An enlarged prostate, also known as benign prostatic hyperplasia or BPH, involves gradual noncancerous overgrowth of the prostate gland. BPH is a common, age-dependent condition. Approximately 50 percent of men have BPH by age 60, according to the American Urological Association. BPH can encroach on the neck of the bladder and urethra, causing urinary symptoms in approximately 50 percent of men with the condition. Treatment options for an enlarged prostate range from behavioral interventions to surgery.
Watchful Waiting
Men with BPH-related urinary symptoms that don't interfere with the activities of daily living don't require medical treatment, according to the American Urological Association practice guideline for the management of BPH. Periodic physician visits are recommended to monitor for progression of symptoms that may signal the need for medical intervention
Men who opt for this approach, known as watchful waiting, may benefit from behavioral changes that may decrease urinary symptoms, the Mayo Clinic says. Limiting fluid intake in the evening can decrease the need to urinate during the night. Regularly scheduled urination times may help decrease symptoms of urinary urgency. Limited intake of caffeine and alcohol may prove useful, as these substances increase urine production and may irritate the bladder.
Alpha-Blocker Therapy
Alpha-blockers are medications that inhibit contraction of the involuntary muscle cells of the prostate. Relaxation of the prostatic muscle cells may relieve partial obstruction of the urinary bladder outlet caused by an enlarged prostate. Alpha-blockers approved by the U.S. Food and Drug Administration for the treatment of BPH include terazosin, tamsulosin, alfuzosin and doxazosin. In a 2006 review article published in "Reviews in Urology," Dr. Herbert Lepor reported that these four medications demonstrate equivalent effectiveness for the treatment of symptomatic BPH.
5-Alpha Reductase Inhibitors
5-alpha reductase inhibitors are medications that decrease the production of the hormone dihydrotestosterone, or DHT, which promotes prostate growth. By blocking the production of DHT, 5-alpha reductase inhibitors can arrest prostate growth and may partially reverse BPH over an extended period. 5-alpha reductase inhibitors approved by the FDA for the treatment of BPH include finasteride and dutasteride.
The American Urological Association says you may need six to 12 months of treatment to achieve significant symptom improvement with 5-alpha reductase inhibitor therapy. Additionally, sexual side effects may occur, including decreased sexual interest and erectile dysfunction.
Prostate Ablation Procedures
Men with BPH may opt for a procedure to reduce the size of the prostate by destroying a portion of the tissue overgrowth. The American Urological Association reports that prostate ablation options include transurethral needle ablation, transurethral microwave thermotherapy, interstitial laser coagulation and holmium laser enucleation of prostate, or HoLEP.
Surgery
Men with moderate to severe urinary symptoms associated with BPH may opt for surgical removal of the tissue overgrowth. The National Institute of Diabetes and Digestive and Kidney Diseases reports that partial removal of the prostate is most commonly accomplished with a transurethral resection of the prostate procedure, more commonly known as a TURP. The surgery is performed through a fiber-optic instrument inserted through the urethra to the prostate.
References
- American Urological Association: Benign Prostatic Hyperplasia (BPH) Treatment Options
- American Urological Association: AUA Guideline on the Management of Benign Prostatic Hyperplasia: Diagnosis and Treatment Recommendations
- "Reviews in Urology"; The Evolution of Alpha-Blockers for the Treatment of Benign Prostatic Hyperplasia; Herbert Lepor, M.D.; 2006
- National Institute of Diabetes and Digestive and Kidney Diseases: Prostate Enlargement: Benign Prostatic Hyperplasia
- Mayo Clinic: Benign Prostatic Hyperplasia (BPH) Treatment
