National Association For Continence is a national, private, non-profit 501(c)(3) organization dedicated to improving the quality of life
of people with incontinence. NAFC’s mission is
threefold: 1) To educate the public about the
causes, diagnosis categories, treatment options,
and management alternatives for incontinence,
nocturnal enuresis, voiding dysfunction and related pelvic floor disorders, 2) To network with
other organizations and agencies to elevate the
visibility and priority given to these health concerns, and 3) To advocate on behalf of consumers who suffer from such symptoms as a result
of disease or other illness, obstetrical, surgical or
other trauma, or deterioration due to the aging
process itself.
Enlarged Prostate:
What are the
treatment options?
Enlarged Prostate
Benign Prostatic
Hyperplasia:
What are the
treatment
options?
This publication is supported by GlaxoSmithKine Inc.
Detrusor Muscle
(bladder)
Promoting Quality
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Consumer
Education
A publication by
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Prevalence
Enlarged prostate, or benign prostatic hyperplasia
(BPH), is a common occurrence among men as
they age. Benign means that the enlargement is not
caused by cancer or infection, or is unnatural; prostatic
refers to the area affected (the prostate gland); and
hyperplasia means enlargement. As many as 50% of
men experience symptoms of an enlarged prostate
by age 60, and 90% of men will report symptoms by
age 85.
Anatomical Position and Function
The prostate gland is located just below the bladder
at the site where the bladder connects to the urethra.
The urethra is a tube inside the penis that carries urine
and semen out of the body. The prostate gland is the
size and shape of a chestnut, and it has an important
role in sexual function in that it makes semen, which
is a transport medium for sperm.
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flow of urine and semen. This obstruction may cause
a number of irritating symptoms and, if untreated, can
lead to more serious problems as well.
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Sphincters
Prostate
Urethra
1: Prostate - shown in relation to the
bladder, sphincters, and urethra
In most men, the prostate gland will undergo two
stages of growth. The first stage occurs early in life and
is usually complete by the end of puberty. The prostate
remains the same size for many years but may begin
growing again, as it does in most men, and may cause
problems by age 40. If the prostate becomes enlarged it
can sqeeze the urethra, potentially blocking the natural
Causes
Physicians cannot be certain exactly why prostate
enlargement occurs, but it is believed that it may be
due to an excess of certain hormones in the body.
One theory regarding the origin of an enlarged
prostate involves the presence of a hormone called
dihydrotestosterone (DHT) in the blood. DHT is a
natural hormone that is responsible for the initial
stage of prostate growth. As men age, DHT may
cause the prostate to continue growing after it has
reached full-size. Studies have shown a high positive correlation between DHT levels and enlarged
prostate. Physicians have noted that men who do
not produce DHT do not experience an enlarged
prostate. Research has shown evidence that estrogen and genetics may play roles in BPH as well.
It is important to note that the actual size of the
prostate does not necessarily denote the severity of
the symptoms. Often times it is the position of the
gland that causes problems.
Symptoms
Although men may experience varying symptoms as a
result of an enlarged prostate, most men experience
problems relating to the obstruction of urine flow.
Some common symptoms include:
● A weak or interrupted urine flow
● Sudden urgency to urinate
● More frequent urination
● Inability to completely empty the bladder during urination
● Trouble initiating flow even when bladder feels full
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Diagnosis
Some men with an enlarged prostate do not experience
any of these symptoms. The only way to be certain
whether or not you have an enlarged prostate is to
consult a physician. What matters is how significantly
quality of life and freedom is impacted by the symptoms
being experienced.
In order to determine the degree of symptoms
experienced, the International Prostate Symptom Score
may be given to patients by asking a set of specific
questions related to urination habits. Answers to each
question have corresponding numerical values, known
as the BPH Symptom Score Index, which are totaled to
understand the severity of symptoms.
Along with this test your physician will most likely
conduct a thorough medical history examination, a
complete physical, as well as urinalysis. Depending
on the individual case of each patient, additional tests
may be administered as well. Following is a description
of each of these tests:
Digital Rectal Exam (DRE)
The DRE is an element of a routine physical exam.
Due to the natural position of the prostate gland, an
enlargement may commonly be felt through the wall of
the anus. Your physician will check for the enlargement
by inserting a gloved finger into the rectum in order to
monitor the size and condition of the gland.
