Prostate enlargement, or benign prostatic hyperplasia (BPH)

The prostate continues to grow during most of a man’s life and can begin to cause problems in later years. An enlarged prostate presses against the urethra like a clamp on a garden hose, causing bladder irritation and contraction. Eventually, the bladder may no longer empty completely.

 

Possible causes

 

As common at BPH is, its causes are not well-understood. It’s thought that the natural elevation of hormones in older men promotes cell growth in the prostate. Another theory focuses on the accumulation of high levels of dihydrotestosterone (DHT) in the prostates of some older men, causing cell growth.

What to look for

Problems with urination are the most common symptoms of BPH: interrupted or weak stream, urgency and leaking or dribbling, more frequent urination especially at night, or acute urinary retention — the inability to urinate at all. In 8 out of 10 cases, these symptoms suggest BPH, but they also can signal more serious conditions, including prostate cancer. Get in touch with your doctor if you’re experiencing any of these symptoms.

Check out your own symptom score here.

 

For mild-to-moderate symptoms of BPH, a drug regimen may be the answer. Finasteride (Proscar) and dutasteride (Avodart) inhibit production of the hormone DHT and can either prevent progression of growth of the prostate or actually shrink the prostate in some men. Terazosin (Hytrin), doxazosin (Cardura), tamsulosin (Flomax) and alfuzosin (Uroxatral) relax the smooth muscle of the prostate and bladder neck to improve urine flow and to reduce bladder outlet obstruction.

For mild-to-moderate symptoms of BPH, a drug regimen may be the answer. Terazosin (Hytrin), doxazosin (Cardura), tamsulosin (Flomax) and alfuzosin (Uroxatral) relax the smooth muscle of the prostate and bladder neck to improve urine flow and to reduce bladder outlet obstruction. These medications can improve urinary symptoms within a few weeks.

Finasteride (Proscar) and dutasteride (Avodart) inhibit production of the hormone DHT and can either prevent progression of prostate growth or actually shrink the prostate in some men. They can take 3 to 6 months to work. They can also affect PSA levels, which must be accounted for when screening for prostate cancer.

UroLift is a minimally-invasive procedure that lifts and holds the enlarged prostate tissue so it no longer blocks the urethra. Typically performed as an outpatient procedure using only sedation, it employs using small implants introduced with a cystoscope to increase the opening of the urethra. Patients usually go home the same day without a catheter.

Rezūm is a minimally-invasive water vapor therapy treatment that precisely targets the prostate’s obstructive tissue with controlled doses of steam to eliminate the tissue which is later absorbed by the body. This shrinks the prostate and relieves the pressure that makes urination difficult. The outpatient procedure takes only seconds and is performed under light sedation.

The prostate tissue is surgically removed using electrocautery. The procedure is done in the hospital and requires an overnight stay. Your urologist will recommend this procedure based on factors found during prostate imaging or cystoscopy. A catheter may be needed after the procedure for a short time.

A specialized laser is used to remove prostate tissue. HoLEP is often used for very large prostates for maximum removal of tissue and to create a wide-open channel for urine elimination. The procedure is done in the hospital and requires an overnight stay. A catheter is left after the procedure for a short time.

Your urologist may recommend opening up the prostate channel with a robotic surgical procedure or traditional open surgery. Surgery is usually reserved for severely-enlarged prostates that are unlikely to respond to other treatment options. This procedure requires a catheter afterward and a hospital stay.