Prostate cancer gets lots of media coverage but prostate enlargement is far more prevalent.
Technically known as benign prostatic hyperplasia (BPH), the condition affects more than half of men over age 50 and 80% of men by age 80.
The prostate is actually a walnut-sized gland which encloses the urethra at the base of the bladder. It produces one component of seminal fluid and helps propel the fluid through the urethra during orgasm.
For unknown reasons, the prostate often begins to enlarge around age 40.
The enlarged tissue presses against the urethra, often leading to urinary problems
Difficulty in starting the flow of urine a weak urine stream stopping and starting during urination and dribbling afterward.
An urgent need to urinate up to several times an hour a constant feeling of fullness in the bladder and frequent awakening at night to go to the bathroom.
Although BPH is unrelated to a man’s risk of developing prostate cancer, it’s prudent to see an urologist if you’re experiencing any urinary difficulties.
Reason: BPH and prostate cancer produce similar symptoms. Also, untreated BPH can lead to urinary tract infection or even bladder or kidney damage.
After reviewing your symptoms and medical history, the urologist should take a urine sample to check for infection. Then he/she should perform a digital rectal exam to feel for prostate enlargement
The doctor should also test your blood level of prostate-specific antigen (PSA). A high level suggests prostate cancer.
For mild BPH, the doctor will probably recommend watchful waiting. That involves simply keeping an eye on your symptoms, with checkups at least once a year to make sure no complications have developed.
Caution: Antihistamines and decongestants can worsen your symptoms. If you have BPH, ask your doctor about avoiding these drugs.
More aggressive treatment may be called for if your BPH is clearly getting worse if the symptoms are causing moderate discomfort or if you have to restrict your life to deal with them (such as always having to be near a toilet). Two classes of drugs are used to treat BPH
Alpha-blockers such as terazosin (Hytrin) and doxazosin (Cardura). These drugs also used to treat high blood pressure relax the prostate muscle.
• 5-alpha reductase
5-alpha reductase inhibitors such as finasteride (Proscar). It shrinks the prostate by blocking the prostate-stimulating effect of dihydro testosterone.
In deciding which kind of drug is appropriate, it’s important to understand that the prostate is made up of two types of tissue glandular tissue, which enlarges, producing mechanical obstruction and smooth muscle tissue, which squeezes the urethra shut.
Which drug is best for your BPH depends on which of the two kinds of tissue is the real culprit.
If your prostate is enlarged
Finasteride may help by shrinking it. It may need to be taken for six months to a year before symptoms begin to improve.
Impotence occurs in fewer than 5% of men taking finasteride. Potency generally returns when medication is stopped.
If your prostate is of normal size:
It doesn’t help to shrink it. The treatment of choice is an alpha-blocker.
Weakness, dizziness and drowsiness occur in up to 10% of men taking an alpha-blocker. To avoid these problems, ask your doctor about adjusting the dose and taking the drug at bedtime.
If drugs fail to bring relief, surgery can help. The “gold standard” for surgical treatment of BPH the one considered most effective is transurethral resection of the prostate (TURP).
In this procedure, the surgeon inserts a tiny lighted instrument called a resectoscope into the urethra. Excess tissue from the prostate’s “inner ring” is chipped away bit by bit.
TURP is attractive to patients because it involves no incision minimal postoperative pain and a hospital stay of less than three days (followed by a week of rest at home).
If the prostate is of normal size, the surgical treatment of choice is transurethral incision of the prostate (TUIP).
As in TURP, a resectoscope is inserted through the urethra. But instead of chipping away tissue from the inner ring, the surgeon makes two tiny cuts in the muscular portion of the prostate. This relaxes its grip on the urethra.
Many men fear they’ll become incontinent or impotent as a result of surgery. In fact, fewer than 4% of men who undergo TURP or TUIP experience such problems.
However, three out of four men who undergo TURP (and a slightly smaller proportion of those who undergo TUIP) experience retrograde ejaculation. In this condition, sperm liberated by orgasm go backward into the bladder instead of being ejected from the penis.
Retrograde ejaculation can render a man infertile. It is not dangerous, however, nor does it interfere with a man’s enjoyment of sex.
More surgical procedures
Two newer procedures destroy excess prostate tissue via heat administered via catheter
- Transurethral needle ablation (TUNA) uses radio waves to produce heat.
- Transurethral microwave thermal therapy (TUMT) uses microwaves.
TUNA and TUMT have real advantages over TURP and TUIP. They can be done on an outpatient basis, for instance, and the risks of retrograde ejaculation, impotence and incontinence are smaller.