What is the Latest Treatment for Enlarged Prostate?

What is the latest treatment for enlarged prostate? Exciting new advancements are providing patients with innovative solutions that promise improved comfort and faster recovery times. Living with a large prostate, medically known as benign prostatic hyperplasia (BPH), can bring challenges. The condition is often uncomfortable for men and may disrupt their normal daily lifestyle. The good news is that there are several effective treatment options available.

In this article, we’ll provide a comprehensive look at this disease, BPH symptoms, and the latest techniques for treating it. This can help patients be more informed about their overall health while gaining an understanding of what their healthcare team can do to help.

Defining Benign Prostatic Hyperplasia (BPH)

Benign prostatic hyperplasia is a non-cancerous enlarged prostate gland. This gland is located below the bladder and in front of the rectum. It surrounds part of the urethra, a thin tube that carries urine from the bladder out of the body. The gland helps produce semen in men. While normally the size of a walnut, the prostate gland can grow to about the size of a lemon as men age.

The exact cause of BPH isn’t known, but it’s believed to be linked to hormonal changes. Evidence suggests that Dihydrotestosterone (DHT) is one specific male hormone that is linked to prostate growth. Other factors may come into play with enlarged prostates, including:

• Genetic factors
• Obesity
• Lack of exercise
• Type 2 diabetes
• Vascular disorders like heart disease

Although benign prostatic hyperplasia isn’t life-threatening in itself, if left untreated it can result in medical problems like chronic urinary tract infections, bladder stones, and kidney damage.

BPH Symptoms

An enlarged prostate will naturally press against the urethra and bladder causing a variety of urinary symptoms. These may range from mild to severe. Talk with your healthcare professional if you notice these common symptoms:

• Increased Urinary Frequency: Needing to urinate more often, especially during the night.
• Urgency: Having a sudden, strong urge to urinate.
• Difficulty Starting to Urinate: Trouble initiating urine flow.
• Weak Stream: A weak and interrupted urine flow.
• Incomplete Bladder Emptying: Feeling that your bladder isn’t empty after urination.
• Straining: Needing to strain or push to begin urine flow.

Treatment Options for Benign Prostatic Hyperplasia

Fortunately, there are many treatment options for BPH. Some of these are simple adjustments in self-care to improve your quality of life that carry little risk except an adjustment to your routine. Several classes of medications can work to shrink the prostate. Other minimally invasive procedures can help to improve urinary symptoms. Some doctors may recommend a combination therapy of several treatments to form a comprehensive plan.

Lifestyle Changes

The first treatment option is one that you can begin yourself. Consider taking steps to manage BPH symptoms through adjustments in your daily life. Incorporate fruits, vegetables, and whole grains into your diet. Reduce red meat and fatty foods which may make symptoms worse. Limit fluids in the evening and avoid caffeine and alcohol since they may irritate your bladder.

Get regular exercise to maintain a healthy weight. Low-impact activities like walking, swimming, and yoga may be good options, especially if your prostate size is related to age. Manage stress with relaxation techniques like meditation and deep breathing exercises as stress can also exacerbate symptoms.

Practice bladder training exercises such as scheduled voiding and double voiding (urinating, waiting a few minutes then repeating). You may discover better urinary control with kegel (pelvic floor) exercises.

However, lifestyle changes alone may not be enough to find relief as they don’t address the enlarged prostate directly.

BPH Medications

Several medications are available to help manage BPH. These drugs work in different ways and may be used individually or in combination.

• Alpha Blockers: These medications relax the bladder neck muscles and prostate, making it easier to urinate. Tamsulosin and Alfuzosin are examples of Alpha Blockers.
• 5-Alpha Reductase Inhibitors: This class of drugs shrinks the prostate gland itself by blocking hormones responsible for prostate size increase. Dutasteride and Finasteride are types of 5-Alpha Reductase Inhibitors.
• Phosphodiesterase-5 Inhibitors: Medications like Tadalafil are normally used to treat erectile dysfunction but may provide relief from BPH symptoms.

