Men's Health

Treatments for Enlarged Prostate

The National Institutes of Health reports that approximately 50 percent of men aged 51-60 and more than 90 percent of men older than 80 will develop an enlarged prostate – a condition known as Benign prostatic hyperplasia, or BPH.

In fact, Dr. Dudley Danoff, who has taught on the clinical faculty of the UCLA School of Medicine for more than twenty-five years and is the founder and president of the Cedars-Sinai Tower Urology Medical Group, says that BPH is nearly inevitable in aging males.

Think of the male bladder as a balloon placed neck-side down in the pelvis, and visualize the prostate as a doughnut around the neck of the balloon. As a man ages, the doughnut gets larger and the hole in the doughnut gets smaller, making it more difficult to empty the balloon through urination.

Danoff says that the most reliable method of identifying which patients need treatment for BPH is a questionnaire developed by the American Urological Association (AUA) that examines the conditionÕs most prominent symptoms, which include incomplete bladder emptying; frequency, intermittency, and urgency of urination; weakness of the urine stream; straining during urination; and nighttime urination. These symptoms are rated on a scale of 0 to 5. The higher the total score, the more likely it is that a patient will need treatment for BPH.

If you get a BPH diagnosis, here are Danoff’s top ten suggestions about what to do next:

  1. Have a complete urologic and prostate examination, which should include a digital rectal exam and a blood screening exam that uses a prostate-specific antigen (PSA) to test for the presence of possible prostate cancer.
  2. Get a noninvasive ultrasound to measure the amount of urine remaining in the bladder after urination. An ultrasound can also detect structural abnormalities in the prostate and determine the need for a biopsy.
  3. Consider watchful waiting if symptoms are mild or moderate. Progression of symptoms is not inevitable, and some men’s symptoms spontaneously improve or resolve.
  4. Ask about medical treatments for BPH. A recently developed class of drugs called alpha blockers has been widely and safely used for a number of years to relieve the symptoms of BPH. In general, they relax the neck of the bladder (widening the hole in the doughnut) to allow more complete emptying.
  5. Find out about shrinking the prostate. Another class of drugs called 5-alpha-reductase inhibitors affects the cells of the prostate, reducing the size of the gland and improving symptoms. This treatment usually takes six months and may cause side effects like erectile dysfunction, decreased libido, enlarged breast tissue, and ejaculation problems.