How is an enlarged prostate treated?
For most men, medication is usually the first treatment considered. There are two classes of medicines: alpha-blockers and 5-alpha reductase inhibitors. Which medicine is used depends on the specifics of a man’s situation. In some instances, both medicines are used simultaneously. As long as bladder function is good, approximately 75 percent of men can be managed, at least initially, with medications in a satisfactory manner. There are side effects, which occur in 5 percent to 8 percent of men from these medicines, but, in general, they are well tolerated.
Medical management does not work for all men. In addition, there is a subset of men who, for various reasons, do not want to take medications. In these settings, there are some minimally invasive procedures as well as surgical procedures that can be done to alleviate the obstruction. The “standard” operation is transurethral resection of the prostate, or TURP. In this procedure, the obstructing tissue is surgically removed from the inside of the prostate. To visualize how this is done, the prostate could be considered as an orange. During the surgery, the fruit is resected and peel is left behind leaving a wider opening for urine to pass through. This is a very effective procedure at relieving obstruction. The downside to TURP is that there are some side effects that can occur which are undesirable.
In recent years, minimally invasive surgical procedures have been developed. The advantage of these procedures is that the side effect and complication risk is decreased, but a potential disadvantage is that in many men the results are not as consistent as those with a TURP. There are options that heat the prostate either with radio frequency energy or microwave energy. The heat to the tissue shrinks the prostate and interrupts the nerve supply, which can improve symptoms in many men. In addition, many urologists now use a laser to perform vaporization of the prostate as a substitute for the standard TURP.
Men who have bothersome urinary symptoms should discuss this issue with a urologist. Some men are concerned about bringing this to the doctor’s attention for fear that they may require treatment. Many older men today remember either their father or another male relative 20 or 30 years ago who received prostate surgery and was “never the same afterward.” With modern techniques, the complications and risks of surgery are much less than in previous eras. Treatment is not something a man should fear if he is having difficulties urinating.