If you have an enlarged prostate, your treatment plan will be determined by how severe your symptoms are.
If your symptoms are mild to moderate, you will receive no immediate medical treatment but will be given regular check-ups to carefully monitor your prostate. This is often referred to as "watchful waiting".
You will probably also be advised to make changes to your lifestyle to see if they improve your symptoms. These lifestyle changes are explained below, along with the training and treatments than can later be tried, if necessary.
Lifestyle changes
You may be advised to:
- Stop drinking any liquids for one to two hours before going to bed. This will help to prevent nocturia (waking up during the night to pass urine).
- If you've been prescribed medication (see below), experiment with the time you take this. For example, taking it at 7pm may help prevent nocturia.
- Stop drinking alcohol and caffeine, or limit your consumption of them. They can irritate your bladder and make your symptoms worse.
- Exercise regularly. Research has shown that moderate exercise, such as walking for 30 to 60 minutes a day, can improve symptoms (although it is unclear exactly why this is).
- Join a patient support group (your doctor should be able to recommend one), which may help you manage mild symptoms without the need for medication.
Bladder training
Bladder training is an exercise programme to increase the time between urination and to increase the amount of urine your bladder can hold.
You will be given a target, such as waiting for at least two hours between each time you urinate. It's a good idea to use a bladder training chart, which allows you to record each time you pass urine and record the volume of urine passed (you'll need a plastic jug to measure this). Your doctor should give you a chart to take home.
You will also be taught a number of exercises, such as breathing, relaxation and muscle exercises, to help take your mind off the need to urinate.
Over time, your target time will be increased and at the end of the programme you should find that you are able to go for longer without urinating.
Bladder training should only be tried under medical supervision.
Medication
Medication, in combination with the lifestyle changes above, is usually recommended to treat moderate to severe symptoms of prostate enlargement.
Finasteride or dutasteride
Finasteride and dutasteride are widely used to treat prostate enlargement. They block the effects of a hormone called DHT (see causes of prostate enlargement) on the prostate gland, which can reduce the size of the prostate and improve your associated symptoms.
If you are prescribed one of these medications, you may experience an immediate improvement in symptoms. However, you'll need to take it for at least six months to get the maximum benefit, and your doctor will need to monitor you every year.
Use condoms if you are sexually active, because if a man with prostate enlargement impregnates a woman, there is a risk that the baby could develop birth defects.
Side effects include:
- impotence (inability to get an erection)
- little or no sperm when you ejaculate
In many cases, these side effects will improve as your body gets used to the medication. See your GP if the side effects are troubling you.
Research has shown that the long-term use of finasteride or dutasteride have both benefits and risks in relation to prostate cancer.
The benefit is that taking the medication will lower your risk of getting prostate cancer. The risk is that if you do develop prostate cancer, it may be a more aggressive form of cancer.
Your GP can give you more information about the risks and benefits of finasteride.
Alpha blockers
Alpha blockers help relax the muscles of your bladder, making it easier to pass urine.
You may be given alpha blockers as your primary treatment or in combination with finasteride.
Tamsulosin and alfuzosin are two alpha blockers commonly used to treat prostate enlargement. Side effects of tamsulosin and alfuzosin are uncommon and usually mild. They include:
- dizziness
- headaches
- weakness
- little or no sperm when you ejaculate
You should only begin taking alpha blockers over a restful weekend when you're not planning to drive, as there's a risk these could cause low blood pressure and fainting.
Generally, if you experience dizziness while on this medication, avoid driving or operating heavy machinery until it has passed.
Insertion of a stent
If you are not responding to medical treatment and are not ready or fit for surgery, a Memokath stent can be inserted into your urethra (tube through which urine passes) to help you urinate more easily and to relieve your symptoms. This is done using a local anaesthetic, and you can go home the same day.
A Memokath stent is like a tiny metal spring that holds open the urethra, allowing urine to flow through. It can be temporary or left in permanently.
Surgery
Surgery is usually only recommended for moderate to severe symptoms of prostate enlargement that have failed to respond to medication.
Trans-urethral resection of the prostate (TURP)
Trans-urethral resection of the prostate (TURP) is a surgical procedure where excess prostate tissue is removed to reduce the pressure on your bladder.
The surgeon will insert a small instrument into your urethra (tube through which urine passes). An electric wire loop heated by radio waves is moved across to slice away excess tissue.
TURP is not painful because it is performed using either a general anaesthetic (where you are asleep) or a regional anaesthetic (where you are awake, but the lower half of your body is numbed).
Most men are well enough to leave hospital two to three days after the operation.
A common complication of TURP is that you will no longer produce semen when you ejaculate. This is known as retrograde ejaculation. It results in sperm going into your bladder rather than out of your penis during ejaculation.
However, you will still experience the physical pleasure associated with ejaculation (the climax).
Transurethral incision of the prostate (TUIP)
Transurethral incision of the prostate (TUIP) is an alternative to TURP for men who:
- only have a small or moderately enlarged prostate and/or
- are in poor health and are not be suitable for TURP (TUIP generally involves less blood loss than TURP, so may be a safer treatment option)
After TUIP, there is a lower risk of experiencing retrograde ejaculation, which may be an important consideration for some men, particularly if they wish to have children.
TUIP is carried out in a similar way to TURP, but rather than removing prostate tissue, two small cuts are made in the prostate to allow your urethra to be widened, making it easier for you to pass urine.
Prostatectomy
During an open prostatectomy, an incision is made in your tummy and the outer portion of your prostate is removed.
While open prostatectomy may be effective in treating your symptoms, it carries a high risk of complications such as wound infection or a blood clot. Therefore, it is usually only recommended for men who have a severely enlarged prostate.
An alternative method of removing part of a very large prostate is laparoscopic (keyhole) prostatectomy. This uses smaller incisions and is less invasive, but is only performed by very experienced laparoscopic surgeons.
Laser treatment
Laser treatment can be used in men who are not healthy enough to have surgery or who only have a moderately enlarged prostate.
During surgery, a very narrow optic fibre will be inserted through your urethra (tube through which urine passes). Normally, a laser is beamed out of the optic fibre to burn or slice off excess tissue.
After surgery, you may need to use a catheter (a flexible tube that you place into your bladder) to remove urine from your bladder while your urethra recovers. Many men experience pain while urinating for several weeks after the operation.
As with other types of prostate surgery, laser surgery carries a risk of developing retrograde ejaculation. There is also a risk of serious damage to the bladder.
As laser surgery is a new technique, its long-term effectiveness is unknown.
