You’re getting older. You wake up needing to use the bathroom every few hours. And even after you pee, you feel like you still have to. You might need to strain to get any kind of flow going.
You can’t get a good night’s sleep. Your friends ask you to join them on a day-long hike in the mountains, but you decline because you’re not sure there will be bathrooms nearby. Your partner expresses some concerns about your overall health. You wonder what’s going on?
To many men, especially over the age of 50, this scenario has a familiar ring. These are all signs of a common, treatable condition: Benign prostatic hyperplasia (BPH) otherwise known as an enlarged prostate. Most of the time, the prostate gets bigger as men age. About half of men between the ages of 51 and 60 have some degree of BPH, according to the American Urological Association (AUA). The rates increase as men get older.
For some men, BPH is no problem. For others, prostate growth squeezes the urethra and disrupts urine flow.
Fortunately, there are lots of ways to treat an enlarged prostate.
Choosing a BPH treatment can be a challenge. It’s normal to have lots of questions:
- Should I wait and see what happens?
- Should I try medication?
- Should I go with a minimally-invasive procedure? (And what does “minimally-invasive” really mean, anyway?)
- Should I have surgery?
- What are the risks of each treatment?
- What will my recovery be like?
- How long do the results last?
Treatment terminology can be confusing, too, with acronyms like TURP, TUIP, TULIP, HoLEP, HoLAP, TUMT and more. How can you determine which treatment options are right for you?
Your urologist can be both a trusted resource and a faithful advocate. Rely on your doctor’s training and experience as you weigh the pros and cons of your options. Don’t hesitate to ask questions.
Let’s look at some considerations doctors make when guiding BPH treatment decisions:
How severe are your symptoms?
Not all men have bothersome symptoms. Or their symptoms might happen just every once in a while. These men might decide on watchful waiting, holding off on any treatment and seeing if the symptoms worsen.
On the other hand, men whose symptoms affect their day-to-day life will probably choose a more active treatment path.
How large is your prostate?
On average, the prostate gland is about the size of a walnut and weighs about an ounce. Prostate growth varies from man to man.
If your prostate is growing modestly, your symptoms might not be severe. Typically, the larger your prostate, the more troublesome your symptoms will be. Some treatments are often recommended specifically for men with larger prostates. Your urologist will be able to discuss the treatment that is best suited for your particular condition.
How’s your overall health?
Are you generally healthy and fit, or do you have other medical conditions, like diabetes or heart disease, that complicate things?
For example, the AUA cautions about alpha blocker medications for men who need cataract surgery. This can be discussed and coordinated with your urologist and ophthalmologist. There are other minimally invasive treatments that can be used for men who can’t have surgery due to their overall health. Convective water vapor ablation (destroying excess prostate tissue with steam) might be a better option for men who don’t have success with BPH medications. Again, this and other treatment options should be discussed with your urologist to fit your particular needs.
Your treatment path may also depend on other urological issues you might be having, like bladder stones, bleeding from the prostate, blood in your urine, or difficulty emptying your bladder.
What’s your preference?
Some men are uncomfortable taking medications, or they might decide the side effects aren’t worth it. Others aren’t comfortable with having anesthesia or surgery. Still others might be reluctant to have procedures involving lasers, electric currents, or microwaves.
Other considerations: What are potential complications? What are the side effects? Will you have trouble with erections or ejaculation? Will there be significant pain? Does the treatment require a hospital stay? Will you have restrictions?
In some cases, your treatment decisions might be quite limited. In other situations, you might have a number of options to consider. You, your doctor, and your partner and family, if appropriate, can work together to come up with a BPH management plan that meets your needs.
“What is Benign Prostatic Hyperplasia (BPH)?”
(Updated: May 2019)
Cunningham, Glenn R., MD and Dov Kadmon, MD
“Patient education: Benign prostatic hyperplasia (BPH) (Beyond the Basics)
(Last updated: July 24, 2018 with literature review current through June 2020)
www.uptodate.com (by subscription)