ENLARGED PROSTATE (BPH)
The prostate gland is the male organ that produces semen, the milky-colored fluid that nourishes and transports sperm during ejaculation. It is located beneath the bladder and surrounds the urethra — the tube that drains urine from your bladder. When it becomes enlarged, the prostate gland can put pressure on your urethra and cause difficulty urinating.
For most men the prostate gland begins to enlarge in their late 40’s. As the central portion of the prostate gland grows the urinary flow may decrease and aggravating voiding symptoms such as nocturia (waking up at night to urinate), urinary frequency, urinary urgency, difficulty initiating the urine stream, difficulty emptying the bladder or straining to void may occur.
Diagnosis of BPH or prostate gland enlargement is made using a combination of pertinent urinary symptoms, digital rectal exam and occasionally other tests such as cystoscopy or ultrasound.
Treatment of BPH depends on your signs and symptoms. Treatment modalities may include medications, minimally invasive procedures or surgery.
At Urological Surgical Associates we offer an advanced comprehensive array of treatment options for BPH, including the latest laser prostate surgery.
Treatment Options:
Medications. In general oral medications for the treatment of BPH fall into two broad categories; alpha-blockers and 5-alpha reductase inhibitors. The prostate contains two separate types of tissue, muscular and glandular. Medications are designed to attack one cell type or the other. Some patients may require only one of these medications and others may require a combination.
Alpha-blockers work to relax the muscular tissue and decrease the physical pressure the prostate is placing on the urethra. The effect of these medications usually takes place with 1-3 weeks.
Terazosin (Hytrin)
Doxazosin (Cardura)
Tamsulosin (Flomax)
Alfuzosin (Uroxatral)
Silodosin (Rapaflo)
Five-alpha reductase inhibitors work on the glandular tissue. These medications actually shrink the size of the prostate gland by inhibiting the growth of the glandular tissue. The effect of these medications may take several weeks to several months.
Finasteride (Proscar)
Dutasteride (Avodart)
Minimally Invasive Procedures.These procedures are outpatient treatment modalities performed in the office. They are non-invasive and require only oral pain medications with a local anesthetic. The procedures are fast and typically have minimal to no recovery. They are designed for patients with mild to moderate urinary symptoms who would like to discontinue their oral medications
TUMT (Transurethral Microwave Therapy of the Prostate). This procedure uses heat in the form of microwave energy to safely destroy the inner portion of the enlarged prostate gland. After the patient receives mild oral anesthesia and a local anesthetic a small catheter is inserted into the urethra. A tiny internal microwave antenna inside the catheter delivers a dose of microwave energy that heats and destroys enlarged cells. You may feel some heat in the prostate and bladder area and have a strong desire to urinate. These responses usually disappear after the treatment is finished. Patients go home the same day of the procedure. It may take several weeks to notice an improvement in voiding.
Surgery. Surgery is indicated for patients with moderate to severe voiding symptoms or any patient who prefers definitive management and wishes to stop their oral medications. Thanks to the recent development of laser surgery the majority patients undergo outpatient, ambulatory surgeries. Most patients are discharged the same day of their surgery without a catheter.
Laser Prostatectomy. This new technology uses a high-energy laser therapy to destroy enlarged prostate tissue. Since the laser does not penetrate deeply it does not damage surrounding tissue. It also causes minimal to no bleeding and can be safely performed on patients maintained on blood thinners. The most common types of laser surgery are photosensitive vaporization of the prostate (PVP, GreenLight®), continuous wave 2-micron laser (RevoLix®) and holmium laser enucleation of the prostate (HoLEP). Operative times are typically less than one hour. Majority of patients are discharged the same day without a catheter. Results are excellent and most men note a dramatic improvement in their urinary symptoms almost immediately.
TURP (Transurethral Resection of Prostate). This surgery was the mainstay of BPH treatment prior to laser prostatectomy. It is still an excellent option for many patients as it has the best long term results. The procedure is performed in a hospital setting and requires either spinal or general anesthesia. A telescopic camera is inserted into the urethra. Using a small electrode enlarged prostate tissue is resected opening the channel of urine of flow. A catheter is typically left in place for 24-48 hrs.
