Enlarged Prostate – A Normal Part of Aging

Posted on Jan 4, 2012 in The Doctor Is In by eParisExtra

by Chris Prakash, MD

Do you get up several times a night to go to the bathroom? Do you have difficulty starting urination? Do you dribble after urination ends?  You may have BPH (benign enlargement of prostate).

BPH is a very common condition affecting most men by age 60, but it could start earlier. It is a normal part of the aging process, and by age 85, almost every man has BPH.

It is important to know that this is a benign condition (not cancer) and it does not put you at risk for cancer.

The prostate gland is located underneath your bladder and surrounds your urethra, which empties urine from the bladder. As the prostate gland expands, it squeezes the urethra or causes the muscles around the urethra to contract, making it difficult to urinate. 

The Dreaded Finger Exam

Examination by putting a finger in the rectum is all that may be required to diagnose this condition. Sometimes a transrectal ultrasound is performed to get an image of the prostate gland. In addition, you may be asked to complete a self screening form to evaluate the severity of your symptoms and the impact on your daily life. Your doctor can use this to monitor your condition over time. 

Treatment Approaches

Treatment will depend on your age, overall health, and the severity of your symptoms. There are many ways to successfully treat BPH, including some simple lifestyle changes if your symptoms are mild, and several medications that can be effective. If no other therapies work and the symptoms are severe enough, there are also several types of surgery to correct the condition.

Medications

• Alpha blockers – relax the muscles around your bladder, making it easier to urinate. These drugs were originally used to treat high blood pressure. Common side effects include decreased ejaculation and low blood pressure. Alpha blockers include: Terzosin (Hytrin), Doxazosin (Cardura), Tamsulosin (Flomax), Alfuzosin (Uroxatral).
• 5-alpha-reductase inhibitors – shrink the prostate gland by lowering the amount of dihydrotestosterone, a hormone the prostate needs to grow. These drugs take longer to work than alpha blockers, and they also lower PSA levels (a high level of PSA can indicate prostate cancer), making it harder to screen for prostate cancer. These include:

Finasteride (Proscar), and Dutasteride (Avodart).

Your doctor may also suggest combination therapy — taking an alpha blocker and an enzyme inhibitor at the same time.

Minimally invasive surgery

These techniques are often not as effective as surgery but have minimal side effects.

• Microwave therapy – uses heat from microwaves to shrink the prostate. This procedure works best for men with moderate symptoms and enlargement of the prostate.
• Needle ablation – uses radio waves to get rid of the part of the prostate that is blocking urine flow. It works best for men with mild to moderate enlargement of the prostate.
• Laser therapy — uses a laser to destroy excess tissue and shrink the prostate. It works best for men who have mild to moderate enlargement of the prostate and don’t experience urinary retention.

Surgery

Surgery is the most effective way to reduce your symptoms, but potential side effects include a small risk of erectile dysfunction or urinary incontinence.

• Transurethral resection of the prostate (TURP) — is the most common surgical treatment for BPH. It is performed by inserting a scope through the penis and removing the interior of the prostate piece by piece. It reduces symptoms quickly and is often used to treat men with moderately or severely enlarged prostates. One potential side effect is retrograde ejaculation, where semen goes into the bladder instead of out the urethra.
• Laser surgery — Two types of laser surgery are used: Photosensitive vaporization of the prostate (PVP) is used for men with mild to moderate prostate enlargement, while holmium laser enucleation of the prostate (HoLEP) is usually used for men with severely enlarged prostates. Side effects can include retrograde ejaculation.

 Does Saw Palmetto work?

There is conflicting and contradictory research about the benefits of saw palmetto for prostate symptoms. Some research had previously shown that saw palmetto might modestly improve symptoms such as going to the bathroom at night in some men. But recent studies (higher quality and more reliable research) seems to indicate that saw palmetto has little or no benefit for reducing these symptoms.

 

This information is strictly an opinion of Dr Prakash, and is not intended to replace the advice of your doctor. Dr Chris Prakash is a contributing columnist, and author of eParisExtra’s “The Doctor is In” column. He is a medical oncologist at Texas Oncology Paris. He is board certified in Internal Medicine, Oncology and Hematology. He lives in Paris, TX with his wife and two children, and can be reached at 9037850031, or Sucharu.prakash@usoncology.com