Prostate enlargement refers to a common condition called benign prostatic hyperplasia. This condition tends to affect men beginning at age 55. It is not a precancerous condition but can be distressing for some patients. Treatment options for this condition can be classified as surgical or non-surgical.
Alpha-1 Bockers
There are two main group of drugs used in the treatment of BPH. Both relieve the symptoms of BPH but do so via different methods. The first group of drugs are called alpha-1 blockers. These drugs work by attempting to relax the muscles at the base of the bladder allowing urine to flow. Examples of these drugs are prazosin (Minipress®, Vasoflex®), terazosin (Hytrin®) and tamsulosin (Flomax®, Flomatra® Urimax®).
5-Alpha Reductase Inhibitors
A second group of drugs used to treat BPH is 5-alpha reductase inhibitors. These drugs act by inhibiting the enzyme 5-aplha reductase. This enzyme is important in the manufacture of testosterone. Testosterone is a hormone important in determining and maintaining prostate size. Examples of these drugs include finasteride(Proscar®)and dutasteride (Avodart®). These drugs, over time, shrink the size of the prostate and thus relieve the symptoms associated with an enlarged prostate.
Combination Therapy
Both groups of drugs are sometimes used together to provide even greater relief of symptoms. The study, "Medical Therapy of Prostatic Symptoms," published in the New England Journal of Medicine in 2003 was conducted on 3,047 men with BPH. The research demonstrated that combination therapy with an alpha-1 blocker and a 5-alpha reductase inhibitor was better than using either drug on its own.
Herbal Remedies
There are some herbal remedies which have been used to treat this condition, but they have not been approved by the U.S. Food and Drug Administration for this use. The Saw palmetto berry is one such herbal extract thought to be beneficial for BPH. Its proposed effects are supposedly similar to 5-alpha reductase inhibitors. Rye pollen is another herbal remedy used in BPH. Its mechanism of action is similar to that of aplha-1 blockers.
Surgical Options
The most common surgical treatment for BPH is transurethral resection of the prostate (TURP). This procedure involves the use of a small video camera passed through the urethra in the penis along with a wire loop through which an electrical current is passed allowing the surgeon to shave away pieces of prostatic tissue. This procedure can have complications including significant bleeding, urinary incontinence and possible impotence. The procedure is performed under general or regional anesthesia.
Several different devices can be used to cut away prostatic tissue but the principles of transurethral surgery remain the same irrespective of the actual method used. These include microwave therapy, heat, laser therapy and radiofrequency ablation.
Open prostatectomy is another surgical modality that can be used to treat BPH. This procedure is only done when the prostate is extremely enlarged or when there are other conditions within the bladder that also require treatment. Open surgery is performed under general or regional anesthesia via an incision in the lower abdomen. The bladder is opened and the prostate removed.
Conclusion
BPH is a common problem in men and is considered part of the aging process. Treatment options are constantly evolving.
References
- The long-term effect of doxazosin, finasteride, and combination therapy on the clinical progression of benign prostatic hyperplasia. New England Journal of Medicine. Dec 18 2003;349(25):2387-98McConnell JD, Roehrborn CG, Bautista OM, Andriole GL Jr, Dixon CM, Kusek JW.
- "Bailey & Love Short Practice of Surgery." Russel, R.C.G., Williams, N., Bulstrode, C. 2009
