Treatments for Enlarged Prostate

By Jane Farrell

The National Institutes of Health reports that approximately 50 percent of men aged 51-60 and more than 90 percent of men older than 80 will develop an enlarged prostate – a condition known as Benign prostatic hyperplasia, or BPH.

In fact, Dr. Dudley Danoff, who has taught on the clinical faculty of the UCLA School of Medicine for more than twenty-five years and is the founder and president of the Cedars-Sinai Tower Urology Medical Group, says that BPH is nearly inevitable in aging males.

Think of the male bladder as a balloon placed neck-side down in the pelvis, and visualize the prostate as a doughnut around the neck of the balloon. As a man ages, the doughnut gets larger and the hole in the doughnut gets smaller, making it more difficult to empty the balloon through urination.

Danoff says that the most reliable method of identifying which patients need treatment for BPH is a questionnaire developed by the American Urological Association (AUA) that examines the conditionÕs most prominent symptoms, which include incomplete bladder emptying; frequency, intermittency, and urgency of urination; weakness of the urine stream; straining during urination; and nighttime urination. These symptoms are rated on a scale of 0 to 5. The higher the total score, the more likely it is that a patient will need treatment for BPH.

If you get a BPH diagnosis, here are Danoff’s top ten suggestions about what to do next:

1. Have a complete urologic and prostate examination, which should include a digital rectal exam and a blood screening exam that uses a prostate-specific antigen (PSA) to test for the presence of possible prostate cancer.
2. Get a noninvasive ultrasound to measure the amount of urine remaining in the bladder after urination. An ultrasound can also detect structural abnormalities in the prostate and determine the need for a biopsy.
3. Consider watchful waiting if symptoms are mild or moderate. Progression of symptoms is not inevitable, and some men’s symptoms spontaneously improve or resolve.
4. Ask about medical treatments for BPH. A recently developed class of drugs called alpha blockers has been widely and safely used for a number of years to relieve the symptoms of BPH. In general, they relax the neck of the bladder (widening the hole in the doughnut) to allow more complete emptying.
5. Find out about shrinking the prostate. Another class of drugs called 5-alpha-reductase inhibitors affects the cells of the prostate, reducing the size of the gland and improving symptoms. This treatment usually takes six months and may cause side effects like erectile dysfunction, decreased libido, enlarged breast tissue, and ejaculation problems.
6. Consider combination therapy. The combination of tamsulosin (an alpha blocker) and finasteride (a 5-alpha-reductase inhibitor) has been shown to decrease symptom scores and increase urinary flow rates significantly greater than the use of either drug alone. Over the last several years, combination therapy has vastly decreased the need for surgical intervention in the treatment of BPH.

7. Learn about phytotherapy, a class of treatment using plants or plant extracts for medicinal purposes. The use of phytotherapy for BPH is popular in Europe, and enthusiasm for this treatment is growing in the United States. Although some studies have noted improvements in symptom scores and flow rates, others show no benefit beyond placebo, so use phytotherapy with caution.
8. Consider a transurethral resection of the prostate (TURP) if symptoms are severe and other therapies have failed. To visualize what a TURP is, think of a plumber unclogging a pipe. Most TURP procedures use spinal anesthesia, require no incision and only a brief hospital stay, preserve continence and potency, and produce results superior to that of any other minimally invasive therapy. Possible complications include retrograde ejaculation (semen entering the bladder) and stricture (the formation of scar tissue.
9. Research other minimally invasive procedures that open the urinary channel by destroying prostate tissue. Though not as effective as TURP, these procedures do not require an incision and may reduce complications. They include laser therapy, transurethral electrovaporization, hyperthermia, transurethral needle ablation, high-intensity focused ultrasound, and intraurethral stents.
10. Most important, get an annual prostate examination after age 40. This is especially true if prostate cancer runs in your familyÑa man is 30 percent more likely to develop prostate cancer if a relative had the disease. Approximately one in seven men will develop prostate cancer in his lifetime, and 240,000 cases of prostate cancer will be diagnosed this year in the United States alone.

Dudley Seth Danoff, MD, FACS, is a diplomat of the American Board of Urology and a fellow of the American College of Surgeons, with a medical degree from Yale University and urologic surgical training and fellowship from Columbia University-Presbyterian Medical Center. He is a former member of the clinical faculty at the University of California-Los Angeles School of Medicine, the founder and president of the Cedars-Sinai Tower Urology Medical Group. He is the author of  three books: Penis Power, Superpotency and The Ultimate Guide to Male Sexual Health. He lives in Beverly Hills, California.