Treatment Options For Enlarged Prostate
For men over 50, prostate problems are common. The prostate gland is located just below the bladder and surrounds the top portion of the urethra, which is the tube that drains urine from the bladder. The prostate’s primary function is to produce the fluid that nourishes and transports sperm.
As men age, the prostate gland tends to grow larger. Benign prostatic hyperplasia, also called prostate gland enlargement, can cause uncomfortable urinary symptoms, such as blocking the flow of urine out of the bladder, or bladder, urinary tract or kidney problems. Fortunately, a wide variety of treatments are available for enlarged prostate, including medication, minimally invasive therapies and surgery.
On the next Mayo Clinic Radio program, Dr. Mitchell Humphreys, a Mayo Clinic urologist, will highlight prostate health and treatment options for benign prostatic hyperplasia. Also on the program, Dr. Francisco Lopez-Jimenez, a Mayo Clinic cardiologist, will discuss sex after a heart attack. And Dr. Bruce Levy, a Mayo Clinic orthopedic surgeon, will share how his patients’ experiences with lack of privacy during surgery led him and his wife to found a new company, COVR Medical.
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Do Supplements Help For An Enlarged Prostate
They arent as closely regulated as medicines that your doctor will prescribe. So quality, safety, and their effects can differ. As mentioned above, saw palmetto remains one of the best-known supplements to treat BPH. Here are three others:
Always speak to your doctor before starting supplements because it can cause problems mixing with prescription medicines, treatments, or tests you might need.
How Might An Enlarged Prostate Affect My Life
Having an enlarged prostate affects men in different ways. Some men can manage mild symptoms and dont need treatment. Other men find they need to stay near a toilet. This can make it difficult to work, drive, be outdoors and attend social events. If you need the toilet a lot during the night, this can affect your sleep and make you feel more tired during the day.
Some men with an enlarged prostate find their symptoms improve over time without treatment. But for most, the symptoms will stay the same or slowly start to cause more problems over time unless they have treatment.
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What Are Enlarged Prostate Treatments
There are a wide variety of strategies for getting that prostate gland back to normal, according to Dr. Ramin. In less severe cases, he notes, it may be enough to limit coffee, tea, and sodacaffeine can stimulate the bladder and increase urinary frequency, which might be putting stress on the prostate.
In slightly more advanced situations, medications like alpha blockerswhich relax muscles in your bladder and prostate to make peeing easier, and alpha reductase inhibitors, which can shrink prostate growth, may be needed.
There are also minimally invasive treatment options like microwave therapy, Dr. Ramin says. In other cases, you may need to undergo resection of the prostate through laser therapy.
For markedly enlarged prostates, patients may need a robotic subtotal prostatectomy procedure.
The best treatment option really depends on a particular patients symptoms and results of testing, says Dr. Ramin. Not every patient with enlarged prostate is created equal, and not every treatment option is a good option for all patients.
So talk to your doctor about whats right for you. Just dont ignore the issue: Untreated enlarged prostate can lead to issues like incontinence, blood in your urinedue to inflammation from straining to peeand eventually, youre at risk for kidney damage, says Dr. Ramin.
Blood In Urine/bladder Stones
A number of factors associated with enlarged prostate can cause blood in the urine: Enlarged veins in the prostate can rupture, or if youre forcing hard to urinate, that can also rupture veins. Blood in the urine can also be a sign of a UTI. Urine retention in your bladder can also cause bladder stones. These occur when urine becomes concentrated and crystallizes. They can be very painful and can further block the flow of urine. However, its unlikely that bladder stones would be the first noticeable symptom of an enlarged prostate, Dr. Linehan says.
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How Bph Is Treated
A number of medications can relieve symptoms of BPH. However, these medications may cause sexual side effects, such as ejaculation problems and erectile dysfunction.
Other nonsurgical therapies include transurethral microwave thermotherapy and water-induced thermotherapy. Both use heat to destroy prostate tissue and reduce or resolve urinary symptoms.
If medications and/or thermotherapies are unsuccessful, surgery may be recommended.
Excess prostate tissue often can be surgically removed using a transurethral approach, which does not require an outside incision.
A more traditional, open surgery, which does require an incision, may be necessary if the prostate gland is very large or when the bladder has been damaged and needs to be repaired.
