Treatment Options for Enlarged Prostate (BPH)

Benign Prostatic Hyperplasia (BPH), also known as an enlarged prostate, is a common condition that affects men as they age. In fact, 50 percent of men ages 50 or older may have symptoms. That percentage increases by 10 with each additional decade of life: 60 percent of men in their 60s, 70 percent of men in their 70s, etc.

As its name implies, it is not cancerous. However, the symptoms associated with an enlarged prostate can significantly impact a man’s quality of life. 

Symptoms of BPH

There is currently no test for an enlarged prostate. A diagnosis is based on the symptoms, which may include:

• Frequent or urgent need to urinate.
• Slow or weak urinary stream.
• Feeling as if your bladder is not completely empty.
• Difficulty or delay when starting to urinate. 
• Urinary stream that starts and stops.

Treatment Options for BPH

When a man is diagnosed with BPH, treatment options include medications, minimally invasive procedures, and surgery. Treatment is based on an individual’s symptoms, prostate size, age, and tolerance of potential side effects of treatment. 

Your doctor can discuss these options with you and together, you can develop a treatment plan that is right for you and your unique needs. 

Medications for BPH

Medications are often the first treatment for BPH. There are two types of medications that may be prescribed. 

• Alpha-Blockers: This type of medication relaxes the muscles in the prostate and bladder neck, which helps urine flow better. Tamsulosin and alfuzosin are common alpha blockers often used as the first line of defense against BPH symptoms. They can provide relief for many individuals.
• 5-Alpha Reductase Inhibitors: These medications target the hormones (dihydrotestosterone) that cause the prostate to grow. Finasteride and dutasteride are common examples of these medications, which slow the growth of the prostate and improve urinary symptoms over time.
• Combination Therapy: In some cases, your physician may prescribe a combination of alpha-blockers and 5-alpha reductase inhibitors for a combined effect, offering both immediate relief and long-term benefits.

While medications can be effective in treating an enlarged prostate, some individuals may not be able to tolerate their side effects. Those may include lightheadedness, dry mouth, low blood pressure, falls, headaches, erectile dysfunction, retrograde ejaculation, reduced libido, nausea, or vomiting. If these occur and become burdensome, talk to your doctor so other treatment options can be explored.

Minimally Invasive Procedures for BPH

Beyond medications, there are several minimally invasive procedures that can treat the symptoms of BPH. They include:

• iTind: The iTind procedure is one of the newest treatment options for BPH. This non-surgical approach uses a temporary stent to increase space in the prostate gently and gradually for urine flow, while preserving sexual function. Men will notice improvements in urine flow within five to seven days. The stent is then easily removed during an office visit with the surgeon, allowing for a swift return to normal activities. 
• UroLift: This outpatient procedure uses suture-like implants to move prostate tissue that blocks urine flow, without any cutting, heating, removal of tissue, or sexual dysfunction. Patients resume normal urinary function and daily routines within about one week. 
• GreenLight laser prostatectomy: This minimally invasive laser procedure is highly effective in removing prostate tissue that is blocking the flow of urine. It is performed on an outpatient basis.
• Thulium Fiber Laser Enucleation (ThuLEP): ThuLEP is another option that uses a high-powered laser to remove prostate tissue that is obstructing the flow of urine. Without any incisions, this procedure is ideal for men with large prostate size but equally as effective for smaller size prostates.

Surgical Options for BPH

When medications or minimally invasive procedures are not effective in relieving a man’s BPH symptoms, surgical options are also available. 

• Transurethral resection of the prostate (TURP): This traditional surgical approach uses an electrically charged wire loop to remove excess prostate tissue that is blocking urine flow. It may be performed on an outpatient basis or may include an overnight stay in the hospital. While effective, it may require a longer recovery period compared to minimally invasive procedures.
• Robotic simple prostatectomy: For men with an extremely enlarged prostate, significant obstruction, or urinary retention concerns, a robot-assisted simple prostatectomy is another option. It is a minimally invasive approach to traditional open surgery and allows for more precise removal of the inner part of the prostate. The benefits of robotic surgery include surgical incisions of one inch or less, less blood loss during surgery, reduced need for blood transfusion, less pain and discomfort, a shorter hospital stay, and faster overall recovery. The MIUI performed the first robot-assisted simple prostatectomy in New England and is one of only a few institutes to offer this treatment.
• Open Prostatectomy: In cases of extremely enlarged prostates, open prostatectomy may be recommended. This involves the removal of the obstructive tissue through a small incision in the abdomen.

You don’t have to live with an enlarged prostate and its symptoms. Selecting the most appropriate treatment for BPH involves careful consideration of individual symptoms, overall health, and personal preferences. Whether opting for medications, minimally invasive procedures, or surgery, the goal is to improve a man’s quality of life by addressing urinary symptoms and restoring normal function. 

Our team of experts at the Minimally Invasive Urology Institute (MIUI) are here to help. Learn more about the treatment options for BPH.