Open Prostatectomy. This surgery is reserved for patients with an extremely large prostate gland. A small incision is made in the lower abdomen, the bladder is opened and the prostate is identified. The inner portion of the prostate is cored out establishing a wide open urethra. A hospital stay of 2-4 days is usually required.
Prostate Cancer:
The prostate is a small walnut-shaped gland in males that produces seminal fluid, the fluid that nourishes and transports sperm. Prostate cancer is one of the most common types of cancer in men, affecting about one in six men in the United States.
The diagnosis of prostate cancer is made after performing a needle prostate biopsy (TRUS BX). A prostate biopsy is indicated in men with an abnormal PSA level or an abnormal digital rectal exam (nodule detected on the surface of the prostate). Needle biopsy confirms the presence or absence of cancerous prostate cells. If prostate cancer has been detected the patient will undergo further testing to determine if the cancer is its early stages (organ confined) or advanced stages (metastatic). Treatment options vary depending on the stage of the cancer.
Treatment Options:
Radical Prostatectomy. This refers to the complete removal of the prostate gland. It is indicated for healthy men who are suspected to have organ-confined prostate cancer. Radical prostatectomy has the best long term data in terms of cancer control and cure rates. With the advent of nerve-sparing procedures, the chance of post-operative erectile dysfunction is greatly decreased. Chances of incontinence are also significantly reduced with the latest nerve sparing technique we employ here at Urological Surgical Associates. A retropubic radical prostatectomy is performed through a lower abdomen incision. The entire prostate is removed and nerves are spared. A catheter is left in place for 7-14 days. Generally a 2 day hospital stay is required. Radical prostatectomy is a very well tolerated surgery and indicated for healthy men under the age of 70.
Radioactive Seed Implantation (Brachytherapy). This treatment modality is indicated for men with organ confined disease, moderate to low grade cancer and medium to small prostate glands. Larger prostate glands can be shrunk with medications in preparation for this procedure. During this procedure 40-100 rice sized radioactive pellets are placed throughout the prostate under general anesthesia. The surgery takes approximately one hour and most patients are discharged home the same day without a catheter. The radioactive pellets continue to emit radiation and kill prostate cancer cells over the next few months.
External Beam Radiation therapy (EBRT). This treatment is indicated for men with organ confined disease or with slightly higher grade cancer without metastasis. It is often used in combination with brachytherapy (seed implants) to achieve higher cure rates. External beam radiation delivers high dose x-ray radiation to the prostate to kill the cancerous cells. It is generally performed 5 days a week for 8 weeks. Each radiation treatment takes 10 minutes. No anesthesia is required and there is no pain involved. Side effects are generally mild and usually disappear after treatment is complete. Long term results are fairly comparable to radical prostatectomy.
At Urological Surgical Associates, a division of Premier Urology Group, we provide state of the art Tomotherapy®. TomoTherapy® is an all in one machine that brings greater accuracy to the treatment of prostate cancer. It provides unparalleled precision minimizing damage to the surrounding healthy tissue. It utilizes state of the art 360º helical radiation combined with CT imaging guidance. TomoTherapy® treatments are completely painless, more effective and a more efficient radiation process
Hormone Therapy. This treatment can be used alone in patients with advanced stages of prostate cancer or in combination with either EBRT or Seed implantation to achieve better cure rates. It can also be used to shrink the size of prostate glands prior to other therapies. Hormone therapy stops the production of testosterone in your body. Testosterone is known to stimulate the growth of prostate cancer cells. The hormones, known as luteinizing hormone-releasing hormone (LH-RH) agonists, chemically block the production of testosterone and retard the growth of cancer cells. The hormones do not kill the prostate cancer cells only slow their growth. They are administered as injections every 1,3,4 or 6 months.
Chemotherapy. This treatment modality is reserved for men with advanced prostate cancer who are not responding to hormone therapy or have developed a resistance to hormone therapy. This therapy is usually administered under the supervision of an oncologist.
Watchful Waiting. Watchful waiting is also known as expectant therapy or deferred therapy. With the advent of PSA more and more men are being diagnosed with very early, low grade prostate cancers. Since some of these cancers will never progress to clinically significant cancers some men opt for watchful waiting or very close observation. Typically these men are seen in the office at least every 3 months. Regular follow-up blood tests, rectal exams and possibly repeat biopsies may be performed to monitor progression of the cancer.