Addressing Excess Prostate Tissue the Old School Way: TURP

A common surgical treatment for benign prostatic hyperplasia is Transurethral Resection of the Prostate or TURP. Here’s a detailed look at how the medical procedure is performed.

The patient is given a general anesthetic to put them to sleep during the hour-long surgery. Alternatively, a spinal anesthetic may be used to numb the lower half of the body while keeping the patient awake.

Next, a surgeon inserts a resectoscope through the tip of the penis into the urethra. This thin tube includes a light, a camera, and an electric loop of wire that will be used to cut away small pieces of prostate tissue. This will relieve pressure on the urethra and improve urinary symptoms. The electrified wire cauterizes and seals blood vessels as it goes to minimize bleeding.

The prostate tissue fragments are evacuated using a special fluid and then can be spent for lab testing to ensure an absence of cancerous cells. After the resection procedure, a catheter is inserted through the urethra into the bladder to aid in draining urine and allow for healing. This may be left in place for a few days. Patients can expect a hospital stay of one or two days.

Long-term, TURP is a highly effective way to remove tissue that is causing prostate problems and relieves symptoms like frequent urination. However, it does carry risk just as any surgical treatment. Infection, bleeding, and difficulty urinating may result. In severe cases, some patients have experienced side effects like urinary incontinence and sexual dysfunction (erectile dysfunction or retrograde ejaculation).

In severe cases, transurethral resection may not be an option. A full open prostatectomy may need to be performed where a surgeon removes part or all of the prostate.

An Updated Approach: Laser Therapy

High-energy lasers can also be used to remove or reduce excess prostate cells. For example, the Holmium Laser Enucleation of the Prostate (HoLEP) procedure is very similar to the Transurethral Resection of the Prostate surgical option with a few key differences. Instead of an electric wire, a laser directly cuts and removes the offending tissue. Recovery time is quicker and usually with less blood flow to stop. Some patients can return home the same day.

A New Method, Steam-Powered: Water Vapor Thermal Therapy

A newer and less invasive therapy uses steam to shrink and remove tissue. Controlled bursts of steam lasting less than 10 seconds each are released directly into the prostate tissue. The steam causes the prostate cells to die and be absorbed by the body over time – all without the need for an incision. The entire procedure takes about half an hour and most patients require only one session.

A Less Invasive Treatment: Prostatic Urethral Lift

The prostatic urethral lift procedure lifts and holds the enlarged prostate tissue out of the way so that it no longer blocks urine flow. A urologist inserts small implants through the urethra into the prostate, creating a wider channel.

Unlike some other procedures, this one does not involve cutting, heating, or removing tissue from the prostate. This presents a lower risk of sexual function side effects.

The New Standard: Prostate Artery Embolization (PAE)

Prostate Artery Embolization (PAE) is a minimally invasive, often outpatient procedure. An interventional radiologist typically performs PAE under local anesthesia, inserting a catheter through a small puncture in the groin or wrist.

With the aid of X-ray imaging, the doctor will position the catheter in the arteries responsible for blood supply to the prostate. The doctor injects microscopic plastic beads to block blood flow, gradually causing the prostate to shrink over time.

Of the surgical options, PAE offers short-term and long-term benefits over more invasive surgery. Most patients have only one small puncture from the catheter insertion, which they can easily care for with a temporary bandage. It has a short recovery time with normal activity resuming in a few days. Patients can expect to see symptom relief beginning within a few weeks, with full benefits in as little as three months. Prostatic Artery Embolization carries a lower risk of sexual activity impairment than other more involved surgery options.

Conclusion

Many men will face an enlarged prostate as they age. Although symptoms can be uncomfortable, doctors have long relied on well-tested surgical options to effectively remove prostate tissue. Newer, minimally invasive procedures, such as prostatic urethral lift and prostate artery embolization, now offer effective treatment for excess prostate tissue with the promise of quick recovery and minimal side effects. When combined with appropriate medication and lifestyle changes, many men can find relief from urinary problems associated with an enlarged prostate. Talk to your doctor today to learn about the quality of life improvements you may discover with one of these procedures.