If you're a man over age 50, chances are you spend a fair amount of time running to the bathroom. Prostate enlargement-also known as benign prostatic hyperplasia (BPH)is among the most common problems men face as they age. It affects about 40% of American men in their 50s and 90% of those in their 80s.
Fortunately, BPH is not cancer, nor does it raise cancer risk. But it can cause extremely bothersome symptoms, including frequent and/ or urgent urination which can wake men at night and interfere with sleep)...a weak urine stream...and sometimes urine leakage.
Good news: An increasing number of highly effective treatments now are available for BPH. The question is, which is best for you? What you need to know…
If you're a man who is concerned about developing BPH, it's wise to focus on your diet. One recent study found diets low in fat and high in vegetables (five-plus servings daily, especially of vitamin C-rich bell peppers, cauliflower, Brussels sprouts and tomato juice) to be associated with lower BPH risk.
Millions of men who have BPH use saw palmetto, an herb, to treat the condition, but research is mixed as to its effectiveness.
When nondrug approaches don't work, medication is usually the next step. Two-thirds of all men treated with medication have shown improvement in BPH symptoms and are able to delay or avoid surgery.
Among the most widely used BPH drugs are alpha-blockers, such as terazosin (Hytrin) and tamsulosin (Flomax), which relax the prostate and bladder-wall muscles to improve urine flow...and 5-alpha reductase inhibitors, such as finasteride (Proscar) and dutasteride (Avodart)-these drugs block formation of the hormone dihydrotestosterone, which fuels prostate growth.
While both alpha-blockers and 5-alpha reductase inhibitors relieve symptoms, finasteride and dutasteride shrink the prostate and limit growth over time, leading to less risk for sudden blockage or need for surgery. If one drug type does not work well, try using both a 5-alpha reductase inhibitor and an alpha-blocker.
For men who have risk factors for prostate cancer, including a family history of the disease, the 5-alpha reductase inhibitors often are worth considering. These drugs not only treat BPH but also may lessen the risk for a prostate malignancy.
Important: Earlier studies have suggested an increase in aggressive prostate tumors among men who took 5-alpha reductase inhibitors, and subsequent research has failed to fully resolve the issue. Discuss the pros and cons of these drugs with your doctor.
Latest development: Recent research, including a 2010 Mayo Clinic study of more than 1,000 men, has shown that erectile dysfunction (ED) drugs, such as sildenafil (Viagra) and tadalafil Cialis), can improve urinary symptoms of BPH.
The combination of an ED drug with a standard medication for prostate enlargement might be helpful for men with both erection and prostate problems, but ED drugs should not replace BPH drugs.
Do You Need Surgery?
Unfortunately, there's no one medication that controls BPH for all men. Surgery can be highly effective, but many men think of it as a last resort, fearing complications such as erection problems and incontinence though these are rare).
But for some men, there are risks associated with not having surgery. For example, when the prostate gland is enlarged, the bladder may never fully empty and urine stagnates. This sets the stage for possible recurrent urinary tract infections and painful bladder stones.
Over time, the pressure of a blocked urinary tract also may damage the kidney and/or the bladder may become irreversibly stretched and unable to function properly. What's more, the larger a man's prostate, the longer, more complicated corrective surgery becomes, increasing the risk for complications.
How can a man tell if he may need surgery for BPH? Surgery is worth considering if symptoms (including slow urinary stream, urinary frequency, difficulty emptying the bladder or waking at night to urinate) persist despite taking medication for at least six months. In other cases, side effects (including dizziness from alpha-blockers and loss of sex drive from 5-alpha reductase inhibitors) keep him from taking medication properly. Surgery is also a reasonable option if a man develops signs of worsening BPH, such as urinary tract infections, bleeding or bladder stones.
Also useful to determine whether BPH requires surgery: No test provides sure answers about when to operate, but a man's responses on the International Prostate Symptom Score (IPSS) questionnaire are the most helpful. It's designed to determine the seriousness of urinary symptoms. Increasing scores over time signal worsening symptoms. Simple office tests (such as flowmetry, which measures the rate at which the bladder empties, and/or ultrasound) are useful indicators but not definitive.
The Laser Revolution
For men who do require surgery for BPH, the most significant recent change is the increasing use of laser technology, which uses extreme heat to vaporize excess tissue in the prostate.
There are several different types of laser surgery. One of the most effective is performed with a potassium-titanyl-phosphate (KTP), or green light, laser.
Clinical trials confirm that results from KTP laser surgery are comparable to those from transurethral resection of the prostate (TURP), in which the surgeon manipulates tiny instruments through the penis and urethra to remove excess tissue from the prostate.
Important recent finding: When 120 men with advanced BPH received either KTP laser surgery or TURP, they experienced an equal improvement in symptoms, but recovery was faster after laser, according to a 2010 study reported in the British Journal of Urology.
Advantages of KTP: KTP laser causes less bleeding than TURP, and the urinary catheter, generally necessary after either procedure, can be removed sooner, reducing the risk for infection. While TURP usually requires two to four days in the hospital, with KTP laser, most men can go home after an overnight stay or even the same day.
Possible complications of laser surgery include tissue regrowth, which may necessitate a repeat operation, and/or persistent urinary symptoms, such as urgency and frequency. About 2% to 3% of patients have side effects after TURP or KTP laser.
For some men, including those who take a blood-thinning drug, such as warfarin (Coumadin), laser is usually the obvious choice because it causes less blood loss.
However, the risk for problems with laser surgery is greatly increased if the surgeon is not well-qualified. If you choose laser surgery, make sure your surgeon is well-trained and performs the procedure multiple times each year.
Another option: The holmium laser. It uses a different energy source than that used for KTP laser to cut prostate overgrowth into fragments that are then ground up with a device and removed-a process that helps reduce the need for retreatment. Holmium laser surgery is effective for prostates of any size, according to a 2010 study reported in the journal Urology, and may be a particularly good choice when the prostate is large.
Caution: Unless holmium laser surgery is performed by an extremely skilled surgeon, risk for bleeding or damage to the bladder or rectum is higher than with the KTP laser or TURP. Because this type of surgery is still not widely available in this country, it may be harder to find a well-qualified surgeon. A medical center that is affiliated with an academic institution is generally the best place to find such a surgeon.
Medication for Enlarged Prostate Reduces Cancer Risk
Roughly 16% of men will be diagnosed with prostate cancer. Men who take dutasteride (Avodart) or finasteride (Proscar, Propecia) for benign enlarged prostate are 26% less likely to develop prostate cancer.
But: Men taking either drug who do develop prostate cancer are slightly more likely to have a more dangerous form of the disease.