The treatment for BPH is based on how bothered you are with the severity of your urinary difficulty. Many men can live with their urinary symptoms and no treatment is warranted.
However, for men who are frustrated with their urinary symptoms, drug therapy may be warranted. There are two types of medications that have been shown to be very effective for the treatment of BPH.
Alpha-blockers: (common names: tamsulosin – Flomax, alfusozin – Xatral, silodisin – Rapaflo) This class of medication causes the muscles within the prostate gland to relax. This can relieve the blockage caused by the prostate and improve the flow and emptying of urine. Side effects include a sudden drop in your blood pressure causing dizziness and light-headedness (particularly when getting up to stand), retrograde ejaculation (your semen goes into the bladder during orgasm and not out the normal way), back and joint pain and stuffy nose. It can also effect the pupils in your eye and you cannot take this drug if you are planning eye surgery. This medication must be taken on a continual basis – that is, you must take it for life. If you stop, your urinary symptoms will return.
5-alpha reductase inhibitors (common names: finasteride – Proscar, dutasteride – Avodart) This class of medication reduces the production of an active testosterone-type hormone, called dihydrotestosterone which causes the actual size of the prostate to shrink in size. These drugs take time for it to take effect. It can take up to 6 months. Clinical trials have also proven this drug to be effective in relieving urinary symptoms and may be used in combination with an alpha-blocker drug (that is, you may be prescribed both). Side effects include impotence, loss of interest in sex (reduced libido), abnormal ejaculation, and increased breast size or tenderness. These are due to the hormonal changes the drug causes on the prostate gland. These drugs also reduce your PSA level and they needed to be monitored by your prescribing physician at least every 6 months. They have also been evaluated to determine whether they can prevent the development of prostate cancer. Although finasteride has been proven to reduce rates of prostate cancer, the ones that do develop may be more aggressive in form. As such, physicians generally do not use these drugs to prevent prostate cancer. In fact, men should not be on this drug indefinitely for this reason and its use should be monitored by your prescribing physician.
When medications become ineffective and urinary symptoms continue to get worse, surgery on the prostate gland may be warranted. Sometimes, surgery is offered right away, before the use of medication. This can occur if the urinary blockage causes an impairment in kidney function, if there are recurring urinary infections, if there is recurring bleeding from the prostate gland, if there recurring urinary retention requiring catheters, or if there are significant bladder stones that form from the urine that is always left behind from incomplete bladder emptying.
The gold standard of surgery is a procedure called Transurethral Resection of the Prostate (TURP). This procedure requires a general anesthetic and requires one or two days stay in the hospital. It is done through the urinary channel (urethra) and no surgical incision is necessary. The inner blockage of the prostate is then removed using a device that shaves off the part of the prostate that blocks the urinary passage using electrocautery methods. Short-term side effects may include excessive bleeding (requiring blood transfusions), electrolyte abnormalities (requiring prolonged hospital stay and can even cause seizures), and a temporary inability to urinate (requiring a catheter). Long-term side effects from TURP include permanent urinary incontinence (leakage of urine) or erectile dysfunction (impotence). It will also cause permanent retrograde /abnormal ejaculation.
Another surgical procedure called a Green-light laser TURP may be offered. This procedure uses laser technology to remove the blockage from the prostate gland, rather than electrocautery. The procedure offers less hospital stay, less bleeding and other short-term complications compared to TURP. The long-term complications remain similar to TURP. Consult with your specialist to determine which treatment would be best for you.
Minimally Invasive Techniques
For patients who do not wish to take medications and do not want to undergo a TURP, a new treatment called REZUM may be an appropriate option.
REZUM works by inserting sterile water vapour (steam) into the prostate gland in a very focal and precise way. This removes the blockage within the prostate gland, allowing an improvement in urine flow. This technique avoids the short- and long-term side effects of TURP and the Green Light Laser TURP. No medications will be required. The procedure is performed in a clinic, outpatient setting and does not require any hospital stay.
Prostaterisk.ca now offers a new, non-invasive procedure called REZUM to treat men with BPH.