Prostate Gland Enlargement-A New Minimally Invasive FDA Approved Treatment

Most men experience benign enlargement of the prostate gland that causes symptoms of difficulty with urination, dribbling after urination and getting up multiple times at night to urinate. All of these symptoms can impact a man’s quality of life.
Enlargement of the prostate gland occurs naturally as men age. Unfortunately, this process can press on the urethra and result in some frustrating side effects including urination and bladder problems. The good news is that an enlarged prostate is benign (not cancerous) nor will it increase your risk of prostate cancer; for these reasons it is often referred to as benign prostatic hyperplasia (BPH) or benign prostatic hypertrophy.

The exact cause of BPH is unknown; however, a common hypothesis points to changes in the balance of the sex hormones during the aging process. The testicles may also play an important role in prostate growth: for example, men who have had their testicles removed (i.e. as a result of testicular cancer) do not develop BPH. Furthermore, men who have their testicles removed after having developed BPH will experience a decrease in prostate size.
Medications

Prescription drugs are typically the first line of treatment for BPH. Alpha blockers are typically associated with high blood pressure, but in the case of BPH, act by relaxing the muscles in both the bladder neck and prostate, resulting in effortless urination. The effects of alpha blockers are typically seen very quickly (in about a day or two). Some well-known examples are drugs like Rapaflo or Flomax.

Another set of medications, 5 alpha reductase inhibitors, reduce the size of the prostate, thus reducing the pressure on the urethra. Examples of these are Avodart or Proscar. Often, improvements are not seen for a couple of weeks or even months. Common side effects include decreased sex drive and erectile dysfuction. Combination therapy of alpha blockers and 5 alpha reductase inhibitors can be more effective than either drug alone. Antibiotics may also be prescribed to treat prostatitis (prostate inflammation) which can accompany BPH.

Minimally Invasive Procedures
GreenLight Laser uses a high-powered laser combined with fiber optics to vaporize the overgrowth of prostate cells quickly and accurately. The heat of the laser also cauterizes blood vessels, resulting in minimal bleeding. It is an out-patient procedure that involves catheterization for about two days. Stents can be placed in the urethra to help keep it open and allow urine to flow easier. These stents must be replaced every four to six weeks, and as such, are not considered a long term treatment option.

Now a new treatment, the Urolift, has been approved by the FDA and is a minimally invasive treatment that can be done in the doctor’s office under a local anesthetic with immediate results after a 20-30 minute procedure. The procedure consists of inserting two to four implants that opens the urethra directly by retracting the obstructing prostatic lobes without cutting, heating, or removing prostate tissue. The implants pushes aside the obstructive prostate lobes like opening window curtains. Small permanent UroLift implants are deployed, holding the lobes in the retracted position, and thus opening the urethra while leaving the prostate intact. Patients report marked improvement in symptoms immediately after the procedure. There is no problems with erections after the procedure.

Prostate, shown in yellow, with blockage of the urethra

4 pins in the prostate open the gland and allow improvement in urinary symptoms

Surgical Procedures
If medications are not effective, or if your prostate is too large, surgical intervention may be necessary. Transurethral resection of the prostate (TURP), or the modified Button TURP, involves the removal of portions of prostate which block urine flow. Hospital stay is typically one day with a two-day catheterization. Reserved for those with unbearable BPH symptoms and extremely large prostates, prostatectomy is the complete removal of the prostate gland. It is more invasive than either TURP or GreenLight Laser, and usually has a higher risk of complications and side effects and requires a longer catheterization. For these reasons, prostatectomies are typically not recommended for those with BPH, but rather the go to surgical intervention for men diagnosed with prostate cancer.
Bottom Line: Prostate enlargement affects nearly 14 million American men mostly after age 50. There are many treatment options available for BPH: medications, minimally-invasive procedures and surgery. Which treatment option is best for you depends on your overall treatment goals, the size of your prostate, your symptoms, your age, and your overall health. Make sure you speak with your doctor about the different treatment options; your doctor will recommend treatments based on your symptoms and treatment goals.