Treatments for Benign Prostatic Hyperplasia
Medical, Invasive, and Surgical Therapies for an Enlarged Prostate
Jun 13, 2009
Benign prostatic hyperplasia (BPH), or benign prostatic hypertrophy, is enlargement of the prostate gland due to noncancerous tissue growth. This is considered a normal process in older males that is likely related to the prostate's long-term exposure to testosterone. As a result, most men have BPH by the time they reach 85 years of age.
The prostate gland surrounds the beginning of the male urethra. When the organ enlarges, it constricts the urethra and causes symptoms such as frequent urges to urinate, difficulty with producing an adequate stream of urine, and the sensation of incomplete voiding of the bladder. Blood levels of prostate-specific antigen (PSA) may also be elevated. Given that prostate cancer can also produce these abnormalities and may occur in patients with BPH, transanal ultrasound with biopsy of the prostate is often warranted.
Once BPH has been diagnosed, a variety of treatments are available for the condition. They can be broadly categorized as medical, minimally invasive, and surgical treatments.
Medical Treatment
BPH is believed to be secondary to tension within smooth muscle and other tissues in the prostate gland. Because smooth muscle has alpha-1 adrenergic receptors, drugs that block these receptors (alpha-1 antagonists) can help relieve the symptoms of BPH. These medications include, but are not limited to, terazosin (Hytrin), doxazosin (Cardura), prazosin (Minipress), and tamsulosin (Flomax).
In addition, BPH can be treated by reducing the activity of testosterone. This is done by using finasteride (Proscar) or dutasteride (Avodart) to block 5-alpha reductase, the enzyme that converts testosterone to the more active dihydrotestosterone (DHT).
Minimally Invasive Treatment
If drug therapy is inadequate, there are various minimally invasive methods to treat BPH. Various devices can ablate, or destroy, prostate gland tissue using laser, microwave (transurethral microwave therapy, or TUMT), ultrasound (high-intensity focused ultrasound, or HIFU), radiofrequency (transurethral needle ablation, or TUNA), or electrical energy. These modalities are either accepted as standard practice (e.g., TUNA) or considered investigational (e.g., HIFU).
Other minimally invasive treatment methods include placement of a stent in the prostate and balloon dilation, both of which widen the urethra at the site of obstruction. These methods, however, are not as widely favored as others.
Surgical Treatment
As a last resort, BPH is treated with more invasive surgical methods. Transurethral incision of the prostate (TUIP) is a method that uses a knife or laser to cut into prostate tissue. This can be helpful for some patients as an alternative to transurethral resection of the prostate (TURP), which involves tissue removal but is associated with a greater risk for complications. The most invasive surgical procedure, however, is open prostatectomy, which entails removal of the prostate through a lower abdominal incision and is reserved for patients with significant enlargement of the prostate gland.
References
- eMedicine - Prostate Hyperplasia, Benign
- Urology Channel - Benign Prostatic Hyperplasia (BPH)/Enlarged Prostate Treatments
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