Understanding The Importance Of Your Prostate
Many men do not understand what their prostate does and how it can impact their lives. The prostate is a small gland that is about the size and shape of a walnut that is located below the neck of the bladder. The urethra runs through the center of your prostate, from the bladder through the penis, letting urine flow out of the body.
Your prostate can become larger as you age, and usually begins to grow around the age of 40-50 this is a normal part of aging. Eventually, this growth can lead to Benign Prostatic Hyperplasia, better known as BPH.
As the prostate enlarges, it presses on and blocks the urethra, causing bothersome urinary symptoms such as:
- Frequent need to urinate both day and night
- Weak or slow urinary stream
- A sense that you cannot completely empty your bladder
- Difficulty or delay in starting urination
- Urgent feeling of needing to urinate
- A urinary stream that stops and starts
If you suffer from the above symptoms, you are not alone. BPH is the leading reason men visit a urologist.3
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Tips For Coping With An Enlarged Prostate
When a man reaches about age 25, his prostate begins to grow. This natural growth is called benign prostatic hyperplasia and it is the most common cause of prostate enlargement. BPH is a benign condition that does not lead to prostate cancer, though the two problems can coexist.
Although 50% to 60% of men with BPH may never develop any symptoms, others find that BPH can make life miserable. The symptoms of BPH include:
- a hesitant, interrupted, weak urine stream
- urgency, leaking, or dribbling
- a sense of incomplete emptying
- more frequent urination, especially at night.
As a result, many men seek treatment. The good news is that treatments are constantly being improved. Patients and their physicians now have more medications to choose from, so if one doesn’t do the trick, another can be prescribed. And thanks to some refinements, surgical treatments are more effective and have fewer side effects than ever before.
But there are some things men dealing with BPH can do on their own. When symptoms are not particularly bothersome, watchful waiting may be the best way to proceed. This involves regular monitoring to make sure complications aren’t developing, but no treatment. For more troubling symptoms, most doctors begin by recommending a combination of lifestyle changes and medication. Often this will be enough to relieve the worst symptoms and prevent the need for surgery
Possible Cancer Protection From Prostate Drugs
Early research suggested that 5-alpha-reductase inhibitors , a class of drugs used to treat prostate enlargement, might increase the risk of developing more aggressive prostate cancer. However, newer studies have found that not only do the drugs appear to pose no extra risk, they may even protect against prostate cancer.
For instance, research from the Prostate Cancer Prevention Trial study in 2013 showed that taking the 5-ARI finasteride for seven years could lower the chance of getting low-grade prostate cancer by 25% among men ages 55 and older. A follow-up study of almost 9,500 men, published in the Nov. 1, 2018, issue of the Journal of the National Cancer Institute, also showed that finasteride lowered the risk by a similar amount , and found the protective effect lasted for at least 16 years.
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What Are Additional Tests For Detecting Prostate Problems
If the DRE or the PSA blood test indicates a problem may exist, the health care provider may order additional tests, including urinalysis, urodynamic tests, cystoscopy, abdominal ultrasound, transrectal ultrasound with prostate biopsy, and imaging studies such as magnetic resonance imaging or computerized tomography scan.
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What Is An Enlarged Prostate
Your prostate gland is located underneath your bladder and urethra. When you pee, your bladder pushes its contents into the prostate and then into the urethra, the tube through which urine exits your body.
The opening within the prostate acts as a continence mechanism, says Dr. Ramin, so you only pee when you want to. Without your prostate, youd likely be dealing with urine leaking out of the bladder and incontinence issues.
Robotic Assisted Simple Prostatectomy
A simple prostatectomy is a procedure performed for BPH which involves removing the adenoma, or enlarged obstructing prostate tissue all at the same time. It is for men with extremely large prostate glands and differs from a radical prostatectomy, which is performed for cancer. Traditionally a simple prostatectomy is performed in an open fashion through a lower abdominal incision. This procedure can also be done minimally invasively using the DaVinci robot. One of the benefits of the robotic approach is that small veins which tend to bleed during the open operation are compressed, reducing blood loss and the need for transfusion.
What are the benefits of robotic simple prostatectomy?
- Extremely large prostates can be approached in a minimally invasive fashion eliminating the need for an open incision.
- Other benefits may include decreased pain, hospital stay, blood loss and catheterization time.
