Benign prostatic hyperplasia (BPH) is when the prostate and surrounding tissue gets bigger. As you age, your prostate may get larger. BPH is when it gets large enough to cause problems. While the prostate is usually the size of a walnut or golf ball in adults with prostates, it can grow to be as large as an orange.
As the gland gets bigger, it can squeeze the urethra. The bladder wall becomes thicker. Over time, the bladder may weaken and lose the ability to empty fully. Urine then stays in the bladder. These problems cause many of the lower urinary tract symptoms (LUTS) of BPH.
“The average age people with prostates start to have symptoms of an enlarged prostate is late 40s and can continue into their 90s,” says Amy Elizabeth Krambeck, MD, urologist at Northwestern Medical in Chicago. “Sixty percent of people with prostates in their 60s and eighty percent of people with prostates in their 80s have symptoms of BPH. The symptoms can vary, but generally start with having to get up to go to the bathroom at night, having a weak stream when passing urine and having accidents. This is when we start to see people get concerned and come in for an appointment.”
BPH ranges from mild to severe. A urologist will perform various tests to find out if you have BPH. Tests can include a physical exam, urine test and scans to find out the size and shape of the prostate. BPH is benign (non-cancerous), but if the doctor suspects cancer, they will request a blood test to screen for prostate cancer.
There have been a number of new types of therapy for BPH over the past few years. These include new drugs that more selectively target the bladder and prostate as well as surgical interventions. There are many minimally invasive surgical therapies and surgical alternatives that seem likely to be helpful and may be available treatment options in the future. These therapies include prostatic stents, drug eluting catheters, balloon dilation devices and transurethral prostatic split techniques, to name a few.
Dr. Krambeck explains, “New procedures are less invasive than many older choices, with good results and comfortable recovery. The new guidelines, recently put out by the American Urological Association for treatment of BPH, focus on the size of the prostate and how size helps to guide treatment. This allows urologists to be more accurate when treating patients. The first line of treatment is generally medication, but if that doesn’t work, there are new types of minimally invasive therapies that involve lasers, water vapor, temporary implants and other treatments that help reduce the size of the prostate and relieve urinary symptoms quickly.”
For the patient, successful minimally invasive surgical therapy might include:
- Rapid relief of symptoms
- Short recovery time with quick return to daily activities
- Minimal side effects
- Cost effective
For the urologist, successful minimally invasive surgical therapy includes:
- An out-patient setting under reduced anesthesia
- Ease of follow-up care
- Low risk
- Can be used with many types of patients
The new guidelines for treatment of BPH fall into two categories – medication therapy and surgical treatments.
Medication Therapy
Overactive bladder medications may be offered as a treatment option. Although the causes of BPH and overactive bladder may be different, both have the same symptoms. Studies have shown these drugs work well and do not worsen bladder retention. However, there is increased risk of dementia in patients over 55. There may be big side effects, especially in patients over 70, so the benefits and risks of treatment should be talked about with your doctor.
Many people with enlarged prostates are offered drugs called low dose tadalafil, alpha blockers or finasteride to help with symptom relief. Doctors are often asked if it is helpful to use these drugs at the same time for even better treatment outcomes. But the combination of low-dose daily tadalafil with alpha blockers or low-dose daily tadalafil with finasteride does not improve symptoms any better than using the drugs alone.
Surgical Options
Transurethral Electro Vaporization of the Prostate (TUVP) uses a rolling electrode (rollerball). The roller electrode gives a strong electric current to the body as it is rolled over the prostate. The heat of this current vaporizes the part of the prostate that is causing the urethra to be blocked.
Photoselective Vaporization of the Prostate (PVP) uses a laser and saline to vaporize or burn the prostate to reduce the size of the prostate so the patient can pass urine. This treatment may be less effective for larger prostates.
Water Vapor Thermal Therapy is an option if the prostate is small enough. This procedure uses radiofrequency to create steam, which is delivered to the prostate through a specialized device. The heat from the steam reduces the size of the prostate and creates an opening for the patient to pass urine. Over a three-year period, this treatment has been highly effective.
Water vapor thermal therapy may be offered to patients who want to preserve their ejaculatory function. Compared to many other surgical options for BPH, this treatment has a higher chance of preserving sexual function.
Laser Enucleation is another option that does not depend on the size of the prostate. Using saline and either a holmium or a thulium laser, the prostate tissue is cored out and removed from the body. This treatment gives patients the most amount of urine flow after the procedure and has the best long-term results.
Temporary Implanted Prostatic Devices (TIPD) may be offered depending on the size of the prostate. The device is placed into the urethra by the urologist. Over five to seven days it expands to gently widen the opening through which urine can flow. After five to seven days, it is taken out. There is no heat or tissue removal for this type of treatment. Urine flow rate at three and 12 months has been seen to improve.
Since many people with enlarged prostates stop medical therapy yet few seek surgery, there is a growing need for an effective treatment that is less invasive than surgery. With these new treatment options, perhaps a large portion of people who have stopped medical therapy can be treated prior to struggling with bladder symptoms.
In addition to treatment options, people with prostates can make lifestyle changes that can improve their symptoms. Dr. Krambeck suggests:
- Cutting off fluid intake after 8pm
- Exercise
- Limiting alcohol and caffeine intake
- Eating plenty of fruits and vegetables
- Maintaining a healthy weight
“People with prostate symptoms don’t have to be embarrassed by their symptoms or struggle in silence. BPH is simply a part of getting older,” Dr. Krambeck says. “Many of my patients wished they had come in sooner, but they were worried about how BPH treatment could affect their sexual function. Many treatments do not affect testosterone levels or erections at all. I want to encourage people with prostates who are experiencing symptoms to learn about treatment options and get help so they can enjoy life to the fullest.”
For more information on Benign Prostatic Hyperplasia (BPH), check out this patient guide.