Enlarged Prostate
ALSO KNOWN AS BENIGN PROSTATIC HYPERPLASIA (OR HYPERTROPHY), BPH is enlargement of the
prostate gland. This enlargement can result in difficulty emptying the bladder which man experience as a
variety of symptoms that will be discussed below. The size of the prostate does not always determine how
severe the blockage or the symptoms will be.
LOWER URINARY TRACT SYMPTOMS (LUTS)
Symptoms of BPH most often begin around age 50 but can be seen much earlier. Often the first symptom
is a decrease in the strength of the urinary stream but other symptoms can include:
• a decrease in the force of stream
• a urinary stream that starts and stops throughout the flow
• a delay in starting the stream frequent urination (having to urinate more often than every 3 hours)
• a feeling that the bladder has not emptied completely
• waking up at night to urinate
• dribbling urine at the end of the stream
• inability to urinate
Although many men believe these symptoms are just a part of getting older, the truth is, these symptoms
are not normal at any age and over time these symptoms may be harmful to the bladder and kidneys.
Incompletely emptying the bladder and overworking the bladder muscle can lead to urinary tract
infections, bladder or kidney damage, bladder stones, and incontinence. It is important to seek treatment
early because damage to the bladder can often be permanent. When BPH is recognized and treated in its
early stages, however, there is a lower risk of developing such complications.
EVALUATION
The first step in getting treatment for BPH is to tell your doctor about your symptoms. With many options
available that successfully treat BPH, there is no need to suffer with the disease. To effectively treat BPH
symptoms the doctor will first need to use some evaluation tools to first rule out cancer and infection, and
then evaluate the severity of the blockage to best tailor a treatment that will be most effective for each
patient's situation.
BASIC EVALUATION PROCEDURES
• A symptom score sheet index - Your doctor may ask you to complete a questionnaire to determine the
seriousness of your symptoms.
• A complete medical history will be obtained including symptoms you are experiencing.
• A physical examination will be performed which includes a digital exam to examine the prostate.
• A Urinalysis is done to check urine for presence of bacteria or blood cells and to evaluate for any
potential infection.
PSA Blood Test is often obtained. PSA is a specific substance produced only by the cells of the prostate
gland. Patients with BPH, prostatitis, and cancer can have higher than normal levels of PSA. If your PSA is
higher than it should be and an infection is not present your doctor may want to perform a prostate biopsy
to make sure a cancer is not present (link to prostate cancer section on prostate biopsy for further
information)
Bladder Scan is an ultrasound test that can be used to measure your post void residual (PVR) or the
amount of urine that remains in the bladder after urination.
Uroflowmetry measures urine flow and is often lower than normal in men with BPH.
Prostate Ultrasound takes a picture of the prostate using sound waves. The doctor will perform this test
with a special probe, slightly larger than a finger, that is placed in the rectum to evaluate the size and
shape of the prostate.
Urodynamics are used to measure the pressure in your bladder during bladder filling and urination to
determine whether the urinary problems are due to weakening of the bladder muscle or blockage from
an enlarged prostate.
Cystoscopy may be performed to allow your doctor to view the length of the prostate and to evaluate for
any abnormalities of the urinary channel.
Once it has been determined that BPH is the cause of the symptoms and no other problems exist several
different types of therapy can be used to treat the symptoms. Although many men believe these
symptoms are just a part of getting older, the truth is, these symptoms are not normal at any age and
over time these symptoms may be harmful to the bladder and kidneys. Incompletely emptying the
bladder and overworking the bladder muscle can lead to urinary tract infections, bladder or kidney
damage, bladder stones, and incontinence. It is important to seek treatment early because damage to the
bladder can often be permanent. When BPH is recognized and treated in its early stages, however, there
is a lower risk of developing such complications.
TREATMENT CONSIDERATIONS
The right treatment for each patient is determined by the patient's overall health, the severity of their
symptoms, and patient's preference.
Watchful waiting, or simply observing the patient and making sure no kidney or bladder problems
develop is a reasonable choice for patients with minimal symptoms, or medical conditions that make
treatment too risky.
Medications are often used if a patient is having more bothersome symptoms, but his bladder is still
emptying fairly well, his kidney function is good, and he does not want to undergo any procedures or
surgery. There are a variety of drugs or medical therapy from which to choose.
Alpha blocker are drugs that help relax the muscles in and around the prostate gland and can relieve mild
to moderate symptoms. The older drugs include Hytrin and Cardura. These drugs had side effects of
dizziness and had to be titrated to the right dose so newer drugs like Flomax and Uroxatral are more
often used. These newer drugs are a single dose, often relieve symptoms after only a few doses, and do
not have the side effects often seen with the older drugs.
Another category of drugs includes Proscar and Avodart. These drugs relieve symptoms by shrinking the
prostate. These drugs are very effective but can take 9-18 months to create enough shrinkage for
symptom improvement.
Alternative Drug Therapy
Many patients are turning to vitamins, herbs and natural remedies for BPH and other medical conditions.
Since these supplements are not studied, regulated, or approved by the FDA.
Minimally Invasive Treatments
The right treatment for each patient is determined by the patient's overall health, the severity of
their symptoms, and patient's preference.
For patients who do not want to take medication, or who have tried medication without success,
there are some minimally invasive procedures available Revolex Olympus Button or Prostiva that
may provide an effective alternative to surgery.
BPH is a non-cancerous enlargement of the prostate gland that causes progressive difficulty with
urination. The enlargement process begins during age 30-40, but typically develops so slowly
that manifestations of the condition do not begin to cause problems until their late 50’s-60’s.
Treatment is recommended when the voiding dysfunction is significant enough to affect the
quality of life.
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Treatment options include:
Medical Therapy (MEDICATIONS or watchful waiting)
Thermotherapy
Surgical removal including turp
laser procedures to vaporize or resect the enlarge prostate.
In Office – Prostiva
• A procedure that takes less than an hour (with some additional preparation and recovery time
required)
• Can be performed right in your doctor’s office
• Generally conducted with local anesthesia only
• Allows you to return to many of your normal activities within 24 to 48 hours
• side effects and adverse events when compared to traditional surgical treatment
• Few reports of incontinence
• Few reports of impotence
• Catheterization for 0-2 days
• Improvement within two to six weeks (However, results may vary depending on the severity,
duration, and size of the prostate treated.)
• 5-year durability
Outpatient - Olympus Button
Surgical Treatment
Surgical treatment involves removal of the blocking prostate tissue and remains the gold
standard for symptom relief with up to 96% of patients having improved symptoms. The
transurethral resection of the prostate, or TURP for short, is the "old" method and had
disadvantages of pain, blood loss, and a hospital stay. The newest technology is the Green Light
Laser® or PVP. With the patient under anesthesia a tiny camera is passed into the urethra and
under direct vision this laser is used to vaporize the blocking prostate tissue. This laser creates
the same amount of prostate tissue removal that the "old" TURP did only with less pain, virtually
no bleeding, and patients go home the same day with an often instant relief of symptoms. The
Green Light Laser® is used in not only in patients with severe symptoms and those who have
failed more conservative therapy, but also in patients with any degree of symptoms who want
instant relief without taking medicine.
Although BPH is a common problem it does not have to be one that you have to live with. With
medication, minimally invasive therapies, or the prostiva or green light laser® you can be on your
way to improved urinary health. Consult your doctor to see which therapy might be best for you .