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New Options for Treating Enlarged Prostate Glands

Developing symptoms of an enlarged prostate gland is an inevitable aspect of aging for most men. With the aging of the baby boomers, more and more men will develop symptoms of prostate enlargement and will be looking to their physicians for relief of this common condition. Now there are new treatments for benign prostatic hyperplasia (BPH), the medical the term for nonmalignant enlargement of the prostate gland. Though not a deadly disease like prostate cancer, BPH is actually far more common, appearing in some men as young as 40, and affecting nearly 60% of men over 60 years of age. It is estimated that the condition affects nearly 14 million American men and more than 8 million men are receiving treatment.

What is the prostate gland?

The prostate, which makes the fluid that carries sperm during ejaculation, begins to grow in almost all men as they get older. When the prostate gland grows it compresses the urethra or the tube which is in the penis and transports urine from the bladder to the outside of the body. With significant compression there are symptoms of frequency of urination, urgency of urination, dribbling after urination, and getting up at night to urinate. If the condition is untreated it can result in urinary tract infections, bladder stones, loss of urine or incontinence, erectile dysfunction, and even completely block the urethra and making urination impossible which is a medical emergency.

Treatment for BPH

Men with mild symptoms or with minimal enlargement of the prostate gland can elect to be on a program of watchful waiting. These men require an annual checkup. However, this option is not suggested for men with significant symptoms as they end up with the complications of BPH and\or urinary retention.

In the past the treatment for BPH was surgical removal of the obstructing prostate tissue. This requires hospitalization, a general anesthesia, and occasionally associated with complications. In the 1990’s two classes of drugs became available: alpha blockers and 5-alpha reductase inhibitors. The 5-alpha reductase inhibitors, Avodart and Proscar, actually shrink the size of the prostate and decrease the compression on the urethra improving the urinary flow rate. Unfortunately, these drugs take 3-6 months before there is improvement in the urinary symptoms. The alpha blockers, Flomax, Uroxatrol, Cardura, and Hytrin, produce improvement in symptoms in just a few weeks but the symptoms improvement only lasts a few years. In order for these drugs to work they must be taken for life and once a man stops taking the medication, the symptoms return. Recently a report using a combination of both alpha blockers and 5-alpha reductase inhibitors have been shown to be effective in men with moderate symptoms. However, the problem is the increase in the side effects when both drugs are used and also the cost which is in excess of $1000\year for both drugs. Also men who used medication for treating erectile dysfunction must be careful when using alpha blockers for their BPH. For example, a patient suing Viagra must wait four hours before using an alpha blocker.

Minimally invasive treatment for BPH

Now there are new treatments that can be done in a doctor’s office that provide relief from urinary symptoms. These treatments use heat from microwaves and other sources to shrink or vaporize the prostate tissue. The microwave treatment can be done under a local anesthesia in the doctor’s office. The procedure takes less than one half hour and nearly 85% of the men can expect to have significant improvement in their urinary symptoms.

Other minimally invasive treatments include the TUNA procedure and the green light laser which requires hospital admission and a general anesthesia.

Men who are concerned about developing BPH can take steps to help prevent the condition by improving their diet including easting less red meat, consuming less alcohol and caffeine, as well as getting plenty of exercise. There are studies now being conducted looking at supplements that contain ingredients such as soy, selenium, vitamin D, vitamin E and lycopene. For those wanting more information they can go www.urologyhealth.org.

Bottom line: BPH is a common condition affecting most middle age and older men. It is not related to prostate cancer. Most men can be helped with medication or minimally invasive treatments.

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Reprinted with permission from Neil Baum MD, neilbaum.com.

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