Each treatment may improve your symptoms. But each treatment has different chances of success. All treatments, even watchful waiting, have some risks.
Ask your doctor these questions about each treatment:
* What is my chance of getting better?
* How much better will I get?
* What are the chances that the treatment will cause problems?
* How long will the treatment work?
Both benefits and risks are given below for each treatment. This can help you and your doctor make the best choice for you.
Figure 2 shows that the chance your symptoms will improve after TURP surgery is greater than if you simply watch and wait.
But even with TURP, your chances for improvement are somewhat uncertain. This is because doctors do not know the exact chances that each patient’s symptoms will improve. In general, the worse your symptoms are before treatment, the more they will improve if the treatment works. The success of TUIP and open prostatectomy is similar to TURP.
Figure 3 shows the amount of symptom improvement for each treatment. Again, TURP gives the greatest amount of improvement and watchful waiting gives the least.
Figure 4 shows the chances of having problems during or soon after treatment.
Most of the time, treatments do not cause problems. Most problems are not serious, but some are. TURP can cause serious problems such as urinary infection, bleeding that requires transfusion, or blocked urine flow. Few patients have these serious problems after surgery (see Outcomes of BPHtreatments).
For patients taking alpha blocker drugs, the most common side effects are feeling dizzy and tired and having headaches.
With finasteride, about 5 out of 100 patients have some kind of sexual problem such as a lower sex drive or trouble getting an erection.
With watchful waiting, there is no active treatment and no added chance of problems right away. But over time, the BPH itself can cause symptoms to grow worse or cause other problems. OnlyTURP clearly reduces that risk. Doctors do not know if alpha blocker drugs, finasteride, or balloon dilation lower the risk of future BPH problems.
Figure 5 shows the chance of dying from treatment. There are probably no added chances of dying from watchful waiting, alpha blocker drugs, and finasteride. There is now no information for balloon dilation.
Some BPH treatments can make it hard to control urine, leading to leakage (urinary incontinence). Over time, BPH itself can cause incontinence. Also, men treated with alpha blocker drugs, finasteride, or balloon dilation may have some risk of incontinence from BPH in the future.
Although it is rare, some men have severe uncontrollable incontinence after treatment (Figure 6). About 7 to 14 out of 1,000 men have this problem after TURP. Men in a program of watchful waiting have no immediate risk of uncontrollable incontinence.
The chance of needing surgery in the future differs for each treatment. Some men who at first choose watchful waiting or nonsurgical treatment may later decide to have surgery to relieve bothersome symptoms. Also, some men who have surgery may need to have surgery again. One reason isthat the prostate may grow back. Another is that a scar may form and block the urinary tract.
Within 8 years after TURP, 5 to 15 out of every 100 men will need another operation. Doctors are uncertain if treatment with alpha blocker drugs, finasteride, or balloon dilation lowers the chance that surgery will be needed in the future.
Figure 7 shows the chance of becoming impotent (not being able to get an erection) because of BPH treatment. Each year, about 2 out of every 100 men 67 years old will become impotent without BPH treatment.
There is probably no added risk of impotence with watchful waiting and alpha blocker drugs. Finasteride has a small added risk of impotence, but the problem should stop when the drug is stopped. The risk with balloon dilation is unknown, but probably low. WithTURP , the risk of impotence ranges from 3 to 35 out of 100 patients. If your erections are normal before surgery, however, the risk of impotence after surgery may be no higher than withwatchful waiting.
Figure 8 shows about how many days you can expect to lose from work or from what you normally do over the first year. Time at the doctor’s office and in the hospital is included.
One other problem — retrograde ejaculation — can result. It is common with surgery and rare with alpha blocker drug treatment. Retrograde ejaculation means that during sexual climax, semen flows back into the bladder rather than out of the penis.
Men with this problem may not be able to father children. But it does not affect the ability to get an erection or have sex, and it does not cause any other problems. You may want to talk to your doctor about retrograde ejaculation.
Between 40 and 70 out of 100 patients have this problem after surgery. About 7 out of 100 patients have the problem while takingalpha blocker drugs. Retrograde ejaculation does not occur with watchful waiting or finasteride. Some men who take finasteride do notice that they make less semen.
Outcomes of BPH Treatments lists the benefits and risks for each treatment. You can use this table to compare treatments. For example, treatment with either alpha blocker drugs or TURP can result in problems, but some are minor and others are serious.
What Is the Next Step?
Before choosing a treatment, ask yourself these two important questions:
* If my BPH is not likely to cause me serious harm, do I want any treatment other than watchful waiting?
