Treatment For An Enlarged Prostate
Currently, the five ways of treating enlarged prostates are:
- Watchful waiting
- Alpha blocker drug treatment
- Finasteride drug treatment
- Balloon dilation
Surgery will do the best job of relieving your urinary symptoms, but it also has more risk than the other treatments. Unless you have a serious complication of benign prostatic hyperplasia [BPH] that makes surgery the only good choice, you can choose from a range of treatments. Which one you choose if any depends on how much your symptoms bother you. Your choice also depends on how much risk you are willing to take to improve your symptoms. You and your doctor will decide together.
If you have BPH but are not bothered by your symptoms, you and your doctor may decide on a program of watchful waiting. Watchful waiting is not an active treatment like taking medicine or having surgery. It means getting regular exams — about once a year — to see if your BPH is getting worse or causing problems. At these exams, your doctor will ask about any problems you have. He or she may also order some simple tests to see if your enlarged prostate is causing kidney or bladder problems.
A small number of men in watchful waiting become unable to urinate at all. Some also get infections or bleed, or their bladder or kidneys are damaged. But such major problems are uncommon.
Your doctor may suggest some tips to help control your symptoms. One is to drink fewer liquids before going to bed. Another is not to take over-the-counter cold and sinus medicines with decongestants, which can make a prostate condition worse.
Without treatment, BPH symptoms may get better, stay the same, or get worse. If your symptoms become a problem, talk to your doctor about treatment choices.
Alpha blocker drug treatment
Alpha blocker drugs are taken by mouth, usually once or twice a day. The drugs help relax muscles in the prostate, and some men will notice that their urinary symptoms get better.
During the first 3 or 4 weeks, the doctor may see you regularly to make sure everything is okay. The doctor will check your symptoms and see if the medicine’s dosage (how much you take and how often) is right for you. After that, you will visit the doctor from time to time to have your symptoms checked and prescription refilled. There is no evidence that alpha blockers reduce the rate of BPH complications or the need for future surgery.
Side effects can include headaches or feeling dizzy, lightheaded, or tired. Low blood pressure is also possible. Because alpha blocker treatment for BPH is new, doctors do not know its long-term benefits and risks.
Alpha blockers include doxazosin (Cardura), prazosin (Minipress), and terazosin (Hytrin). Hytrin is the only alpha blocker now approved for BPH treatment by the Food and Drug Administration.
Finasteride drug treatment
Finasteride (Proscar) is taken by moutdonce a day. It can cause the prostate to shrink, and some men will notice that their urinary symptoms get better. It may take 6 months or more before you notice the full benefit of finasteride. You still need to see your doctor on a regular basis while you take this drug. There is no evidence that finasteride reduces the rate of BPH complications or the need for future surgery.
Finasteride drug treatment is new, and doctors do not know its long-term benefits and risks. Also, finasteride lowers the blood level of prostate-specific antigen. Doctors do not know if this affects the ability of the PSA test to detect prostate cancer.
Side effects of finasteride include less interest in having sex, problems getting an erection, and problems witd class=”bodyText”ejaculation.
Balloon dilation is done in the operating room in a hospital or doctor’s office. After the patient gets anesthesia (medicine to reduce pain), the doctor inserts a catheter (plastic tube) into the penis. The catheter goes through the urethra and into the bladder. The catheter has a limp balloon at the end.
The doctor inflates the balloon to stretch the urethra where it has been squeezed by the prostate. In some patients, this can allow urine to flow more easily.
Balloon dilation can cause bleeding or infection. It can also make patients unable to urinate for a time. If there are no problems, you may go home the same day. Some patients have to stay overnight at the hospital.
Balloon dilation is a fairly new treatment for BPH, and doctors do not know all its long-term benefits and risks. In many patients, this treatment seems to work for only a short time.
Because surgery has been used for many years to treat BPH, its benefits and risks are fairly well known. Compared witdother treatments, surgery has the best chance for relief of BPH symptoms. Although surgery is also most likely to cause major problems, most men who undergo surgery have no major problems.
By itself, an enlarged prostate does not mean you need surgery. An enlarged prostate may not become larger. Also, no operation for BPH lowers the chance of getting prostate cancer in the future.
Surgery is almost always recommended for men witdcertain problems caused by BPH. These include:
- Not being able to urinate at all
- Urine backup into the kidneys that damages the kidneys
- Frequent urine infection
- Major bleeding through the urethra caused by BPH
- Stones in the bladder
If you do not have any of these serious problems, but you are bothered by your BPH, you may still want to consider surgery.
There are three types of surgery for BPH:
- Transurethral resection of the prostate (TURP) is the most common. It is a proven way to treat BPH effectively. TURP relieves symptoms by reducing pressure on the urethra.
After the patient gets anesthesia, the doctor inserts a special instrument into the urethra through the penis. No skin needs to be cut. The doctor then removes part of the inside of the prostate.
After TURP, patients usually need to wear a catheter (a tube in the penis for draining urine) for 2-3 days and stay in the hospital for about 3 days. Most patients find that their symptoms improve quickly after TURP. These men do well for many years.
- TUIP may be used when the prostate is not enlarged as much. In TUIP, tissue is not removed. Instead, an instrument is passed through the urethra to make one or two small cuts in the prostate. These cuts reduce the prostate’s pressure on the urethra, making it easier to urinate. TUIP may have less risk than TURP in certain cases.
- Open prostatectomy may be used if the prostate is very large. In this procedure, an incision is made in the lower abdomen to remove part of the inside of the prostate. Surgery for BPH improves symptoms in most patients, but some symptoms may remain. For example, the bladder might be weak because of blockage. This means there still could be problems urinating even after prostate tissue is removed.
New treatments for BPH appear every year. Examples are laser surgery, microwave thermal therapy, prostatic stents, and new drugs. Use of a laser is still surgery, and doctors do not yet know if its benefits and risks are higher or lower than standard surgery.
There is not yet enough information about these treatments to include them in this information. If your doctor suggests a treatment not discussed here, ask for the same type of information on risks and benefits included in this information for other treatments.