What is an enlarged prostate?

Enlarged prostate, also known as Benign Prostatic Hyperplasia (BPH), is a common benign (non-cancerous) condition affecting older men in which the prostate gland enlarges. The prostate is a walnut-sized gland that produces semen – the fluid that transports sperm.

What causes an enlarged prostate?

BPH is commonly a result of the normal aging process, and is influenced by changes in the body’s levels of the male hormone testosterone. In some cases, an enlarged prostate may also be genetic. BPH affects more than half of men over age 50, and 90 percent of men over age 80.

What are the symptoms of an enlarged prostate?

Some men with BPH experience a variety of urinary symptoms, which can range from mild and barely noticeable, to severe and life-altering. These symptoms include:

  • Recurring, sudden need to urinate
  • Increasing frequent urination, especially at night
  • Weak or interrupted urine stream
  • Difficulty starting urination
  • Urine leakage (urinary incontinence)
  • Inability to completely empty the bladder

Caffeine, alcohol, spicy or acidic foods, certain cold and pain medications, and constipation can make symptoms worse. Left untreated, symptoms may worsen over time and can cause complications that may include inability to urinate (urinary retention), bladder or kidney damage, bladder stones, and urinary tract infections (UTI).

Men experiencing any of these urinary symptoms should have a thorough evaluation performed by a urologist as other conditions such as a UTI, prostatitis (inflammation of the prostate), prostate cancer, and diabetes can cause similar symptoms.

Normal Prostate

Enlarged Prostate

How is an enlarged prostate diagnosed?

The first step to diagnosing BPH is to see a urologist. Your doctor will take a complete medical history and physical exam. Your urologist may order a prostate specific antigen (PSA) test. Elevated levels of PSA can indicate BPH, prostatitis (prostate inflammation), or prostate cancer.

Through this comprehensive evaluation, your urologist will determine whether your urinary symptoms are indeed caused by BPH, and the next steps to treating your urinary symptoms.

Additional tests to make the most accurate diagnosis may include:

  • Uroflow – Measures the flow and force of your urine stream and is often performed in patients who have an obstruction or other problems with urination.
  • Bladder Ultrasound (post void residual): A non-invasive ultrasound test that assesses the ability of the bladder to empty.
  • Cystoscopy – A small telescope is used to look inside the bladder to assess your internal prostate size and your bladder for stones, tumors, and signs of obstruction or other abnormalities that may cause your symptoms.
  • Urodynamics – A test which helps determine whether a blockage of the prostate is the cause of your symptoms.
  • Transrectal Ultrasound – Ultrasound to assess prostate size. This test is also useful to assess bladder function.

What are the treatment options for enlarged prostate?

Treatment for enlarged prostate, or BPH, focuses on alleviating bothersome symptoms and will depend on the severity of your symptoms and how much they interfere with your lifestyle.

Men with minimal urinary issues may only need to make lifestyle changes; those with more pronounced symptoms or complications from BPH may require medication or a minimally invasive surgical procedure to restore urinary function and quality of life.

Your provider can help you determine which treatment is more appropriate for you.

Avoid caffeine, acidic drinks such as colas, tomato and orange juices, and alcohol. Cold medications containing antihistamines or pseudoephedrine can cause urinary problems. Constipation can also make it more difficult to urinate.

Limit evening beverages and urinate when you first feel the urge.

Your doctor may prescribe one or a combination of medications that can help alleviate urinary symptoms caused by your enlarged prostate. Medications often have some side effects, so talk to your urologist about which medication is right for you.

  • Alpha blockers to relax the smooth muscle tissue in the bladder and prostate, increasing urinary flow.
  • Enzyme (5-alpha reductase) inhibitors, such as Avodart and Proscar, shrink the prostate.
  • Anticholinergics to relax the bladder muscle and reduce frequency and urgency.
  • Your urologist may prescribe a combination of an alpha-blocker and a 5-alpha reductase inhibitor, which has been shown to be more effective in reducing BPH symptoms than either medication taken on its own.

Specialized, minimally invasive procedures to treat enlarged prostate / BPH are excellent and effective alternatives to long-term medication therapy, often with quick results fewer side effects and improved quality of life. Your urologist will work with you to determine your best treatment option.

UroLift

The UroLift System is a new alternative to medications and surgery to treat BPH. This approach to treating BPH lifts or holds the enlarged prostate tissue out of the way so it no longer blocks the urethra, relieving urinary symptoms. Implants are inserted and act like “window curtain tie-backs”, holding the lobes of the enlarged prostate open. There is no cutting, heating, or removal of prostate tissue involved.

