Enlarged Prostate: Treatment Overview

An enlarged prostate, also known as benign prostatic hyperplasia (BPH), is a common condition affecting men, especially as they age. Globally, there were 94 million cases of BPH in 2019, which is almost double the number of cases in 2000. Living with an enlarged prostate can be challenging, as it often causes uncomfortable urinary symptoms, such as weak urine flow, frequent urination and trouble fully emptying the bladder.

The symptoms of an enlarged prostate can disrupt daily life and may even lead to more severe complications if left untreated. A healthcare professional can diagnose BPH with a physical examination and laboratory tests, such as blood tests or imaging studies. Various enlarged prostate treatment options are available to manage symptoms. These options may include medications, like alpha-blockers and 5-alpha reductase inhibitors, minimally invasive procedures and surgeries.

Enlarged Prostate Treatment Options

The choice of treatment for an enlarged prostate depends on the severity of the symptoms, a patient's overall health and their personal preferences. Medications are generally used as a first-line option to improve urine flow, reduce discomfort and relieve other symptoms. In more severe cases or when other treatments have failed, surgery might be necessary. It may be helpful to consider all treatment options and discuss them with a healthcare professional to take the best course of action.

Medications

When it comes to treating an enlarged prostate, there are several medications available that can help manage the condition. Two common classes of drugs used for an enlarged prostate are alpha-blockers and 5-alpha reductase inhibitors.

Alpha-blockers are a type of medication that helps relax the muscles in the prostate and bladder neck, making it easier to urinate. Some common alpha-blockers used for treating an enlarged prostate include:

• Tamsulosin (Flomax®)
• Terazosin (Hytrin®)
• Doxazosin (Cardura®)
• Silodosin (Rapaflo®)
• Alfuzosin (Uroxatral®)

These medications can provide relief from symptoms in a relatively short period, often within a few days or weeks. However, they don't reduce the size of the prostate and may occasionally cause side effects such as dizziness, headache and low blood pressure.

5-alpha reductase inhibitors work by shrinking the prostate gland, which can help improve urinary flow and reduce the symptoms of an enlarged prostate over time. Two common 5-alpha reductase inhibitors include:

• Finasteride (Proscar®)
• Dutasteride (Avodart®)

These medications are typically more effective for men with larger prostates, and it may take several months to notice a significant improvement in symptoms. Possible side effects include a decrease in libido, erectile dysfunction and a reduced volume of ejaculate. In some cases, a combination of both alpha-blockers and 5-alpha reductase inhibitors may be recommended to provide the most effective treatment. In addition to medications, lifestyle changes, such as avoiding drinking water or other beverages right before bed, avoiding caffeine and alcohol and practicing pelvic floor exercises, may also help alleviate the symptoms of an enlarged prostate.

Minimally Invasive Procedures

Minimally invasive procedures may provide relief while causing fewer complications and requiring shorter recovery time than traditional surgery. They are often a preferred option for those who want to avoid potential erectile or ejaculatory problems. However, they may not provide permanent relief, which may require future interventions. These procedures include:

Water vapor thermal therapy: This treatment uses steam to remove excess prostate tissue with minimal anesthetics or pain relievers needed. It can often be done in an office setting.

Microwave thermotherapy (TUMT): Like water vapor thermal therapy, microwave thermotherapy uses heat to remove prostatic tissue. A tiny instrument called an antenna is passed through the urethra and releases heat (microwave) energy to eliminate the excess prostate tissue blocking urine flow.

Prostatic lift: During this procedure, a healthcare provider inserts a device into the urethra to increase the size of the urethral opening. The goal is to reduce the obstruction of urine flow by positioning one or more tiny implants to maintain the opening of the urethra.

Keep in mind that each procedure has its own set of potential benefits and risks. Consult with a qualified healthcare professional to determine the most appropriate treatment option.

Other procedures

Other procedural options are available for men experiencing urinary problems due to an enlarged prostate. Various procedures may help relieve symptoms and improve overall quality of life. The following are some common procedures for an enlarged prostate:

• Transurethral resection of the prostate (TURP): TURP is a common surgery to treat urinary problems caused by an enlarged prostate. A resectoscope, a specialized instrument, is inserted through the tip of the penis and into the urethra. Prostate tissue is carefully removed to help restore regular urine flow.

• Transurethral incision of the prostate (TUIP): TUIP is a less invasive option compared to TURP. During this procedure, small incisions are made in the prostate, which can help reduce urinary blockage without removing a significant amount of prostate tissue. TUIP may be recommended for men with smaller prostates or those who are not candidates for other surgeries.

• Open simple prostatectomy: In cases where the prostate is significantly enlarged, an open simple prostatectomy may be performed. This surgery involves making an incision in the lower abdomen to remove a portion of the prostate. It is typically reserved for patients with a severely enlarged prostate or when other treatment options have not provided sufficient relief.

• Laser surgery: Prostate laser surgery can provide relief for moderate to severe urinary symptoms. During this surgery, a scope is inserted through the tip of the penis into the urethra. A laser is then used to remove prostate tissue. One example of this type of surgery is holmium laser enucleation of the prostate (HoLEP).

• Plasma vaporization: Also known as the button procedure, plasma vaporization involves the use of a special probe to remove prostate tissue located between two electrodes. It is comparable to the standard TURP method.

Each surgical option has its benefits and risks, and the choice of procedure will depend on the individual's medical history, severity of symptoms and overall health.

Consult a Healthcare Provider

Seek medical advice from a healthcare provider when considering enlarged prostate treatment options. A healthcare professional can assess symptoms, medical history and potential risk factors. They can then outline the benefits and potential drawbacks of various therapies. In addition to selecting the right treatment, a healthcare provider can determine the correct medication dosages and discuss potential side effects, interactions, warnings and precautions.

Sources: https://www.auanet.org/guidelines-and-quality/guidelines/benign-prostatic-hyperplasia-(bph)-guideline https://www.uptodate.com/contents/benign-prostatic-hyperplasia-bph-beyond-the-basics#H10