Be sure to check with the hospital to make sure everything is covered. Prostate for Dummies is not affiliated with Bangkok Hospital and cannot be certain these procedures are what is required for each individual. We provide the cost information for information purposes only.

What is the first-line treatment for benign prostatic hyperplasia?

The first-line treatment for BPH typically involves lifestyle changes and medications. Doctors may recommend reducing fluid intake before bedtime and limiting caffeine and alcohol consumption.

Alpha-blockers or 5-alpha reductase inhibitors are often prescribed as initial pharmacological interventions. These medications can help relax prostate muscles or shrink prostate tissue, alleviating urinary symptoms.

What options are available for surgical intervention in BPH?

Surgical options for BPH include transurethral resection of the prostate (TURP), which removes excess prostate tissue. Laser therapies like Holmium laser enucleation (HoLEP) offer less invasive alternatives.

Newer techniques such as UroLift and Rezum use implants or water vapor to reduce prostate obstruction. These procedures often have shorter recovery times compared to traditional surgery.

Which Supplements are recommended for BPH?

Saw Palmetto and Beta-Sitosterol are commonly recommended as a first line of defense for BPH. Other supplements include Pumpkin Seed Oil and Rye Grass Extract. For more information on Supplements check out our article on the Best Supplements for BPH.

Which medications are commonly prescribed for managing symptoms of an enlarged prostate?

Alpha-blockers like tamsulosin and alfuzosin are frequently prescribed to relax prostate and bladder muscles. 5-alpha reductase inhibitors such as finasteride and dutasteride can help shrink the prostate over time.

Some patients benefit from combination therapy using both types of medications. Anticholinergics may be added to address overactive bladder symptoms in certain cases.

What advances have been made in non-invasive treatments for enlarged prostate?

Recent advances include minimally invasive procedures like prostatic urethral lift and water vapor thermal therapy. These techniques aim to provide symptom relief with fewer side effects than traditional surgery.

Focused ultrasound therapy is another emerging non-invasive option. It uses targeted sound waves to destroy excess prostate tissue without incisions.

How can the progression of benign prostatic hyperplasia be effectively slowed?

Regular exercise and maintaining a healthy weight can help slow BPH progression. A diet rich in fruits, vegetables, and whole grains may also be beneficial.

Consistent use of prescribed medications, especially 5-alpha reductase inhibitors, can help prevent prostate growth over time. Regular check-ups allow doctors to monitor symptoms and adjust treatment as needed.

What are the current clinical guidelines for the treatment of benign prostatic hyperplasia?

The American Urological Association recommends a stepped-care approach. This begins with watchful waiting for mild symptoms and progresses to medication for moderate symptoms.

Surgical interventions are typically reserved for severe symptoms or cases where medications prove ineffective. Guidelines emphasize shared decision-making between patients and healthcare providers to determine the most appropriate treatment plan.