Benign Prostatic Hyperplasia, or BPH, is a condition in which the prostate enlarges as men get older. Over 70% of men in their 60s have BPH symptoms so it is very common¹. While BPH is a benign condition and unrelated to prostate cancer, it can greatly affect a man’s quality of life.

The prostate is a male reproductive gland, about the size of a walnut that produces fluid for semen. The prostate surrounds the urethra, which is the tube that carries urine from the bladder out of the body. As the prostate enlarges, it presses on and blocks the urethra, causing bothersome urinary symptoms such as:

• Frequent need to urinate both day and night
• Weak or slow urinary stream
• A sense that you cannot completely empty your bladder
• Difficulty or delay in starting urination
• Urgent feeling of needing to urinate
• A urinary stream that stops and starts

If you suffer from the above symptoms, you are not alone. BPH is one of the leading reasons for men to visit a urologist².

If you have been diagnosed with an enlarged prostate due to BPH, there are several treatment options available. Consult your physician to determine which treatment is right for you.

Treatment Options

Watchful Waiting

When symptoms are mild, your doctor may just monitor your condition and ask you to track your symptoms before deciding if any treatment is necessary.

Medications

Your doctor may prescribe medications to manage your symptoms. These medications include alpha blockers which relax the muscles around the neck of your bladder, making it easier to urinate, and alpha reductase inhibitors which act to shrink the prostate. While medications can be helpful in relieving symptoms for some men, patients must continue taking them long-term to maintain the effects.

Some patients may suffer side-effects including dizziness, headaches, or sexual dysfunction. Some may not get adequate relief of their symptoms. Over 16% of men on medication for BPH discontinue treatment early for reasons such as being dissatisfied with side-effects or not getting adequate symptom relief.

UroLift® System Treatment

The UroLift® System treatment is a minimally invasive approach to treating BPH that lifts or holds the enlarged prostate tissue out of the way so it no longer blocks the urethra. There is no cutting, heating or removal of prostate tissue. Clinical data has shown that the UroLift System treatment is safe and effective in relieving lower urinary tract symptoms due to BPH without any impact to sexual function.

Learn more about how the UroLift System treatment works or visit our FAQ page for more information on the benefits, risks, and recovery.

Rezūm

Rezūm is a treatment for BPH that can be performed in a clinic or out-patient setting. Rezūm uses the stored thermal energy in water vapor (steam) to treat the extra prostate tissue that is causing symptoms such as frequency, urgency, irregular flow, weak stream, straining and getting up at night to urinate.

Inside a hand-held device, radiofrequency energy is applied to a few drops of water to create vapor (steam). The water vapor is injected into the prostate tissue that is blocking the flow of urine from the bladder, where it immediately turns back to water, releasing the energy stored in the vapor into the cell membranes. At this point, the cells are gently and immediately damaged, causing cell death. Over time, your body will absorb the treated tissue through its natural healing response.

Rezūm provides the following benefits:

• Potential alternative to BPH medications

• Relieves symptoms safely and effectively¹

• Provides noticeable symptom improvement within two weeks

• Simple in-office/out-patient therapy

• Does not require general anesthesia

• Preserves sexual and urinary functions¹

• Allows patients to return to regular activities within a few days¹

We are the 1st clinic in Georgia approved to perform this cutting-edge procedure.

¹ McVary KT et al. Minimally Invasive Prostate Convective Water Vapor Energy (WAVE) Ablation: A Multicenter, Randomized, Controlled Study for treatment of Lower Urinary Tract Symptoms Secondary to Bening Prostatic Hyperplasia. J Urol. 2015 Nov 22. pii: S0022-5347(15)05258-1. doi: 10.1016/j.juro.2015.10.181. [Epub ahead of print] – update to new citation

Learn more about Rezūm Water Vapor Therapy at http://www.rezum.com/the-rezum-system/.

Thermotherapies

Thermotherapies are minimally invasive treatments where heat energy such as microwave or radiofrequency is applied to destroy prostate tissue. Less invasive than TURP, these treatments are generally safe, can be performed under local anesthesia and provide moderate symptom relief for some patients.

Applying high heat to the prostate can cause tissue swelling and uncomfortable urinary symptoms during the healing period. Symptom relief does not occur immediately, and patients often need to have a catheter that is attached to a urine bag inserted into their bladder during the recovery period.

Laser

Laser Resection of the Prostate

TURP may be performed with a laser in procedures called photoselective vaporization of the prostate (PVP) or holmium laser enucleation (HOLEP). Laser therapy lessens the bleeding risks of traditional TURP. However, since prostate tissue is still removed, there can be tissue swelling and an uncomfortable healing time. Typically, a catheter has to be inserted into the bladder after the procedure.

