The prostate naturally enlarges as men age.
- Prostate Illustration
The prostate gland is the only organ in the body that continues to grow throughout life. Its main function is to make fluids that help the body produce semen. When it becomes enlarged, some men develop troublesome urination. Common symptoms of an enlarged prostate include changes in the urine stream (weaker, harder to start, harder to keep going), having to go frequently in the day and night, having a strong urge to go, and dribbling urine after voiding. An enlarged prostate can also cause bleeding, retention of urine (inability to empty the bladder), and urine infections.
Many men with enlarged prostates do not have symptoms. The condition does not need to be treated if it is not causing problems. For those who do have symptoms, treatment options range from lifestyle changes (to help the bladder and prostate work more easily) to medications to surgery.
An enlarged prostate can put strain on the bladder. It is very important to pay attention to your bladder and make its job as easy as possible. Several factors, such as emptying your bladder regularly (and not holding your urine) and watching the types and amounts of fluid you drink, can make a tremendous impact on your symptoms. The Restoring Bladder Health hand-out provides details on these and other things you can do to keep your bladder healthy.
Other natural treatments may help ease prostate symptoms. UrologyChannel.org has a list of alternative treatments that many men have found effective. One of the most commonly used is saw palmetto, an herbal remedy that can be purchased over-the-counter.
Several medications are available to help ease enlarged prostate symptoms.
This group of medications includes drugs such as Cardura, Hytrin, Flomax, and Uroxatral. They work by relaxing smooth muscle in the prostate and opening the urinary channel. Older drugs such as Cardura and Hytrin work on both the prostate and on blood vessels, so are sometimes used to treat both an enlarged prostate and high blood pressure. Sometimes, these drugs can cause dizziness and lightheadedness, and one must be cautious when beginning these medications.
Newer versions of alpha blockers, Flomax and Uroxatral, do not have an effect on blood vessels. They do not usually cause dizziness and lightheadedness and cannot be used to treat high blood pressure.
These drugs usually provide an improvement in symptoms very quickly. Men often find that they need to stay on them indefinitely to keep symptoms under control.
5-alpha Reductase Inhibitors
These are medications that stop the conversion of testosterone into dihydrotestosterone, a form of the hormone that works in the prostate gland. Examples are Proscar and Avodart. Over time, these drugs result in shrinkage of the prostate gland and a lowering of the PSA levels in the blood. They do not usually provide immediate results and must be taken for several weeks before an effect is seen.
These drugs are effective in combination with alpha blockers and are particularly recommended for men with very large prostates.
It is important for men on these drugs to know that the PSA is artificially lowered, and, therefore, PSA values that are usually considered normal can be a sign of a problem in men taking 5-alpha reductase inhibitors.
This is a group of medications designed to relax bladder contractions. Examples are Ditropan (oxybutynin), Detrol, Enablex, Sanctura, and Vesicare. These drugs are particularly helpful for symptoms of urgency and frequency. They must be used with caution, however, because they can make it more difficult to empty the bladder in men who are already retaining urine. They are usually combined with other drugs, such as alpha blockers.
Some men do not wish to take medications for the rest of their lives or wish to stop them because of side effects. If symptoms are very bad, surgery may be recommended (see below). However, men whose symptoms can be controlled with medications, but who do not wish to take them, now have the option to undergo office procedures that can result in effective relief of prostate symptoms without the need for drugs.
Available treatments work by delivering energy to the prostate in a variety of ways in order to help open the channel. These treatments have been found to have very good results. Two of these treatments, Prolieve and Prostiva, are available in our office. Prolieve, which uses microwave therapy to dilate and treat the enlarged prostate, often results in immediate improvement. The procedure is done in the office and does not typically require wearing a catheter afterwards. They typically produce relief that lasts for at least 2 to 3 years.
Prostiva works by delivering heat in the form of radiofrequency to destroy enlarged prostate tissue. It does require wearing a catheter for a few days afterwards, but may also be more durable than other therapies; in studies, it has been reported to last several years.
Men who have very bothersome symptoms from enlarged prostate, such as urinary troubles that do not improve with medication, infections, inability to empty the bladder, or bleeding, are very likely to benefit from surgery of the prostate. This surgery is usually done endoscopically, through a camera which is passed through the urethra. The surgery can be done using electrocautery or laser therapy. Both result in effective and durable cures in many cases. These operations are described in further detail in the articles titled Laser Resection of the Prostate and TURP (Transurethral Resection of the Prostate).
The ultimate decision of which treatment to pursue depends on the level of your symptoms and how much they are bothering you. Enlarged prostate has troubled many men for centuries, and we are very fortunate to be able to offer a variety of effective therapies today.
Posted by Adrienne Carmack, MD