Urinalysis
Urinalysis is the laboratory testing of urine in order
to determine if any infections or other problems are
responsible for symptoms.
Prostate-Specific Antigen Test (PSA)
The PSA monitors the level of a prostate-specific
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antigen in the patient’s blood. Although this test is typically
used to check for prostate cancer, it can also detect an
enlarged prostate.
Urodynamics Tests
Urodynamics are a group of diagnostic tests done to
evaluate the performance of the lower urinary tract.
These tests can reveal abnormal patterns in urination
that may be a sign of an enlarged prostate. Specifically,
urodynamics detect problems such as urine control,
urinary frequency or urgency, poor bladder emptying, and
intermittent urination.
Cystoscopy
During a cystoscopy, a small camera is inserted in the
urethra through a cystoscope to evaluate the anatomy of
the urethra, prostate and bladder.
Treatment
Watchful Waiting
Some men experiencing minimal symptoms of BPH may
choose to practice what is called watchful waiting. This
means that the patient will simply monitor his condition
and continue to meet with his physician regularly until
changes warrant intervention.
Drug Therapy
There are two main groups of pharmaceuticals that work
to alleviate enlarged prostate symptoms. The first class
includes alpha-blockers that work by relaxing the smooth
muscles around the bladder neck and within the prostate.
Relaxing these muscles improves urine flow.
The second class of pharmaceuticals is called 5-alpha
reductase inhibitors. These medicines work by inhibiting
the production of the hormone DHT to reduce the gland’s
size and thus blockage. As mentioned earlier, DHT is a
hormone in the body associated with prostate growth.
Minimally Invasive Therapy
Drug therapy is not effective in all patients. Therefore,
some men may consider a minimally invasive option for
treating enlarged prostate symptoms.
Transurethral Microwave Therapy
During this therapy, a controlled dose of microwave
energy is delivered to the prostate transurethrally
through a specially designed catheter that encases a tiny
microwave antenna. While heat is being delivered into
the enlarged prostate, cool water circulates throughout
the length of the catheter in order to protect nearby
tissue from excessive heat. By preserving the urethra,
the patient does not experience the serious side effects
that can result from surgery.
●
Transurethral Needle Ablation
Transurethral needle ablation delivers low-level radio
frequency energy to the prostate. This procedure relieves
obstruction without damaging the urethra. During the
procedure a small probe is inserted through the urethra
into the prostate. The probe sends energy to the prostate
destroying excess tissue.
Transurethral Surgery
Transurethral surgery is the most common form
of surgery for treating an enlarged prostate and is
currently considered the gold standard. This surgery
requires no external incisions. A small tool called a
resectoscope is inserted through the urethra and uses
an electrical wire loop to cut tissue away from the part
of the enlarged prostate constricting the urethra. This
surgery, called Transurethral Resection of the Prostate
(TURP), is used whenever possible because it is less
traumatic than open surgeries. A similar procedure,
transurethral incision of the prostate (TUIP), is also
performed through the urethra, but it widens the
urethra by making a few small incisions. TUIP has
received good reviews but its benefits and lasting side
effects have not been clearly established to date.
●
●
Urethral Stent
A wire mesh stent is placed in the urethra within the
prostate to gently hold the urethra open to allow the
passage of urine. This is a permanent stent placed in
an outpatient setting with a special delivery tool and an
endoscope, a tool that allows a lighted view of the urethra
and prostate.
●
Surgery
Surgery is most commonly recommended for men
experiencing severe and persistent symptoms due to
an enlarged prostate. There are many different types
of surgeries that may be performed. Some of these
surgeries include:
Open Surgery
When transurethral surgery is not a viable option,
an open prostate surgery, called a prostatectomy,
is performed. In open surgery, an external incision
is made in the perineum, the area between the
testicles and the anus, or just above the pubis. This
form of surgery is usually performed in the case of
a significantly enlarged prostate. There are three
different types of open procedures. A physician will
decide which procedure to use based on the prostate’s
location and the patient’s general health.
●
Conclusion
It is important for men experiencing any bothersome
urinary symptoms to see their physician as soon as
possible. These signs may be indicators of more serious
conditions and should be diagnosed immediately. It
is also important for men without symptoms to be
screened routinely. Men diagnosed with an enlarged
prostate should be comforted by the wide range of
treatment options available to them.
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