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Lifestyle And Food For Prostate Changes
Certain lifestyle changes may make all the difference in relieving symptoms of an enlarged prostate. Some guys might want to wait and see before they opt for surgery or drug therapy, and they might love the idea of natural choices first such as these:
- Limiting their caffeine and alcohol intake or avoiding it altogether.
- Making food for prostate to improve your diet.
- Avoiding drinking fluids in the evening.
- Trying to urinate at least every 3 hours.
Are There Any Risks And Side Effects To Prostate Massages
The anal mucosa and the anus itself are very sensitive,” Hong explains. Although the anus is built to stretch to a certain extent, it doesnt self-lubricate, meaning without proper precautions anal stimulation can cause pain and tearing . This means that its super important for everyone involved to prepare for giving and receiving a prostate massage . Its also worth mentioning that this might feel a bit uncomfortable at first. As SELF previously reported, making sure youre getting in sufficient amounts of foreplay is a big part of lowering the odds that youll deal with things like pain and tearing.
Large Prostate With Significant Symptoms
For patients who have moderate or severe symptoms that have failed medical therapy from very enlarged prostates, the optimal treatment is often surgery. For very enlarged prostates, there are four main surgical options:
Results Of Enlarged Prostate Surgery
Most men who have prostate surgery have improvement in urine flow rates and symptoms. But as mentioned earlier, there are risks which should not be discounted. Possible complications include impotence, urinary incontinence, retrograde ejaculation , infertility, and urethral stricture . So make sure your urologist explains them to you clearly, so that you can make a proper judgment on the best treatment for your enlarged prostate – after all, you, not he, will live with the results.
Signs You Should See A Urologist
An enlarged prostate obstructs the bladder opening and can lead to a myriad of bothersome urinary symptoms. Symptoms of BPH include frequent urination, a weak or slow urine stream, incomplete bladder emptying, difficulty or delay in starting urination and a urine stream that stops and starts. Its important to see a physician if any of these problems arise or persist.
Enlarged prostate can also cause loss of productivity and sleep and, in some cases, can lead to depression. According to a survey sponsored by NeoTract, one of the most common symptoms of BPH interrupted sleep is also impacting mens partners. Sixty-four percent of women surveyed who were affected by their partners BPH symptoms said it impacts their sleep, too.
Using Medication To Reduce Symptoms
Vitamin D Deficiency: Health Complications
Additionally, vitamin D deficiency can increase cardiovascular risk factors. Some of them increases the risk of BPH. These parameters are inversely related to prostate volume. In other words, as obesity or hypertension becomes worse, the prostate gland tends to increase.
Another vitamin D deficiency risk that causes prostate enlargement is oxidative stress. In an environment with excess free radicals, the structures of the molecules start to change. The prostate tissue undergoes changes as well and starts to grow in response.
Thats why a recent study evaluated all of these associations, and the authors gave their opinion. They suggest that vitamin D deficiency counts as an independent risk factor for BPH. In other words, you can have normal health, but vitamin D deficiency alone will cause BPH. The authors of this study published in the journal Urology recommend vitamin D as a therapeutic target and a potential marker of BPH .
Similarly, other studies have evaluated the effect of vitamin D levels in the incidence of prostate cancer. The authors report that vitamin D levels are lower in patients with BPH. However, they are still lower in patients with prostate cancer. As vitamin D levels were reduced, the Gleason score and the aggressiveness of cancer increased .
Turp / Greenlight Pvp Laser / Thermotherapy
Transurethral resection of the prostate has long been the mainstay of enlarged prostate surgery, but less invasive alternatives are now available, with the potential for equal results. With TURP, the obstructing portion of the enlarged prostate tissue is removed. Although effective, TURP requires hospitalization and catheterization for 48 hours or more and comes with risks associated with anesthesia bleeding during and after the operation and, in rare cases, fluid absorption that can be life-threatening.
Prostate LaserOne alternative that has emerged is laser enlarged prostate surgery. Like TURP, the so-called GreenLight PVP Laser Therapy aims to create a channel in the urethra through which men can urinate more freely but the surgery is considerably less invasive. Instead of cutting tissue out, the newer technique creates the channel by vaporizing the tissue using laser energy. Thus far, almost every study has shown that when done by experienced urologists, the laser enlarged prostate surgery produces results that are equal to those with TURP, but without the severe side effects and risks. It is an outpatient procedure with minimal to no bleeding, no risk of fluid absorption, and catheterization only overnight, if at all.