Treatment for an enlarged prostate

Most men stop getting taller around age 18, but after 40, they often begin growing elsewhere — particularly in their prostate gland. Benign prostatic hyperplasia (BPH), also known as an enlarged prostate, affects about 50 percent of men ages 51 to 60 and up to 90 percent of men older than 80.

As the prostate grows, it presses on the urethra, the tube that carries urine out of the body (see image). For about half of men with BPH, this causes urination problems. Common issues include a hesitant, interrupted, or weak urine stream; dribbling after urinating; a feeling the bladder does not completely empty; and more frequent urination. Some men also experience urinary tract infections or urinary incontinence, the involuntary discharge of urine.

First-line options

A combination of lifestyle changes and medication are the first-line treatments for BPH. “Cutting down on caffeine and not drinking liquids after dinner may help with the constant need to urinate, especially during the night,” says Dr. Martin Kathrins, a urologist with Harvard-affiliated Brigham and Women’s Hospital.

Three types of drugs are approved to treat BPH: alpha-blockers, such as alfuzosin (Uroxatral) and tamsulosin (Flomax); the 5-alpha-reductase inhibitors dutasteride (Avodart) and finasteride (Proscar); and the PDE5 inhibitor tadalafil (Cialis), best known as erectile dysfunction (ED) drug.

These drugs work in different ways to alleviate symptoms. Your doctor may prescribe one or several, as they work well together. For instance, alpha-blockers relax specific muscles in the prostate and bladder to improve urination, and 5-alpha-reductase inhibitors shrink the prostate, so it doesn’t push against the urethra and lower part of the bladder. Tadalafil helps relax the bladder neck (which connects the bladder to the urethra), easing the flow of urine.

Help Wanted

But lifestyle changes can only do so much, and sometimes medication does not work. “You often know if drugs help after a few months,” says Dr. Kathrins. If the problems persist, the next step is a surgical procedure. Here are two commonly recommended ones.

Transurethral resection of the prostate (TURP). TURP involves inserting a thin tube through the urethra and up to the prostate. At the end of the tube is an electrified wire loop, which scoops away prostate tissue to relieve urinary obstruction. The tissue fragments are removed with the tube. “TURP is effective in about 85% to 90% of men,” says Dr. Kathrins.

Still, TURP can have sexual side effects, such as ED or retrograde ejaculation (in which semen travels backward into the bladder rather than coming out). Other less common problems are infection and urinary incontinence.

Photoselective vaporization of the prostate (PVP). With PVP the surgeon guides a thin optic fiber through the urethra to the prostate. The fiber conducts laser energy that disintegrates excess prostate tissue, and the remnants leave the body in the urine.

The success rates for PVP are similar to TURP. One advantage to PVP is a lower risk for bleeding, which is ideal for men who take blood thinners. The downside is that since the tissues are destroyed, they can’t be examined for cancer. Also, the laser may have trouble reaching some tissue if the prostate has pushed too far into the bladder, in which case TURP is a better option. “PVP is still a relatively new procedure, so it’s not yet clear if prostate tissue will grow back after 10 years,” says Dr. Kathrins.

If you have a large prostate gland or you are interested in the most definitive therapy, your doctor may recommend a prostatectomy, in which the inner part of the gland is removed. There are several ways to do this surgery, some less invasive than others.

Minimal moves there are minimally-invasive options available for BPH, as long as your prostate gland is not too large (weighing less than 80 grams). Two popular choices are a prostatic urethral lift and water vapor thermal therapy (known by the brand name Rezum).In the prostatic urethral lift procedure, a device called a UroLift is inserted through the urethra to the prostate. It pushes obstructive tissue to the sides and delivers tiny implants that lift and hold the tissue in place so urine can flow easily. This approach doesn’t require any tissue removal, so recovery is minimal, and there are no sexual side effects. However, the effectiveness tends to wane over time. With Rezum, a thin tube is guided through the urethra to the prostate, where it shoots brief blasts of steam that kill prostate cells. This causes the enlarged tissues to gradually shrink. Rezum doesn’t appear to cause sexual side effects. Since Rezum is new, it’s unknown whether another procedure will be needed in the future.

Bible verses for today’s meditation and inspiration: Matthew E. McLaren

2 Corinthians 13:9 For we rejoice when we ourselves are weak but you are strong; this we also pray for, that you be made complete.

Colossians 1:28 We proclaim Him, admonishing every man and teaching every man with all wisdom, so that we may present every man complete in Christ.

Colossians 4:12 Epaphras, who is one of your number, a bondslave of Jesus Christ, sends you his greetings, always laboring earnestly for you in his prayers, that you may stand perfect and fully assured in all the will of God.

2 Corinthians 10:15-16 not boasting beyond our measure, that is, in other men’s labors, but with the hope that as your faith grows, we will be, within our sphere, enlarged even more by you, so as to preach the gospel even to the regions beyond you, and not to boast in what has been accomplished in the sphere of another.

2 Thessalonians 1:3 We ought always to give thanks to God for you, brethren, as is only fitting, because your faith is greatly enlarged, and the love of each one of you toward one another grows ever greater;

2 Peter 3:18 but grow in the grace and knowledge of our Lord and Savior Jesus Christ To Him be the glory, both now and to the day of eternity. Amen.

Ephesians 1:17-18 that the God of our Lord Jesus Christ, the Father of glory, may give to you a spirit of wisdom and of revelation in the knowledge of Him. I pray that the eyes of your heart may be enlightened, so that you will know what is the hope of His calling, what are the riches of the glory of His inheritance in the saints,

Ephesians 3:16-19 that He would grant you, according to the riches of His glory, to be strengthened with power through His Spirit in the inner man, so that Christ may dwell in your hearts through faith; and that you, being rooted and grounded in love, may be able to comprehend with all the saints what is the breadth and length and height and depth, read more

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