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Prostate enlargement

There is a lot of “hype” in the press regarding the use of natural supplements to promote prostate health. The unfortunate reality is that despite the use of these herbal compounds, over 70% of men over the age of 50 will be affected by enlargement of the prostate. This condition, referred to as benign prostatic hyperplasia (BPH), results in a broad spectrum of progressive signs and symptoms. Fortunately the condition is highly treatable and correctable when addressed in a timely fashion.

Frequent urination, getting up at night to urinate, urgent urination and later, weak urinary flow, incontinence, renal failure and sexual dysfunction are all potential problems. The cause of this condition is largely genetic and is linked to the male endocrine system. With advancing age the balance between testosterone, dihydrotestosterone and estrogen changes. In addition, the behavior of the various hormone receptors becomes modified and results in the stimulation of hyperplastic prostate gland growth.

Prostate cancer is not caused by BPH, nor is the presence of BPH associated with the increased incidence of prostate cancer. Because men with significant BPH are more likely to seek medical attention, however, they are also more likely to be screened for and diagnosed with a coexisting silent prostate cancer.

The basic understanding of how BPH develops has led to effective medical treatment options. Drugs including Flomax, terazosin and doxazosin are alpha receptor blockers which effectively relax the smooth muscle of the prostate gland and allow better opening of the bladder neck and prostatic urethra during urination. Avodart and finasteride are 5-alpha-reductase inhibitors and through a hormonal mechanism arrest the growth of the prostate, and may even cause a reduction in size. These two classes of drugs are often used in combination very effectively, and in some cases are also combined with a mild anticholinergic drug similar to oxybutinin to control the overactive bladder symptoms that often accompany BPH. The use of these anticholinergic drugs in the treatment of BPH must only be considered if urodynamic studies confirm that the bladder is emptying adequately, and in combination with Flomax or another alpha blocker. If not, significant urinary retention may occur.

In cases where medical management is suboptimal or when the patient prefers to avoid lifetime medical therapy, there are several safe and affective treatment modalities. Transurethral microwave therapy (TUMT) is a safe and effective treatment used to ablate the obstructing prostate tissue under local anesthesia in an office setting. After cystoscopic examination and urodynamic studies, a preselected treatment catheter is inserted into the bladder and tiny heating coils are used to raise the temperature of the prostate tissue along the urethra and bladder neck just high enough to denature the cell membrane proteins. Over the next few days this tissue then gently sloughs leaving an open channel. The procedure is safe, performed under local anesthesia and can be done while the patient is on warfarin, aspirin and or Plavix.

Another safe and effective approach is Transurethral photoselective vaporization of the prostate (PVP), also known as “Greenlight Laser Therapy.” This technology is based on using the wavelength of a KTP laser which targets hemoglobin and therefore selectively vaporizes the prostate cells while simultaneously maintaining hemostasis. The result is immediate, and although a general anesthetic is required, the procedure times are brief and performed on an outpatient basis. Similar to TUMT, PVP/Greenlight can also be performed on blood thinners in many cases, and is effective on very large prostate glands. Both of these procedures require brief foley catheterization 1-3 days, and have a very low risk and side effect profile, including the preservation of erectile function.

BPH is perhaps the most common disease process affecting the aging but otherwise healthy male. Fortunately there are many options to adequately evaluate and effectively treat this condition. The result is preservation of quality of life including freedom from bathroom mapping as well as the preservation of renal and sexual wellness. Thorough evaluation includes screening for prostate cancer as well as urodynamic studies which help to rule out other causes for the presenting signs and symptoms. When basic dietary recommendations and medical therapy are ineffective in the primary care setting, urological consultation should be encouraged.