About half the men with BPH eventually have symptoms that are bothersome enough to need treatment. BPH cannot be cured, but drugs or surgery can often relieve its symptoms. BPH symptoms do not always get worse.
There are three ways to manage BPH:
- Watchful waiting (regular follow-up with your doctor)
- Drug therapy
- Surgery (traditional and minimally invasive)
Talk with your GP about the best choice for you, or ring one of our advisors.
Watchful waiting
Men with mild symptoms of BPH who do not find them bothersome often choose this approach.
Watchful waiting means getting annual checkups. The checkups can include DREs and other tests. Treatment is started only if symptoms become too much of a problem.
- If you choose to live with symptoms, these simple steps can help:
- Limit drinking in the evening, especially drinks with alcohol or caffeine.
- Empty the bladder all the way when you pass urine.
- Use the toilet often. Don't wait for long periods without passing urine.
Some medications can make BPH symptoms worse, so talk with your doctor or pharmacist about any medicines you are taking such as:
- Over-the-counter cold and cough medicines (especially antihistamines)
- Tranquilizers
- Antidepressants
- Blood pressure medicine
HOWEVER, YOU MAY BE ON THIS MEDICATION FOR A GOOD REASON, SO YOU MUST SPEAK TO YOUR DOCTOR BEFORE STOPPING ANY MEDICATION.
Drug therapy
Many men with mild-to-moderate BPH symptoms have chosen prescription drugs over surgery since the early 1990s. However, now that men can choose minimally invasive surgical techniques with little pain and rapid recovery, the pendulum is swinging in favour of surgical treatment.
There are two main types of drugs used. One type relaxes muscles near the prostate while the other type shrinks the prostate gland. There is evidence that shows that taking both drugs together may work best to keep BPH symptoms from getting worse.
Alpha-blockers
These drugs help relax muscles near the prostate to relieve pressure and let urine flow more freely, but they don't shrink the size of the prostate. For many men, the drug can improve urine flow and reduce symptoms within days. Possible side effects include dizziness, headache, fatigue and ejaculation problems.
5 alpha-reductase inhibitor
This drug, known as finasteride, shrinks the prostate. It relieves symptoms by blocking an enzyme that acts on the male hormone, testosterone, to boost organ growth. When the enzyme is blocked, growth slows down. This helps shrink the prostate, reduce blockage, and limit the need for surgery.
Taking this drug for at least 6 months to 1 year can increase urine flow and reduce your symptoms. It seems to work best for men with very large prostates. You must continue to take the drug to prevent symptoms from coming back.
This drug is also used to treat baldness in men. It can cause these side effects in a small percentage of men:
- Decreased interest in sex
- Trouble getting or keeping an erection
- Smaller amount of semen with ejaculation
It's important to note that taking this drug can lower your PSA test levels. There is also evidence that finasteride lowers the risk of getting prostate cancer, but whether it lowers the risk of dying from prostate cancer is still unclear.
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BPH Medications
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Category
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Activity
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Generic Name
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Brand Name
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Alpha-blockers
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Relax muscles near prostate
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doxazosin
tamsulosin
terazosin
prazosin
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Cardura
Flomax
Hytrin
Minipres
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5 alphareductase inhibitor
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Slows prostate growth, shrinks prostate
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finasteride
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Proscar or Propecia
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BPH surgery
The number of prostate surgeries has gone down over the years. But operations for BPH are still one of the most common surgeries for British men. Surgery is used when symptoms are severe or drug therapy has not worked well.
Types of surgeries include:
- TURP (transurethral resection of the prostate) is the most common surgery for BPH. It accounts for 90 percent of all BPH surgeries. It takes about 90 minutes. The doctor passes an instrument through the urethra and trims away extra prostate tissue. A spinal block is used to numb the area or the procedure may be done under a general anaesthetic. Tissue is sent to the laboratory to check for prostate cancer.
TURP generally avoids the two main dangers linked to other prostate surgeries:
- Incontinence (not being able to hold in urine)
- Impotence (not being able to have an erection)
The recovery period for TURP is much shorter as well.
- TUNA (transurethral needle ablation) burns away excess prostate tissue using radio waves. It helps with urine flow, relieves symptoms, and may have fewer side effects than TURP. Most men need a catheter to drain urine for a period of time after the procedure.
- TUMT (transurethral microwave thermotherapy) uses microwaves sent through a catheter to destroy excess prostate tissue. This can be an option for men who should not have major surgery because they have other medical problems.
- TUVP (transurethral electroevaporation of the prostate) uses electrical current to vaporize prostate tissue.
- Open prostatectomy means the surgeon removes the prostate through a cut in the lower abdomen. This is done only in very rare cases when obstruction is severe, the prostate is very large, or other procedures can't be done. General or spinal anesthesia is used and a catheter remains for 3 to 7 days after the surgery. This surgery carries a higher risk of complications than medical treatment. Tissue is sent to the laboratory to check for prostate cancer.
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