Enlarged Prostate Treatments : Benefits and Risks
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: impotence, Finasteride, Prostate, Retrograde ejaculation, Urinary incontinence, balloon dilation, Urology, Transurethral resection of the prostate, Prostate cancer