Enlarged Prostate

For younger men, the prostate gland is a source of pleasure and fertility. However for men over the age of 50, the prostate gland can cause much suffering, pain, and even death. Fortunately if diagnosed early, prostate problems can be effectively treated.

The prostate gland is a walnut sized organ located at the opening of the bladder and contains a hole through which urine passes to the outside of the body through the urethra. The prostate gland functions to produce the nutrient fluid that is added to the sperm at the time of ejaculation. This article will discuss the diagnosis and management of benign enlargement of the prostate gland.

Benign enlargement of the prostate is an inevitable consequence of aging that develops in nearly half of all men over the age of 50. Though it is not known with certainty what causes this condition, most experts believe that it is related to an increase in the by-product of the male hormone testosterone which is produced in the testicles.

As men age so does their prostate. An aging prostate increases in size and as it enlarges the prostate compresses the urethra and constricts the flow of urine from the bladder to the outside of the body. The typical symptoms of benign enlargement of the prostate includes problems with urination, difficulty starting the urine stream, dribbling after urination, frequency of urination, a decrease in the force or power of the urine stream, and getting up at night to urinate. Severe or neglected cases may cause complete blockage of urination or urinary retention. This is a medical emergency and requires an immediate visit to the doctor or the emergency room.

The diagnosis of benign enlargement of the prostate gland is made by the history of progressive difficulty with urination and the physical examination. This examination requires a rectal examination and causes a minimal amount of discomfort and is not usually painful. Men over the age of 50 should have a blood test called a prostate specific antigen (PSA) to screen for prostate cancer.

The time-honored, gold standard treatment of benign enlargement of the prostate gland is either surgical removal through an incision in the lower abdomen or transurethral resection of the prostate (TURP). The latter involves inserting an instrument into the urethra without any incision. A curved wire carves a passageway through the prostate gland and removes the obstruction. Most men will require a tube or catheter for one to two days and then a four to six week period of no heavy lifting until the operation has healed. Older men who cannot endure the surgical procedure can have a wire stent or tube inserted under local anesthesia that enlarges the opening of the prostate gland and relieves the urinary symptoms.

Potency or the ability to engage in sexual intimacy is unaffected by surgery or the use of the wire stent. The only consequence of the surgical operation is that the ejaculation goes back into the bladder rather than out of the tip of the penis at the time of orgasm.

Drug therapy

There are two types of drug therapy: alpha-blockers and hormone suppressors. Alpha-blockers, such as Flomax, Uroxatrol, and Rapaflo, relax smooth muscle tissue in your prostate and outlet of the bladder, making it easier to urinate. The side effects of the alpha-blockers include dizziness and lethargy in a small number of patients. Some men will also notice that the ejaculation will decrease in volume as the semen goes back into the bladder and is expelled with in the urine at the time of the next voiding.

The hormone suppressor Proscar and Avodart actually shrinks your prostate. These drugs are referred to as 5-alpha reductase inhibitors and they suppress testosterone’s effect on the prostate tissue. The side effects of Proscar and Avodart are a decrease in the volume of the ejaculation and a decrease in the PSA value by 50%.

Now there is a combination of Avodart and Flomax called Jalyn which combines the 5-alpha reductase plus the alpha-blocker. This combination appears to have improved symptoms compared to either drug used alone.

Other Options: 

If you’re unwilling to take medications, unable to take oral medications, or reluctant or unsuited to undergo surgery alternative treatments now exist.

They include:

Microwave of the prostate gland – Now there are minimally invasive treatments that don’t require hospital admission or surgery to relieve the obstruction. Transurethral microwave of the prostate gland or TUMT reduces the enlarged prostate gland symptoms, preserves sexual function, and provides durable results. The technique uses microwaves to reduce the obstruction on the urethra by the enlarged prostate gland. Treatment can be completed within 30 minutes in the doctor’s office and requires only a local anesthesia.

In this treatment, a specially designed catheter is inserted into the prostate through the urethra. This uniquely engineered catheter is used to direct microwave energy into the prostate gland to heat and destroy the enlarged tissue. Most men report improvement in symptoms in 4-6 weeks after the procedure.

Green light laser therapy – A urologist inserts a laser fiber into your urethra via a catheter. The laser heats and destroys prostate tissue which you eliminate over time. This procedure requires hospitalization and an anesthetic. There is also the one-day surgery facility where the surgery takes place without a catheter and can resume all activities in two weeks after the procedure.

Nearly every man will experience prostate problems at some time during his life. Although these problems can significantly impact a man’s quality of life, as well as his partner’s, an annual examination and the PSA blood test are the best protection of your prostate and will ensure that it remains a gland of pleasure.

Contact our office for more information.