Benign Prostatic Hyperplasia (cont.)
William C. Shiel Jr., MD, FACP, FACR
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
In this Article
- Enlarged prostate (BPH) definition and facts
- What is the prostate gland?
- What is benign prostatic hyperplasia (BPH)?
- At what age do men develop the condition?
- How common is the condition? Are there any risk factors?
- What happens in BPH? What are the signs and symptoms?
- Is BPH a type of cancer?
- What procedures or tests diagnose this prostate problem?
- Which specialties of doctors treat the problem?
- Are there natural or home remedies to treat BPH or enlarged prostate?
- Medications and surgery procedures to treat BPH
- Are there other non-cancerous prostate problems?
- Can prostate problems be prevented?
- Enlarged Prostate (BPH) FAQs
- Find a local Urologist in your town
Medications and surgery procedures to treat BPH
There are several different ways to treat BPH:
Men should carefully weigh the risks and benefits of each of these options. Prostate surgery has traditionally been seen as offering the most benefits for BPH but unfortunately carries the most risks.
Medical treatment of BPH is usually reserved for men who have significant symptoms. The available medications include
- alpha blockers relax the smooth muscles of the prostate, and the bladder neck, which helps to relieve urinary obstruction caused by an enlarged prostate in BPH. Medication side effects can include headaches, fatigue, problems ejaculating, or lightheadedness. Commonly used alpha blockers in BPH include tamsulosin (Flomax), alfuzosin (Uroxatral), and older medications such as terazosin (Hytrin), slidosin (Rapaflo) or doxazosin (Cardura). These medicines generally will lead to improvement in symptoms within several weeks and have no effect on prostate size; and
- 5-alpha reductase inhibitors block the conversion of the male hormone testosterone into its active form in the prostate (DHT). The prostate enlargement in BPH is directly dependent on DHT, so these drugs lead to an approximate 25% reduction in prostate size over six to 12 months. For this reason, improvement in urinary symptoms most commonly takes this long to occur. Examples of 5-alpha reductase inhibitors include the drugs Finasteride (Proscar) and dutasteride (Avodart). Side effects of finasteride may include declining interest in sex, problems getting an erection, and problems with ejaculation.
Learn more about: DHT
Surgery or office procedures may also be used to treat BPH, most commonly in men who have not responded satisfactorily to medicine or those who have more severe problems, such as a complete inability to urinate.
- Transurethral resection of the prostate (TURP) has been used for the longest period of time. After the patient is given anesthesia, the doctor inserts a special instrument into the urethra through the penis. With the instrument, the doctor then shaves away part of the inner prostate to relieve the outflow of urine from the bladder.
- Laser procedures: A number of laser procedures are available, some of which can be performed in the doctor's office with minimal anesthesia. These procedures also involve the removal of obstructing prostate tissue. They are generally associated with less bleeding and quicker recovery than TURP.
- Microwave therapy: This procedure is generally performed in the office and involves the use of microwave energy delivered to the prostate to kill some of the cells leading eventually to shrinkage of the prostate.
Are there other non-cancerous prostate problems?
Yes, aside from BPH, there are a number of prostate problems that also have nothing at all to do with prostate cancer. Among these benign disorders of the prostate are acute prostatitis and chronic prostatitis.
Acute prostatitis is a bacterial infection of the prostate. It can occur in men at any age. Symptoms include fever, chills, and pain in the lower back and between the legs. This problem also can make it hard or painful to urinate. Doctors prescribe antibiotic medicines for acute prostatitis and recommend that the patient drink more liquids. Treatment is usually successful.
Chronic prostatitis is a prostate inflammation that tends to recur over time. It is usually not associated with true bacterial infection but causes similar symptoms of pain and discomfort, without fevers or chills. Chronic prostatitis is difficult to treat, and the exact cause is not well understood. Antibiotics may be used in some cases as well as anti-inflammatory medicines such as ibuprofen. In many cases, symptoms will resolve on their own.
Can prostate problems be prevented?
The best protection against prostate problems is to have regular medical checkups that include a careful prostate exam. See a doctor promptly if symptoms occur such as:
- A frequent urge to urinate
- Painful urination
- Bloody urine
- Difficulty in urinating
- Dribbling of urine
Regular checkups are important even for men who have had surgery for BPH. Surgery does not protect against prostate cancer because only part of the prostate is removed. In all cases, the sooner a doctor finds a problem, the better the chances that treatment will work.
REFERENCE: Deters, LA, MD. "Benign Prostatic Hyperplasia." Medscape. Updated: Nov 06, 2016.
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