The prostate normally enlarges as men age, although occasionally a younger patient will have an enlarged prostate. Symptoms of an enlarged prostate include: increased urinary frequency, urgency, hesitancy, decrease in the size and force of the stream, dribbling at the end of urination, and waking up at night to urinate more frequently.
The diagnosis of an enlarged prostate is made by a combination of patient symptoms and physical examination. Rectal examination can determine size, shape, and consistency of the prostate. Frequently, a bedside bladder scanner is used to determine the amount of urine left in the bladder after voiding. Electronic uroflowmetry may also be used to measure the flow rate of the urine. A PSA (prostate specific antigen) may be ordered to check for cancer, but an enlarged prostate does not increase the risk of having prostate cancer.
Once it is determined that a patient may have BPH, a cystoscopy may be ordered. A flexible scope is inserted into the urethra through the penis and advanced into the prostate and then into the bladder. The size and shape of the prostate, as well as any bladder changes which may be due to an enlarged prostate, are determined.
There are several options for treatment of an enlarged prostate depending on the severity of the symptoms, the ability to empty the bladder, and the cystoscopic findings. Medical treatments fall into two general categories. The first is a medication to shrink the prostate. The two medications in this category include proscar and avodart. Although this, indeed, shrinks the prostate to some degree over a period of time, the symptoms do not always resolve. Side effects include decreased volume of semen, small risk of impotence, and the need for lifelong medication. The second class of medications is a highly specific type of smooth muscle relaxant called alpha-blockers, which relax the muscles of the bladder neck and within the prostate. The effects are usually realized within a couple weeks of initiation of therapy. Side effects of these medications include possible decrease in blood pressure, dizziness, sinus pressure, and retrograde ejaculation (absence of semen with climax). Again, the medication must be taken lifelong.
Surgical therapies all have in common the removal or destruction of the inner core of the prostate which is causing the obstruction or symptoms. These include microwave therapy, laser vaporization, and TURP.
Microwave therapy, called TUMT (Trans Urethral Microwave Therapy) is an office based procedure which takes about 45 minutes. A patient takes an oral sedative. A specially designed catheter is placed into the bladder which has a microwave antenna embedded within it. The inner core of the prostate, excluding the urethra which is cooled, is heated and killed. The patient is sent home usually without a catheter. Over the next 6-8 weeks, the prostate shrinks and the symptoms resolve. It is a very safe procedure with very few side effects.
The laser and the TURP (Trans Urethral Resection of the Prostate) both use heat energy to remove the inner core of the prostate. With the laser, light energy is used to vaporize the prostate, whereas in the TURP electric energy is used to remove strips of the prostate from the inner core. The latter has the advantage of obtaining tissue to submit for pathology. The results of both are excellent, but both require anesthesia to perform. The laser is performed in the office under a local anesthesia and the TURP is done in the hospital under general anesthesia. Side effects of these include: bleeding, retrograde ejaculation, impotence, and possible urethral scarring (strictures).
The choice of procedures would be discussed to determine the treatment based on the urologic findings and patient preference. All questions are answered once the diagnosis is made and before any treatment is scheduled.