Related topics: •  Prostate Health Center •  Prostatectomy, Transurethral

The prostate, a small gland that produces fluid for semen, is in an ideal position to cause trouble. The gland wraps snugly around the urethra, the tube that carries urine from the bladder. It's a tight squeeze -- and it only gets tighter as men grow older.

As men age, the prostate inevitably grows, putting more and more pressure on the urethra. For some men, this growth is too slow to ever cause any symptoms. But for most, it's only a matter of time before trouble sets in. According to the National Institutes of Health, more than half of all men in their 60s and 90 percent of men in their 70s or 80s have symptoms of an enlarged prostate, also called benign prostatic hyperplasia, benign prostatic hypertrophy, or simply BPH.

For most men, an enlarged prostate is little more than a nuisance. But in severe cases, it can completely block the flow of urine and create a medical emergency. Whether a man's condition is mild or extreme, he has many options for relief.

As the prostate begins to squeeze the urethra, emptying the bladder becomes more and more difficult. Common symptoms include the following:

•Frequent urination, especially at night

•A weak urine stream

•Stopping and starting during urination

•Leaking, dribbling

•A feeling that the bladder is never completely empty

If you're a man over 40 with the above symptoms, your doctor will immediately suspect an enlarged prostate. However, it's not the only possible diagnosis. The doctor will probably want to run a few other simple tests to rule out other conditions. A urine test can check for infection. A prostate-specific antigen (PSA) blood test combined with a digital rectal exam can help rule out prostate cancer. The digital rectal exam will also allow the doctor to feel the prostate and gauge its size.

In some cases severe symptoms appear even though the prostate is only slightly larger than normal. For this reason, your doctor may not notice any unusual swelling during the digital rectal exam. If there's doubt about the cause of symptoms, the doctor may take a closer look by inserting a cytoscope -- a narrow tube equipped with a tiny camera -- into the urethra. You may also be asked to urinate into a device that measures urine flow.

First things first: If you have symptoms of an enlarged prostate, you should see your doctor. Remember, there's a chance that your symptoms may signal something more serious. Once your doctor diagnoses your enlarged prostate, there are many things you can do to help yourself. If your symptoms are mild, these self-care steps, adapted from Mayo Clinic guidelines, may be the only treatment you need.

•You can cut down on nighttime trips to the bathroom by avoiding drinking beverages after 7 pm.

•Every time you urinate, make an extra effort to empty the bladder completely.

•Go easy on alcohol and caffeine, which increase the need to urinate.

•Avoid over-the-counter cold remedies that contain antihistamines and decongestants. Antihistamines can impair the muscles that control the opening to the bladder and the bladder itself. Decongestants can tighten muscles around the bladder, making it difficult to empty. If the cold medication contains both, it may be impossible to urinate.

•Stay active. Regular exercise can help keep urine from pooling in your bladder.

•Keep warm. When your body is cold, your bladder is more likely to retain extra urine.

In recent years, the Food and Drug Administration has approved several drugs for the treatment of enlarged prostates. One class of drugs, known as alpha-blockers, improves the flow of urine. Drugs in this category include terazosin (Hytrin), doxazosin (Cardura), and tamsulosin (Flomax). Though the FDA issued a warning in 2005 for tamsulosin. Tamsulosin may cause a pupil disorder that can complicate cataract surgery.

Another option, finasteride (Proscar), works to ease BPH by shrinking the prostate. Because it inhibits the production of PSA, which in levels higher than 2.6 nanograms per milliliters of blood is associated with prostate cancer, researchers believe finasteride may also help prevent that disease as well. In a seven-year, double-blind study of almost 19,000 men reported in the June 24, 2003 issue of the New England Journal of Medicine, researchers found that finasteride reduced the risk of prostate cancer by about 25 percent. However, not all of the results were positive. Although fewer men on finasteride developed prostate cancer than those on a placebo, those who did get the disease were more likely to develop more serious tumors, which tended to grow quickly.

Does this mean that men taking finasteride to prevent prostate problems should stop? That's a question for you and your doctor to decide, according to urologist Peter T. Scardino, head of the urology department at Memorial Sloan-Kettering Cancer Center in New York. In an editorial in the same issue of NEJM, Scardino says that the new research should not necessarily discourage men from using the drug. As long as their doctor carefully monitors them during the process, any cancer should be caught in time to cure it, Scardino says.

Doctors caution that no medication is a sure cure. Although taking these drugs usually improves symptoms, they may not be enough to bring about a return to normal. For this reason, many men eventually need more serious treatment.

According to a recent report from the National Institutes of Health, surgery is often the best option for long-term relief. In the most common procedure, a surgeon inserts a special wire down the urethra and removes a small section of the prostate. This is called transurethral resection of the prostate or TURP. The procedure only takes about 90 minutes, but most patients have to recover in the hospital for several days. The operation carries a small risk of impotence and infection.

If the prostate is extremely large, or if the bladder needs surgical repair, a surgeon may need to operate through an incision. This is a major operation, and surgeons will avoid it if possible.

Several alternatives to surgery have come along in recent years. In a procedure called transurethral microwave thermotherapy (TUMT), a doctor inserts a tube into the urethra that emits carefully aimed microwaves to destroy a section of the prostate. A similar procedure, called transurethral needle ablation (TUNA), does the same job with radio waves. Neither of these procedures is known to cause impotence. Because these methods are relatively new, their long-term effectiveness remains to be seen.

Whatever treatment your doctor recommends, be sure to get a clear explanation of the risks, benefits, and goals of the treatment. With so many options available, you and your doctor should be able to find an approach that works for you.

-- Chris Woolston, M.S., is a health and medical writer with a master's degree in biology. He is a contributing editor at Consumer Health Interactive, and was the staff writer at Hippocrates, a magazine for physicians. He has also covered science issues for Time Inc. Health, WebMD, and the Chronicle of Higher Education. His reporting on occupational health earned him an award from the northern California Society of Professional Journalists.

References

First published March 25, 2002
Last updated February 27, 2008
Copyright © 2002 Consumer Health Interactive

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