The National Institutes of Health reports that approximately
50 percent of men aged 51Ð60 and more than 90 percent of men older than 80 will
develop BPH.
Dr. Dudley Danoff has taught on the clinical faculty of the
UCLA School of Medicine for more than twenty-five years and is the founder and
president of the Cedars-Sinai Tower Urology Medical Group in Los Angeles. He says, "Benign
prostatic hyperplasia (BPH), or the benign enlargement of the prostate, is nearly
inevitable in aging males.
Think
of the male bladder as a balloon placed neck-side down in the pelvis, and
visualize the prostate as a doughnut around the neck of the balloon. As a man
ages, the doughnut gets larger and the hole in the doughnut gets smaller,
making it more difficult to empty the balloon through urination."
Dr.
Danoff says that the most reliable method of identifying which patients need
treatment for BPH is a questionnaire developed by the American Urological
Association (AUA) that examines the condition's most prominent symptoms, which
include incomplete bladder emptying; frequency, intermittency, and urgency of
urination; weakness of the urine stream; straining during urination; and nighttime
urination. These symptoms are rated on a scale of 0 to 5. The higher the total score,
the more likely it is that a patient will need treatment for BPH.
If
you get a BPH diagnosis, here are Dr. Danoff's top ten suggestions about what
to do next:
1.
Have a complete urologic and prostate examination, which
should include a digital rectal exam and a blood screening exam that uses a prostate-specific
antigen (PSA) to test for the presence of possible prostate cancer.
2.
Get a noninvasive ultrasound to measure the amount of urine
remaining in the bladder after urination. An ultrasound can also detect
structural abnormalities in the prostate and determine the need for a biopsy.
3.
Consider watchful waiting if symptoms are mild or moderate. Progression
of symptoms is not inevitable, and some menÕs symptoms spontaneously improve or
resolve.
4.
Ask about medical treatments for BPH. A recently developed class
of drugs called alpha blockers has been widely and safely used for a number of
years to relieve the symptoms of BPH. In general, they relax the neck of the
bladder (widening the hole in the doughnut) to allow more complete emptying.
5.
Find out about shrinking the prostate. Another class of
drugs called 5-alpha-reductase inhibitors affects the cells of the prostate,
reducing the size of the gland and improving symptoms. This treatment usually
takes six months and may cause side effects like erectile dysfunction,
decreased libido, enlarged breast tissue, and ejaculation problems.
6.
Consider combination therapy. The combination of tamsulosin
(an alpha blocker) and finasteride (a 5-alpha-reductase inhibitor) has been
shown to decrease AUA symptom scores and increase urinary flow rates significantly
greater than the use of either drug alone. Over the last several years, combination
therapy has vastly decreased the need for surgical intervention in the
treatment of BPH.
7.
Learn about phytotherapy, a class
of treatment using plants or plant extracts for medicinal purposes. The use of
phytotherapy for BPH is popular in Europe, and enthusiasm for this treatment is
growing in the United States. Although some studies have noted improvements in
symptom scores and flow rates, others show no benefit beyond placebo, so use phytotherapy
with caution.
8.
Consider a transurethral resection of the prostate (TURP) if
symptoms are severe and other therapies have failed. To visualize what a TURP
is, think of a plumber unclogging a pipe. Most TURP procedures use spinal
anesthesia, require no incision and only a brief hospital stay, preserve
continence and potency, and produce results superior to that of any other minimally
invasive therapy. Possible complications include retrograde ejaculation (semen
entering the bladder) and stricture (the formation of scar tissue).
9.
Research other minimally invasive procedures that open the
urinary channel by destroying prostate tissue. Though not as effective as TURP,
these procedures do not require an incision and may reduce complications. They
include laser therapy, transurethral electrovaporization, hyperthermia, transurethral
needle ablation, high-intensity focused ultrasound, and intraurethral stents.
10. Most
importantly, get an annual prostate examination after age 40. This is
especially true if prostate cancer runs in your familyÑa man is 30 percent more
likely to develop prostate cancer if a relative had the disease. Approximately
one in seven men will develop prostate cancer in his lifetime, and 240,000
cases of prostate cancer will be diagnosed this year in the United States
alone.
The
options described above will help every patient with BPH symptoms make an
intelligent treatment choice in consultation with his physician. The right treatment
can dramatically improve a patientÕs quality of life with minimal side effects,
and several minimally invasive treatment options can improve symptoms while preserving
potency and continence.
