What to Know About Enlarged Prostate

 If you’re a man of a certain age, the likelihood is high that you will be diagnosed with an enlarged prostate.

“It’s an age-related condition,” explains Ramgopal Konanur Satyanarayana, M.D., a urologist with the University of Miami Health System. “It’s prevalent for men 50 years of age and above, and more so for those older than 70-80.”

 The numbers tell the story. About one-third of men in their 50s suffer from the condition, but by the time they reach 80, most men do. This doesn’t mean all will experience issues urinating. Only 30 to 40% go on to develop symptoms that can affect their quality of life.

 Enlarged prostate is the common name for benign prostatic hyperplasia or BPH, for short. It is typically more of a discomfort than a danger but left untreated, it can cause serious health issues. Not addressing the symptoms, for example, can cause damage to the bladder or kidney, kidney stones, urinary tract infections, and a complete inability to urinate.

“This is not something that should be ignored,” Dr. Satyanarayana says. “Like other medical conditions, early diagnosis and treatment is the most effective.”

Most men know little about this walnut-shaped gland until it causes problems. The prostate rests below the bladder, but in the upper area of the urethra and, among its many responsibilities, it produces the semen fluid essential to transporting sperm.

Unfortunately, not much can be done to avoid an enlarged prostate. Like dimming eyesight and a slower gait, it is part of growing old. However, urologists know certain lifestyle habits appear to increase the risk of developing BPH at a younger age. Strong family history, eating too much red meat and fatty foods, and sedentary habits appear to increase a man’s chances of developing it early.

In younger men, the prostate size is about 25 to 30 grams.

As they age, however, that little gland grows, with an enlarged prostate potentially weighing as much as 100 grams or more. This growth leads to the narrowing of the urethra, which forces the bladder to work harder to eliminate its liquid waste.

Typical BPH symptoms include urination problems, such as hesitancy when urinating, poor stream, frequency of going (both during the day and night), leaking, and a burning sensation. Sometimes it can be the source of blood in the urine.

Dr. Satyanarayana advises men to have these symptoms checked out right away. A physician can determine if the problem is due to an enlarged prostate or another condition, such as diabetes which causes an increase in urination.  

The good news in a diagnosis? 

BPH doesn’t lead to prostate cancer, as some patients fear.

“They come into the office very fearful and thinking the worse,” Dr. Satyanarayana says of his new patients. “They think it’s cancer, but this is benign and treatable. There’s a certain relief when they hear that.”

Treatments are readily available, too — if needed, because not everyone may need them. After examining a patient and taking a thorough medical history, Dr. Satyanarayana asks: “How bothersome are the symptoms? Are they affecting your quality of life?”

If the answers are very and yes, he prescribes medications that help relax the prostate area. He also notes that they may have side effects, namely retrograde ejaculation. However, the meds “are highly effective with minimal consequences.”

But for the 20- 30% of cases where oral medication does not work or stops working, there are surgical options. 

In some instances, surgery may also be considered if the patient prefers a more permanent solution. Others at a higher risk of UTIs or other bothersome urinary symptoms not alleviated by medications may also choose surgery.

Surgery may also be recommended if complications develop due to longstanding obstructions such as stones, blood in the urine, and changes in kidney function. (The kidneys can be affected when the enlarged prostate obstructs the drainage, resulting in the case of long-term urine retention).

One of the well-known surgical options is the time-tested transurethral resection of the prostate called TURP, which is considered a gold standard. It involves scraping away part of the prostate to allow for urine flow. This is done under general anesthesia.

Alternatives to removing the obstruction caused by an enlarged prostate can also be treated using laser energy (green light laser prostatectomy and HoLEP). These are comparable in efficacy to TURP in treating patients, particularly those with associated disease conditions needing to be on blood thinners.

Robotic procedures to tackle large prostates causing obstruction and possible associated complications such as stones and diverticulitis in the bladder are the best alternative methods.

More recently, minimally invasive procedures have emerged and have been in practice for less than a decade.

One is a urethral lift, usually done in the physician’s office with local anesthesia. This entails widening the urethra to allow for a healthier urine flow.

Another includes injecting water vapor into the prostate. This procedure is called REZUM. Over time this shrinks the gland.

“There are many available and effective options,” concludes Dr. Satyanarayana. “A patient doesn’t have to go through this suffering alone or without relief.”

Ana Veciana-Suarez is a regular contributor to the University of Miami Health System. She is a renowned journalist and author who has worked at The Miami Herald, The Miami News, and The Palm Beach Post. Visit her website at anavecianasuarez.com or follow @AnaVeciana on Twitter.

Tags: bladder stones, Dr. Ramgopal Konanur Satyanarayana, improve urine flow, incision of the prostate, men with an enlarged prostate, prostate gland, prostate growth, surgical procedure, symptoms of bph, transurethral incision