Treatment for an enlarged prostate depends upon the severity of the symptoms, and if the symptoms are mild or absent (asymptomatic), active treatment may not be necessary. Prostate treatment may include
- Medication or drug therapy
- Non-surgical therapies
- Surgical procedures
Drug therapy is the most commonly used method to treat moderate symptoms of prostate gland enlargement and various drugs are currently being used.
Their mode of action is to relax the muscles around the bladder neck and facilitate passage of urine. The alpha blockers that may be used are :
The alpha blockers are very effective and quick acting, and improvement of urinary flow may be noticed within a day or two. Medication is started with a low dosage and may be increased gradually, to counteract any side effects. Drug interactions, like a fall in blood pressure, may occur if used in conjunction with impotence drugs, such as sildenafil, vardenafil, and tadalafil. Alpha blockers may cause pupil disorders which may interfere with eye surgery, and postural hypotension is also a possibility.
Enzyme (5 alpha reductase) inhibitors
This class of drugs include :
These drugs act by reducing the size of the prostate gland, hence they are more effective in patients with a large prostate gland. They take longer to act than alpha blockers and improvement with urine flow may take a few months but have additional advantages in that they are effective in lowering PSA levels in the blood.
Combination drug therapy
A combination of an alpha blocker and an enzyme inhibitor taken together often gives very good results in relieving symptoms as well as preventing them from getting worse. Using a combination drug therapy works better than using a single drug in preventing the chance of developing acute urinary retention and the need for surgery.
There are various non-surgical methods of treatment to reduce the size of an enlarged prostate, which are also known as minimally invasive treatments, and the main aim of these therapies is to dilate the urethra so that urinary problems are relieved.
Transurethral microwave therapy (TUMT)
The inner portion of the enlarged prostate gland is destroyed effectively and safely by using heat in the form of microwave energy. Moderate enlargement of prostate may be treated by this method but it may take a few weeks for any improvement to be noticed. Side effects of more invasive surgery, such as impotence, incontinence, and retrograde ejaculation (semen flowing back into the bladder during ejaculation instead of coming out through the penis) are relatively uncommon with TUMT, but painful urination and hematuria may occur during the recovery period.
Transurethral needle ablation (TUNA)
In this method, heat is used in the form of radio waves to destroy portions of the prostate gland causing urethral compression and subsequent urinary outflow problems. This procedure has no advantages over traditional surgery in relieving urinary symptoms and results are not too satisfactory with a large prostate. Side effects such as urinary retention, hematuria, and painful urination may occur.
Interstitial laser therapy (ILT)
Laser energy is used to destroy the growth of prostate tissue in an enlarged prostate. This procedure is used less frequently than TUMT or TUNA. Incontinence or impotency is rare with this form of treatment.
A tiny metal coil or stent is inserted into the urethra to keep it dilated so that urine flow is normal. Stents have not become a very popular form of treatment for BPH since, apart from being expensive, symptoms are not always relieved and painful urination and recurrent urinary tract infections are quite common. They are sometimes used in patients who are not fit candidates for medical or surgical treatment.
Although surgical treatment gives the best results for relief of symptoms in a patient with benign hyperplasia of the prostate, many patients do not opt for it since alternatives in the form of medicines and non-surgical therapies are available. Surgery, however, is indicated if the symptoms are severe or if there are complications such as :
- Recurrent urinary tract infection.
- Bladder calculus (stones).
- Hematuria (blood in the urine).
- Frequent episodes of retention of urine.
- Retention of urine leading to renal (kidney) damage.
There are a number of surgical procedures for prostate enlargement and different techniques may be employed based on your surgeon’s discretion, your medical history, pre-existing medical conditions and cost considerations.
Transurethral Resection of the Prostate (TURP)
This procedure is performed under general anesthesia or spinal anesthesia and a hospital stay of one to three days after surgery may be necessary. By means of an instrument called the resectoscope, which is passed through the urethra, the overgrowth of prostate tissue is scraped off by tiny cutting instruments.
This form of surgery gives the best results, with quick relief of symptoms, but there may be temporary loss of bladder control and impotence, which are both reversible within a few weeks or months. Retrograde ejaculation may also be a side effect of surgery, but on the whole, complications associated with surgery are not very common.
Transurethral Incision of the Prostate (TUIP)
This procedure is undertaken in patients with moderately enlarged prostate gland and overnight hospital stay is not necessary. Although the side effects associated with this procedure are less, relief of symptoms such as improvement of urinary flow may not be satisfactory and the procedure may need to be repeated.
In TUIP, instruments are passed through the urethra as in TURP, but prostate tissue is not removed. One or two incisions are made over the prostate gland, which help to enlarge the urethral opening, thus facilitating urination.
In this procedure, a high energy laser is used to destroy excess prostatic tissue. Two types of laser surgery are popular :
- Photosensitive vaporization of the prostate (PVP)
- Holmium laser enucleation of the prostate (HoLEP)
This procedure is done under general or spinal anesthesia and overnight hospital stay may or may not be necessary, depending upon the type of surgery. Immediate relief of symptoms and quick recovery are the advantages of laser surgery but retrograde ejaculation may occur and long term efficacy of this form of treatment is not clear as yet.
Open prostatectomy is performed, with the patient being under general, by making an incision in the lower abdomen and removing the inner portion of the prostate while leaving the outer portion as it is. Two to three days or an even longer hospital stay may be necessary after surgery, and complications, though similar to those of TURP, may be more severe. This type of surgery is indicated only if the prostate is very large or if there are other complicating features such as bladder damage, bladder calculus, or urethral strictures.