Advantages:

  • Minimal downtime in normal daily activities
  • Typically no catheter or overnight stay is required
  • Preserves sexual function – typically, no sexual side effects such as erectile dysfunction or ejaculatory dysfunction
  • Lower urinary tract symptom relief in as early as two weeks after treatment

Disadvantages:

  • Temporary urinary urgency
  • Temporary pelvic pain

Rezum

Using sterile water vapor (steam), targeting and controlled doses of stored thermal energy is delivered directly to the region of the prostate gland with the obstructive tissue that causes BPH. Over time, the dead tissue is absorbed by the body’s immune system response, and the reduction in the hyperplastic tissue volume reduces the compression of the urethra, enabling improved urine flow.

Advantages:

  • Rezum water vapor therapy has been proven to provide patients with significant improvement in BPH symptoms, including frequency, urgency, weak stream, straining to urinate and nocturia (frequent nighttime urination), while preserving erectile function and urinary continence
  • The procedure takes less than a half hour and can be done awake with local anesthesia and light sedation
  • Performed in your urologist’s office

Disadvantages:

  • N/A

Laser Vaporization of the Prostate

Laser Vaporization of the prostate (utilizing GreenLight, Evolve and Pro Touch Laser Therapy) is a technique that uses a special laser to heat and vaporize the prostate tissue that is obstructing part of the urethra.

Advantages:

  • Performed on an outpatient basis
  • Most men return home only a few hours after the procedure
  • Quick recovery and return to normal activities
  • Normal urine flow is restored quickly
  • Very few long-term side effects
  • Long-lasting relief from bothersome urinary symptoms

Disadvantages:

  • Urinary tract infection (UTI)
  • Temporary pain and/or bleeding may occur, but typically diminishes within a few weeks
  • Retrograde ejaculation—semen released through ejaculation goes into the bladder rather than out of the penis, which can inhibit fertility

Transurethral Microwave Therapy (Cooled Thermotherapy)

Transurethral Microwave Therapy (TUMT), also known as Cooled Thermotherapy, is an in-office therapy that delivers targeted microwave energy to heat and reduce excess prostate tissue.

Advantages:

  • In-office procedure performed in less than one hour
  • Safe and effective with long-term results
  • Cooling protects the urethra and provides added patient comfort
  • Few long-term side effects

Disadvantages:

  • Urinary tract infection (UTI)
  • Temporary pain or bleeding may occur, but typically ceases within a few weeks
  • Brief inability to achieve or maintain an erection

Radio Frequency (RF) Therapy (Transurethral Needle Ablation)

Transurethral Needle Ablation (TUNA) is an in-office therapy utilizing targeted, low-level radio frequency energy that produces heat to effectively shrink the prostate tissue, allowing men to urinate more normally.

Advantages:

  • In-office, safe and effective procedure
  • Fast, long-lasting relief from BPH symptoms
  • Minimal side effects
  • Precision of energy waves treat only the targeted area

Disadvantages:

  • Urinary tract infection (UTI)
  • Temporary obstruction (blockage)
  • Temporary pain or bleeding may occur, but typically ceases within a few weeks

Minimally invasive procedures are performed to open a passage through the prostate to allow urine to flow with less effort. Many are called “trans-urethral” because instruments are passed through the opening of the tip of the penis and into the urethra.

Surgery to treat BPH is often reserved for men with severe symptoms such as:

  • Not being able to urinate or very limited urination
  • Having a partial urethral blockage causing recurrent urinary tract infections (UTI’s) or bladder damage
  • Kidney damage and hematuria (blood in urine)

Transurethral Resection of the Prostate (TURP)

Obstructing prostate tissue is removed using an instrument which is inserted through the urethra to remove the prostate tissue that is blocking the flow of urine.

Possible side effects of TURP include:

  • Clots
  • Retrograde ejaculation (semen released through ejaculation goes into the bladder rather than out of the penis, which can inhibit fertility); reduction in semen emission/dry orgasm
  • Erectile dysfunction, which is a less common side effect
  • Mild hematuria
  • Urinary tract infection
  • Temporary difficulty urinating, which usually resolves a few days after the procedure

Suprapubic Prostatectomy

A surgical procedure reserved for extremely large prostate glands. This is an open surgical procedure that is rarely performed to remove the obstructing prostate.