* If I do want treatment, which is best for me based on the benefits and risks of each?
No matter what you decide, talk it over with your doctor. Take this booklet with you to your visits. Ask questions. Together, you and your doctor can choose the treatment best for you.Tags: Transurethral resection of the prostate, Urinary incontinence, urinary infection, impotence, Prostate cancer, prostatectomy, Prostate, BPH treatment
Prostate cancer is the second leading cause of death in men, second only to heart disease. Prostate cancer has become the most diagnosed cancer in the U.S. In 2008, more than 186,000 men were diagnosed with prostate cancer, and more than 28,000 men died from the disease. One new case occurs every 2.5 minutes and a man dies from prostate cancer every 19 minutes. As the population ages, these numbers will increase every year.
Even though we hear about it on TV and read about it in newspapers and magazines, most people don’t have a real understanding of prostate cancer and how it can be found. Hopefully, after reading this information you will be more informed about prostate cancer and will have less uncertainty about the exams and tests used for finding it early. Maybe this basic information will provoke you to act on behalf of your own health. Maybe it will persuade you to have the routine exams needed to find cancer in its early stages, when it can be cured.
The Prostate Gland
The prostate is actually a collection of glands and is part of the male reproductive system. Its function is to produce fluid that becomes part of semen. The prostate is about the size of a walnut. It is located below the bladder. The outside of the prostate is a thin capsule of fibrous tissue. Just outside the prostate is a layer of fat.
The prostate is divided into the right and left sides, called lobes. The widest part of the prostate, up next to the bladder, is called the apex. The tip opposite the bladder is called the apex. The word anterior is used to describe the front, and the word posterior is used to describe the back.
Just below the prostate is the wall of the rectum. On each side of the prostate are blood vessels and nerves that play an important part in making choices for cancer treatments. The glands right next to the prostate are called seminal vesicles, and fluid from them drains into the prostate. The vas deferens are tubes from the testicles which also drain into the prostate.
The prostate surrounds the urethra. The urethra is the tube that comes from the bladder, passes through the prostate, goes past the urinary sphincter muscle and through the penis. Its purpose is to carry urine from the bladder to the outside of the body. The urinary sphincter muscle is a circular muscle that prevents urine from leaking.
There are lymph nodes clustered along the sides of both walls of the pelvis. These lymph nodes are part of the lymphatic system. The lymphatic system cleans all of the cells in the body with lymph fluid. The fluid is filtered through the lymph nodes. Any impurities, germs and cancers are captured. After the fluid has been filtered, it is recycled into the bloodstream. There are veins that take blood from the prostate to the heart. These veins run along side the spinal column.
Because of its anatomical position in the body, continued growth of the prostate causes problems, called symptoms. As long as your body produces male hormones, your prostate will continue to grow. Also, cancer in the prostate can cause the prostate to grow. The position of glands and structures closest to the prostate is also important, as they are the first places that prostate cancer spreads when it grows outside of the prostate gland.
The Prostate Exam
The prostate exam is a basic, relatively painless exam, that is performed by your primary care physician or a urologist. You can expect to have several of these exams over your lifetime, especially if you are actively watching the health of your prostate.
The prostate exam is often called a rectal exam, prostate exam, or digital rectal exam. Digital comes from the word digit, meaning finger, and has nothing to do with digital imagery, sound, or computers. The examination is done by the physician inserting a gloved, lubricated finger into the rectum. Fortunately, the wall of the rectum is thin enough that cancers can be felt on the back side of the prostate.
The physician is feeling to “see” if there are any areas that are not smooth or are not soft. The prostate should feel symmetrical, that is, both lobes should feel the same. There should not be any hard nodules or firm areas. If an abnormal area is felt, there may be a reason for it other than cancer, such as previous surgery or a past infection in the prostate. There are growths that are not cancer that can cause nodules or areas that are not smooth.
To rule out the abnormal area as cancer your physician will probably have you go though additional testing. Also, only the back side and not the entire prostate gland can be felt through the rectum. The digital exam is like feeling the back of your head and trying to decide what your face looks like. For these reasons the PSA blood test is often done in addition to the prostate exam if there is a reason to think cancer may be present.
The PSA Blood Test
The PSA Blood Test and the digital rectal exam combined provide the best information needed to determine whether or not prostate cancer is present. A PSA test alone can help detect prostate cancer before it can be felt. Especially, prostate cancer that occurs in areas of the prostate that cannot be reached by a digital rectal exam.
PSA stands for Prostate Specific Antigen. The PSA blood test is testing for the presence of an enzyme that is produced by the cells of the prostate gland. It is produced by both normal prostate cells and cancerous prostate cells. Significant amounts of PSA are not found anywhere else in the body.
