Before starting treatment for BPH, several tests will be performed to help determine that there are no other conditions contributing to your symptoms. These tests usually include:
- IPSS: This is a questionnaire that allows a urologist to assess your urinary symptoms/ LUTS objectively and provide information on the impact your symptoms have on your quality of life.
- DRE or Digital Rectal Examination is a finger examination of the prostate gland.
- Flow rate assesses how quickly urine is passed to help ascertain the presence of a blockage.
- Blood tests – including a PSA – will, however, depend on the age of the man in question and his consent to undergo the test.
- Urine tests (MSU & cytology): this excludes infection and aims to identify the presence or absence of any abnormal cells in the urine
- Ultrasound: An ultrasound gives a rough guide to the size of the prostate, how well the bladder empties and allows the kidney, bladder and connecting piping (ureters) to be looked at.
- Cystoscopy: If irritative symptoms predominate a telescopic camera test to evaluate the lining of the bladder may also be required.
If these tests confirm the presence of an enlarged prostate gland (and exclude other conditions) then treatment can be discussed. Options include:
Observation for an enlarged prostate gland is usually a possibility for men that have mild to moderate symptoms and are not particularly bothered by their symptoms. Many men that I see day to day are relieved to know that they do not have prostate cancer, and once this has been excluded they are quite happy to live with their symptoms as they currently stand.
Observation may entail follow up visits with your urologist to allow reassessment for signs of progression and to assess the severity of symptoms. At the end of the day, the aim of treating an enlarged prostate/BPH is to alleviate symptoms and to improve the quality of a man’s life. Symptoms should only be treated if they are causing a man particular bother.
Natural therapies have been used extensively to treat men with enlarged prostate glands. The most common natural remedy used for this purpose is Saw Palmetto. There are conflicting reports in the medical literature regarding the efficacy of saw palmetto for treating BPH. Some studies report that symptoms can be mildly improved with the use of this agent. A recent trial, however, has concluded that there was no improvement in symptoms amongst those men that used saw palmetto for treating BPH. The therapy, itself, has very few side-effects, which in part is why this treatment option remains popular today. Saw Palmetto is available without prescription.
There exist two common types of medication that can be used to treat men with LUTS/enlarged prostate glands. These include alpha blockers, or medication called five alpha reductase inhibitors. Alpha blockers work by relaxing the smooth-muscle in the prostate and the outlet pipe as it passes through the prostate gland. The net result is an improvement in urinary flow and a reduction in symptoms experienced by men. Alpha blockers tend to be the first port of call when choosing medical therapy to treat BPH. Alpha blockers can also relax the smooth-muscle in blood vessels. This has the potential to lower blood pressure and can make some men feel lightheaded and dizzy. Different alpha blockers affect blood vessels to a different extent. As a result, some alpha blocker medications are more prone to lowering a patient’s blood pressure than others. An alpha blocker, which is particularly specific for the renal tract is a more appropriate selection.
5 alpha reductase inhibitors, work by inhibiting the conversion of male hormone to its active form or metabolite DHT. The net result is a reduction in size of the prostate. It is also important to note that this type of medication has the ability to reduce a man’s psa value by approximately 50% after six months of use. This obviously has significant implications for a man who is undergoing serial psa testing for screening of prostate cancer. In essence the PSA must be doubled to obtain the true PSA value. Five alpha reductase inhibitors have been shown to reduce the relative risk of disease progression of BPH when combined with alpha blockers. However, the absolute reduction in risk of disease progression is not as significant. As a result, this medication although used in Australia is not widespread. The side-effects of this type of medication include sexual side effects. These include a reduction in the libido, ejaculatory disorders, and impotence.
Surgery for BPH / enlarged prostate
There are absolute and relative indications for proceeding on to surgical treatment for BPH. The absolute indications are where there have been complications from the disease. These include acute urinary retention, the formation of bladder stones, development of a bladder diverticulum (this is an acquired pocket that develops in the bladder lining as a result of long standing obstruction), recurrent urinary tract infections, and persistent prostatic bleeding that has been shown to originate purely from the prostate.
There are several different ways to surgically treat a man with BPH / enlarged prostate gland. To date, the most common way to perform this surgery has been with a TURP (transurethral resection of prostate). Although effective at improving urinary symptoms the draw-back to this operation is that there are significant potential side effects including bleeding (which can require blood transfusion), prolonged period of catheterisation and lengthy hospital stay and up to an 18% risk or erectile dysfunction.
There are other newer state of the art modalities which achieve the same goal, but use a different energy sources to remove the overgrown prostatic tissue, and thereby creating a larger channel and reduce the obstruction caused by an overgrown prostate. These newer modalities include GreenLight Laser prostatectomy.