Surgery

Transurethral Resection of the Prostate (TURP)

TURP is the most common surgery to treat BPH. During this procedure, patients undergo general anesthesia, and prostate tissue is removed. TURP is often considered the “gold standard” for long-term results.

After prostate tissue has been removed, the body needs time to heal. The remaining prostate tissue may actually swell and become inflamed before the desired shrinking effect occurs. Patients may suffer an uncomfortable recovery period that includes short-term problems such as bleeding, infection, erectile dysfunction, and urinary incontinence. Patients have to
have a catheter that is attached to a urine bag inserted into their bladder for several days after the procedure.

Symptom relief may not occur immediately, but lasts for a long time in many patients once it does occur.

There can be long-term side effects after TURP such as dry orgasm (retrograde ejaculation), erectile dysfunction or incontinence (leaking of urine).

Prostatitis is an infection or inflammation of the prostate gland. It can be caused by the same bacteria that commonly cause urine infections. However, in most cases, it occurs in the absence of infection. Prostatitis can affect men of all ages, and is a very common reason for a man to be seen by a urologist. It is deemed chronic when it persists for three or more months. Prostate cancer and enlarged prostate (BPH) are ruled out during diagnosis. However, there is no correlation between prostatitis and prostate cancer.

Symptoms:

• Fever
• Burning during urination
• Inability to empty the bladder
• Lower back pain
• Painful ejaculation
• Bladder or rectal pressure
• Blood in ejaculate
• Urinary spraying

Diagnosis:

• Urinalysis: evaluation of the urine under the microscope
• Urine culture: to see if bacteria is actually present in the urine
• Semen culture: to see if bacteria is actually present in the prostate secretions
• Ultrasound: to see detect for possible abscess (pocket of infection)
• Cystoscopy: look inside the prostate and bladder to assess for blockage

Treatments:

• Antibiotics: Specific antibiotics are chosen to target the most-common causative bacteria. Complete eradication of prostate bacteria may take weeks, so be sure to take ALL of your prescribed antibiotics, or your infection may recur.
• Alpha blockers: These medications help relax the muscle fibers in the prostate, helping you to urinate more freely. These may also help to clear infection faster.
• Urinary analgesics:  These are prescribed to help to alleviate discomfort when urinating.
• Pain relievers:  Over the counter ibuprofen or naproxen may help.
• Dietary changes:  Discontinue caffeinated, spicy and acidic foods and beverages.

Digital rectal exam (DRE)

A DRE is a physical exam by a doctor using a lubricated, gloved finger. The finger is placed into the rectum so that the doctor can feel the surface of the prostate. The area of the prostate next to the rectum is where tumors often grow. If the prostate has a hard spot or feels uneven, it may be a sign of prostate cancer

While the DRE may be effective at early detection of colon or rectal cancers, or at catching later-stage prostate cancers, it isn’t a reliable method for finding early-stage prostate cancer. The PSA blood test should also be used starting at age 40. For men with a primary relative with prostate cancer (a brother or a father), the risk is two-fold higher. Men with familial prostate cancer may develop the disease at an earlier age, so screening should be considered as early as age 35.

Prostate-specific antigen (PSA) test

The PSA test is a routine blood screening that can be performed in a lab, hospital or your doctor’s office. No preparation is necessary, except you may be asked to avoid ejaculation, riding a bike, lawn mower or horse for 48 hours prior. The PSA test can detect high levels of prostate-specific antigen (PSA), a protein produced by the prostate. Elevated levels of PSA are often-but not always-an early indicator of prostate cancer, as well as other disorders of the prostate.

PSA is a protein made by cells inside the prostate. In men, PSA can be found in blood. A healthy prostate does not release very much PSA, so a higher blood PSA level may be a warning of prostate cancer. The PSA can be higher for other reasons, such as a benign (noncancerous) growth of the prostate or because of urinary or prostate infection. Low blood PSA level does not always mean that there is no prostate cancer. Many early stage prostate cancers can begin to grow with quite low levels of PSA. Today, a PSA test that shows higher levels is the number one reason why prostate cancer is detected in the United States. This testing has helped doctors find and treat many prostate cancers that otherwise might not have been detected.

Prostate cancer is the #1 most common cancer among men aside from non-melanoma skin cancer. Every year more than 248,900 American men are diagnosed with prostate cancer, and 33,720 die from the disease, according to the National Cancer Institute. In general, the earlier the cancer is caught, the more likely it is for the patient to remain disease-free. Because approximately 90% of all prostate cancers are detected in the early stages, the cure rate for prostate cancer is very high-nearly 100% of men diagnosed at this stage will be disease-free after five years. It’s important to know the facts about prostate cancer so you and your family can make informed choices about screening and treatment.