A small amount of PSA is released into the blood stream all of the time. If the prostate becomes irritated, more PSA leaks into the bloodstream and can be measured by taking a blood sample. The PSA is a very good test for identifying cancer of the prostate as well as other non-cancerous problems.
Normal Ranges for a PSA test are from 0.0 to 4.0. PSA levels can go up into the 100′s. When cancer is diagnosed, the PSA levels are often consistently in the 10′s or 20′s. A PSA level that is extremely high almost always means advanced prostate cancer is present. If PSA test results are in the higher levels, other test are usually ordered to determine if the cancer has spread into the lymph nodes or the bones.
If your PSA test results are in the normal range and your prostate exam was normal, you can feel pretty sure that everything is probably normal and cancer is not present in the prostate. However, this is only a snap shot in time. One exam does not mean you can go for the rest of your life without an exam. As a matter of fact, you should keep records of your exam results and compare them. Keeping records will allow you to watch for trends, such as slight increases, over time. A sudden change in your exam results may mean a problem. There are guidelines discussed later that show you how often to have your prostate checked.
Having a higher than normal PSA level does not mean that you have cancer! It is simply a warning signal. The PSA blood test can tell you that you have a problem with your prostate gland, but it can’t tell you exactly what the problem is. Cancer is only one of the problems it could be. A high PSA level can be caused by those items shown below. If your first reading is high, and your digital rectal exam is normal, your doctor will probably try treating you with medicine first and then a repeat PSA about 6 weeks after treatment. Six weeks may seem like a long time to wait, but enough time has to pass to make sure the repeat test is as accurate as possible.
Causes For A Higher than Normal Elevated PSA Level
- Urinary tract infection
- Urinary catheter in the bladder
- Urinary retention
- Stones in the prostate
- Cancer of the prostate
- Recent prostate surgery or biopsy
- Noncancerous enlargement of the prostate
- Infection of the prostate
- Guidelines For Having PSA Exams
The following are general guidelines only! You should talk with your doctor about your personal needs for this or any other medical test.
If you are not at high risk, you should begin having a PSA blood test by age 50. If you are over age 80, there is no consensus on recommended guidelines for annual PSA tests. Following your doctor’s advice is probably the best course of action for you.
If you are at risk for prostate cancer you should have a PSA and digital rectal exam more often than someone that is not at high risk. Being at high risk means you are more likely to get prostate cancer than someone who is not at high risk. However, being at high risk does not mean that, for certain, you will get prostate cancer. Just as not being at high risk does not mean that, for certain, you won’t get prostate cancer.
You are at high risk if you have a family history of prostate cancer. That means, you are at high risk if your grandfather, father, or a brother have had prostate cancer. You should have a PSA blood test by age 40. You should have a PSA blood test every year thereafter.
African-American men have a higher risk of getting prostate cancer than other men. African-American men should have a PSA blood test every year beginning by age 40.
Just Do It!
Your doctor will not call on your 40th birthday and tell you it’s time to start having prostate exams. He will not call you every year and remind you to have a prostate exam and PSA blood test. It’s up to you to remember, to schedule an appointment, and to keep it! Try picking a meaningful day and do it on the same day every year. Do it on your birthday as a present to yourself. Do it on your wife’s birthday as a present to her. Do it on your anniversary as a present to you both. Just do it!
This information can help you understand benign prostatic hyperplasia (BPH) and how it can be treated. BPH is an enlarged but otherwise normal prostate. It is common in older men and may cause no problems at all. If you want or need to choose a treatment, however, this information describes both benefits and risks of all treatments. Read moreTags: Benign prostatic hyperplasia, Prostate, Urinary retention, Urination Urinary bladder, Urethra, Urinary tract infection
Several national groups can provide more information on BPH and its treatment. They include:
Prostate Health Council
American Foundation for Urologic Disease, Inc.
300 West Pratt Street
Baltimore, MD 21201
National Kidney and Urologic Diseases Information Clearinghouse
Bethesda, MD 20892
For More Information
The information on this site was based on the Benign Prostatic Hyperplasia: Diagnosis and Treatment. Clinical Practice Guideline. The guideline was developed by an expert panel sponsored by the Agency for Health Care Policy and Research (AHCPR), an agency of the U.S. Public Health Service. Other guidelines on common health problems are available, and more are being developed to be released in the near future.
For more information on guidelines and to receive additional copies of this booklet, call toll free (800) 358-9295 or write to:
AHCPR Publications Clearinghouse
Silver Spring, MD 20907