Benign Prostatic Hyperplasia (BPH)/Enlarged Prostate

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Medical Treatment

There are several treatment options for men with benign prostate hyperplasia, depending on the severity of symptoms. If symptoms do not threaten the man's health, he may choose not to be treated. If symptoms are severe enough to cause discomfort, interfere with daily activities, or threaten health, treatment is usually recommended.

Watchful waiting

Men with mild symptoms may choose to return for annual examinations. The physician will perform an examination that includes a DRE, PSA tests, and a urinary flow rate. The patient will be asked to describe symptoms in order to determine if the condition is worsening.

Medication

5-Alpha reductase inhibitors such as finasteride (Proscar®) and dutasteride (Avodart®) prevent the conversion of testosterone to the hormone dihydrotestosterone (DHT). In many cases, a treatment period of 6-month is necessary to see if the therapy is going to work. These drugs are taken orally, once a day. Finasteride is available in tablet form and dutasteride is available as soft gelatin capsules. Patients should see their physician regularly to monitor side effects and adjust the dosage, if necessary.

Side effects include reduced libido, impotence, breast tenderness and enlargement, and reduced sperm count. Long-term risks and benefits have not been studied.

Women who may be pregnant must avoid handling dutasteride capsules and broken or crushed finasteride tablets because exposure to the drugs may cause serious side effects to the fetus. Intact tablets are coated to prevent absorption through the skin during normal handling. Patients should wait at least 6 months after dutasteride treatment to donate blood to prevent pregnant women from being exposed to the drug through blood transfusion.

Alpha blockers relax smooth muscle tissue in the bladder neck and prostate, which increases urinary flow. They typically are taken orally, once or twice a day.

Commonly prescribed alpha blockers include the following:

• alfuzosin (UroXatral®), extended-release tablet taken once daily
• doxazosin (Cardura®), tablet taken once daily
• prazosin (Minipress®), capsule taken 2 or 3 times daily
• tamsulosin hydrochloride (Flowmax®), capsule taken once daily
• terazosin (Hytrin®), capsule taken once daily

Patients taking an alpha blocker require follow-up during the first 3 or 4 weeks to evaluate the effect on symptoms and adjust the dosage, if necessary. Side effects include headache, dizziness, low blood pressure, fatigue, weakness, and difficulty breathing. Long-term risks and benefits have not been studied.

Prostatic stents

Although a prostatic stent is not a medical treatment, neither does it fall under the classification of a surgical procedure. Prostatic stents are used most often for patients with significant medical problems that prohibit medication or surgery. It is a tiny, springlike device inserted into the urethra. When expanded, it pushes back the surrounding tissue and widens the urethra. Prostatic stents have several advantages:

• They can be placed in less than 15 minutes under regional anesthesia.
• Bleeding during and after surgery is minimal.
• The patient can be discharged the same day or the next morning.

There are also several disadvantages:

• Prepositioning can be difficult.
• They may cause irritation and frequent urination.
• They may cause pain or incontinence.
• Removing them (necessary in one-third of cases) can be difficult.

Benign Prostatic Hyperplasia (BPH)/Enlarged Prostate, Medical Treatment reprinted with permission from urologychannel.com
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