Scientists are still trying to determine what causes prostate cancer. What they do know is that there are probably many reasons the disease occurs-and that by examining common risk factors, they can better determine who is likeliest to develop it. These risk factors include:

• Age: The diagnosis of prostate cancer is rare in men younger than 40. As men age, they are increasingly more likely to develop it. 1 in 6 men will be diagnosed in their lifetimes.
• Family history: If your father, grandfather, brother, son or other closely related family member has had prostate cancer, you are at an increased risk yourself.
• Race: African-American men are 60% more likely to develop prostate cancer than Caucasian or Hispanic men. The disease is rarer among Asian-American and American Indian men.
• Diet: Some studies suggest that men with diets high in fat may be at higher risk. Other research suggests that nutritional factors, like greater intake of vitamin D, lycopene and selenium, may lower a man’s risk of developing prostate cancer.

What are the symptoms of prostate cancer?

It’s important to understand that by the time prostate cancer symptoms usually appear, the cancer is likely in a later stage and is generally not curable. The disease needs to be found and cured before symptoms develop, which is why prostate cancer screenings are recommended starting at age 40.

Men with early-stage prostate cancer may not have symptoms at all. In fact, it could be 10 years before symptoms become noticeable. Some older men may never even know that they have prostate cancer since it may have not progressed or caused symptoms in their lifetime. And other forms of the disease may be small and grow so slowly that they don’t require treatment at all.

Some symptoms of prostate cancer may include:

• Difficulty urinating and/or difficulty starting and stopping urine flow
• Needing to urinate frequently, especially at night
• Pain or burning during urination
• Dull lower pelvic pain
• Blood in the urine or semen
• Painful ejaculation
• Pain in the lower back, hips or thighs

Prostate cancer treatment depends on the age and health of the patient, the aggressiveness of the cancer and the extent of the cancer at the time of diagnosis. There is no data that shows one treatment is better than the others. However, all treatments for prostate cancer except observation may have an effect on the quality of life with urinary control, erectile function and bowel function being the primary concerns. For this reason, it is important to have a thorough discussion with your urologist to weigh the risks and benefits of each option.

Active Surveillance

This is also known as watchful waiting. The timing of check-ups will vary for each man. It may be a personal choice or a choice because a man has a shorter life expectancy and wants to avoid possible problems with treatment. This may also be a good choice for a man with a longer life expectancy and a low-risk tumor. Other treatments can be initiated if the cancer shows signs of growth or of becoming more aggressive.

Radiation therapy

There are two types: interstitial prostate brachytherapy and external beam radiation therapy. If the cancer is very aggressive or more extensive, a combination of surgery followed by radiation therapy may be the best chance for a cure. With interstitial prostate brachytherapy, small radioactive “seeds” are planted in the prostate. Before treatment, the size of the prostate is checked to determine the dosage of seeds. These seeds are then placed into the prostate using needles that go through the skin between the scrotum and anus. With external beam radiation therapy, the prostate and other important tissues are treated with a carefully targeted beam of radiation. The advantage of radiation therapy is that it is less invasive than surgery. Urinary incontinence and erectile dysfunction may happen less often with radiation than with radical prostatectomy. However, one disadvantage of radiation therapy is that it leaves the prostate in the body. It is possible for some cancer to remain and worsen in the future.

Surgery

A radical prostatectomy is performed to remove the entire prostate. We have fellowship trained robotic surgeons who can expertly remove the prostate robotically. This newer technology reduces the side effects and offers excellent cancer control. Radical prostatectomy offers the man with cancer that has not spread outside the prostate the possibility of freedom from the disease for the rest of his life. The problems reported most often are erectile dysfunction and urinary incontinence. The chance of having erectile dysfunction depends on a man’s age and health, his sexual function before treatment, the stage of the cancer, and the ability to save the nerves that control erection during the surgery. Younger men (those under 60 years of age) are less likely to have problems with their erections than are older men. Even if erectile dysfunction does occur after surgery, erections may return to normal over time. Refer to Penile Rehabilitation under Erectile Dysfunction on our website for more information. While many men experience some form of urinary incontinence following prostate cancer treatment, the good news is, 90 to 95% of men do regain their continence with time without the need for additional surgery.

Hormone therapy

This involves stopping your body from producing the male sex hormone testosterone which stimulates the growth of prostate cancer cells. Another type of this therapy can block testosterone from getting into the cancer cells. Sometimes a combination of two drugs is used to achieve both effects. While hormonal therapy may lessen the cancer symptoms in men who choose not to or who cannot be treated with other therapies, it makes heart disease and diabetes worse in those who have these diseases. It can be a useful treatment, but does have some undesirable side effects. These include breast enlargement, reduced sex drive, erectile dysfunction, hot flashes, weight gain, and reduction in muscle mass.