What is Enlarged Prostate, or BPH?
The prostate is a walnut-shaped male gland that sits below the bladder and surrounds the urethra. It is part of the reproductive system and is responsible for making ejaculatory fluid. Benign prostatic hyperplasia (BPH) is a common urologic condition in older men, in which the prostate enlarges and squeezes the urethra, resulting in urinary tract symptoms referred to as LUTS (lower urinary tract symptoms).
What are the Symptoms of BPH?
The enlargement of the prostate can result in irritation and obstruction of the bladder. This may manifest as a variety of urinary symptoms such as slow urinary stream, urinary frequency, urgency of urination, nocturia (excessive nighttime urination), urinary hesitancy, starting and stopping when urinating, dribbling of urination, or the sensation of not emptying the bladder completely. In severe cases the prostate can obstruct the flow of urine completely from the bladder, which needs urgent attention. The AUA Symptom Score was developed to help assess the severity of these symptoms.
How is BPH Diagnosed?
An evaluation consists of a thorough history and physical exam (including a digital rectal exam or DRE). The AUA Symptom Score Index helps to assess the severity of your symptoms. A urinalysis is performed to evaluate for the presence of sugars, blood, or signs of infection in the urine.
Depending on the an individual’s symptoms, additional tests may be recommended, including:
- Post void residual by bladder scan: a noninvasive scan of the bladder to estimate how much urine is being retained
- Uroflow: one urinates into a device that measures the strength and pattern of the urinary stream
- Cystoscopy: a small, lighted, flexible endoscope is passed via the urethra into the bladder to evaluate the anatomy and rule out tumors, strictures and other conditions
- Ultrasound of kidneys, bladder and/or prostate: sound waves are used to image a specific organ
- Urodynamics: studies that measure the pressure and function of the bladder and urinary tract
Do I Need Treatment?
Not every patient who is diagnosed with BPH requires treatment. The severity of the condition guides the physician in recommending an appropriate treatment course. For some patients, observation is all that is needed.
What Treatments are Available for Enlarged Prostate?
Initial treatment for most patients consists of different medications. There are also minimally invasive outpatient surgical treatments that can relieve BPH symptoms long term, such as UroLift for BPH, Greenlight™ PVP (photovaporization of the prostate) and transurethral vaporization of the prostate (TUVP). Less commonly used surgical treatments include transurethral resection of the prostate (TURP) or a simple prostatectomy.
What Medications are Used to Treat BPH?
Initial treatment for most patients takes the form of medications. There are three main classes of medications: alpha blockers, alpha reductase inhibitors (ARIs), or the phosphodiesterase inhibitor (PDE5I), tadalafil (Cialis).
Alpha blockers include tamsulosin (Flomax), silodosin (Rapaflo), alfuzosin (Uroxatral), terazosin, and doxazosin. These drugs relax the smooth muscle of the prostate and bladder neck to help relieve symptoms. Side effects can include headache, dizziness, and retrograde ejaculation.
Alpha reductase inhibitors include finasteride (Proscar) and dutasteride (Avodart). These drugs act on the prostate cells to shrink the prostate, though they take months or longer to work. There is some emerging evidence that they can reduce a man’s risk of prostate cancer if taken long term. Side effects include erectile dysfunction, decreased libido and decreased volume of semen.
More recently, the PDE5I tadalafil (Cialis) has been approved for BPH related symptoms. The exact mechanism of this drug on the prostate or bladder is not yet known; it is most commonly used to treat erectile dysfunction. For patients who suffer from both ED and BPH, this drug may be helpful. Side effects may include headache, flushing, and lower back pain.
In some cases a combination of medications are used.
Laser Treatment of BPH
The emerging gold standard for surgical treatment of BPH is a minimally invasive treatment commonly referred to as Greenlight™ PVP or TUVP.