Treatment may depend on lifestyle, age, personal finances etc., but your physician and yourself should be able to tailor a decision to fit your needs.
If you have questions or require further information call The Prostate Centre at:
NIDDK -Prostate Enlargement
Benign Prostatic Hyperplasia is (or will be) a part of life for almost all men. It is important to remember that the treatment of BPH does not prevent cancer, and yearly screening for Prostate Cancer should continue even while being treated for BPH. Treatment may depend on lifestyle, age, personal finances etc., but your physician and yourself should be able to tailor a decision to fit your needs.
Recommended when symptoms are tolerable. Many men can reduce their symptoms by decreasing fluid intake after a certain time in the evening, or limiting caffeine or alcohol intake. You may have an enlarged prostate without actually experiencing symptoms, and this does not require treatment. Your doctor can continue monitoring your progress, and if symptoms worsen, can recommend treatment at that time.
5 Alpha-Reductase Inhibitors (ProscarÆ)
Testosterone is a male hormone secreted by the testes, and when combined with the enzyme 5 Alpha-Reductase in the prostate, changes to Dihydrotestosterone. Dihydrotestosterone is believed to be the active male hormone in the development of BPH. The 5 Alpha-Reductase Inhibitors therefore inhibit this change and shrink the prostate. A fixed dose of the medication is usually used.
This process takes time and the effects of the medication may not occur for several months. The side effects associated with ProscarÆ are: decreased libido (3.3%) and impotence (3.7%). The positive effects of the treatment are an increase in peak urinary flow rate (22%), and a decrease in symptom score (21%).
Alpha-adrenergic Receptor Blockers (Hytrin, Cardura, Flomax)
Variations in the tone of the smooth muscle of the prostate and bladder neck contribute to the reduction in urinary flow rates. Alpha-adrenergic Receptor Blockers act by relaxing the constriction around the prostatic urethra, which leads to improved urinary outflow. The dose of the medication (Hytrin, Cardura) is usually slowly adjusted upward to get the best effect with the least side effects. This usually takes 2 to 3 weeks.
Flomax is a new type of alpha adrenergic blocker termed “Uro Selective” which is designed to preferentially affect receptors in the prostate instead of the other places where alpha receptors work such as the blood vessels. The dose of this medication does not need to be adjusted. Thus the benefit of this drug is seen sooner. There are theoretically fewer side effects with this medication. Blood pressure is not affected and fewer people are dizzy or tired. Retrograde ejaculation is a unique side effect of this drug.
Statistics of side effects vary on the brand of Alpha-adrenergic Receptor Blocker that you take, but the most common side effects are fatigue, dizziness, headache, and decreased blood pressure. There is an approximate 30% increase in peak urinary flow rate, and a 32% decrease in symptom score.
Combinations of herbs are available at natural food stores, or from herbalists. They often include Saw Palmetto, Pygeum, Flax Seed Oil, Pumpkin Seed Oil, and Zinc. Doses should be regulated by a professional herbalist, or according to directions on pre-packaged combination remedies. There is minimal information available on how effective this form of treatment is.
The TURP is a surgical procedure to scrape away excess prostate tissue that is blocking the urethra, and thereby open the channel for urination. It is completed in the operating room under a general anaesthetic or a spinal anaesthetic. An instrument is passed through the urethra to the area of the prostate to perform the operation. The average hospital stay is 1-2 days. Flow-rates increase about 100%, and symptoms usually decrease 80%. This is considered the standard to which all other treatments are compared.
The side effects associated with TURP are retrograde ejaculation (68%); this means semen will no longer flow from the penis, but will instead flow into the bladder and discharge when urinating. Also associated are impotence (16%), and the possibility of requiring a repeat TURP in the future, when tissue regrows (10% after 10 years).
A variety of different laser energies can be used to cut or vaporize obstructing prostatic tissue like the electrical energy in a standard TURP. The major advantage of laser prostatectomy is the decreased risk of bleeding. Because of this, laser prostatectomy can be done as an outpatient. Laser energy causes intense heating in and around the prostate. Because of this there may be an increased likelihood of irritation or damage in structures near the prostate. Follow up of patients treated with laser prostatectomy will determine the risks and benefits of these treatments.
This technique is similar to ILC but instead of a laser a small needle is inserted into the prostate from the urethra. The tips of these needles generate heat when radio frequency energy is applied.
This method inserts a small laser fiber into the prostate through an instrument placed in the urethra. Laser energy heats a selected part of the prostate. Two to four areas are usually treated in areas felt to be blocking the urine flow. These areas are damaged and after several months shrink. This procedure can be done as an outpatient. The procedure can be done under local or general anaesthetic.
Performed in an out-patient setting, a small microwave antenna is passed through the urinary channel in the penis and into the enlarged gland. No anaesthetic is required. Thermotherapy has not been approved by OHIP in Ontario, and the cost for the treatment is $2500.00. The risks of side effects are lower than the TURP, with an approximate 30% increase in flow rate, and 50% increase in symptom score.