Enlarged Prostate

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Treatment options

Histologic BPH without symptoms does not warrant treatment. The decision to treat BPH is based on two important factors:

  • the degree to which it affect's a man's quality of life (see symptoms).
  • whether its obstruction has caused, or is likely to cause, damage to a man's bladder, ureters, or kidneys (see image below).

In the image above, one can see that as the enlarged prostate obstructs the flow of urine through the urethra, the buildup of pressure can be transmitted to the bladder, ureters, and kidneys, thereby damaging these organs.

If treatment is indicated, the specific therapy is based on the severity of a man's symptoms, his overall state of health, the size of his prostate, the geometry (shape) of the prostate and patient preference.

Medicines are usually the first line of treatment. Therapy with alpha-adrenergic blockers (Flomax, Cardura or Hytrin), or 5-alpha-reducatase inhibitors (Proscar or Avodart) may be sufficient.

Alph-adrenergic blockers relax the smooth muscle in the prostate to allow urine to pass more freely. These medicines usually give relief of symptoms in a few days. If medicine is stopped symptoms will recur. 5-alpha-reductace inhibitors work by actually shrinking the prostate but can take 6 months to give optimal effect. In some cases both alpha blockers and 5-alpha reductase inhibitors are given together.

In other situations, a trans-urethral (through the penis) procedure may be necessary. Such therapies include:

Trans-urethral microwave thermotherapy, which is performed in the office setting on an out-patient basis under local anesthesia

Trans-urethral needle ablation (TUNA) which can be performed on an outpatient basis.

Trans-urethral Green-Light laser therapy, which is performed in the operating room, usually on an out-patient basis. This can be performed with patients on blood thinner.

Trans-urethral resection of the prostate, which is performed in the operating room, and usually requires an overnight hospital stay.

Under certain circumstances, BPH may require an open surgery for removal (suprapubic prostatectomy) that entails removal of the enlarged portion of the prostate through an incision. This can be done laparoscopically or through an incision in the middle of the lower part of the abdomen. Note that in this operation the entire prostate is not removed, as is the case in cancer surgery. The prostate is pealed out and the capsule is left much like one removes the pulp from an orange.