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The Medical Minute: Don’t wait to treat your enlarged prostate

Half of all men develop enlarged prostates — also called benign prostatic hyperplasia — by the time they’re 50 years old. The walnut-sized gland never stops slowly growing. But like the fabled frog in hot water, men often don’t realize how disruptive the symptoms of an enlarged prostate have become.

Benign prostatic hyperplasia is, like the name says, not malignant. It is not cancer. Instead, it’s the enlargement of the prostate caused by testosterone. “Because most men produce the hormone throughout their lives, the prostate continues to grow — typically inward, compressing the base of the bladder as well as the urethra,” said Dr. Jaime Herrera Caceres, a urologic oncologist at Penn State Health Specialty Services.

Disruptive symptoms and possible complications

An enlarged prostate makes the bladder work harder to push the urine out due to the increasingly narrow urethra. “Patients start not being able to empty their bladder completely,” Herrera Caceres said. “So maybe they’re retaining three to five ounces in their bladder, meaning it fills more quickly and they have to go more often.”

Not only will those with an enlarged prostate typically have to wake up at night — often multiple times — to relieve themselves, they may also have a weaker urine stream and have to strain to urinate. “Going to the bathroom becomes stressful,” Herrera Caceres said. “When you’re out and about, you’re always conscious of where the next toilet is because you know you’ll need it soon.”

Men may just accept the disruptive symptoms of their enlarged prostate and not seek treatment. But Herrera Caceres cautions that as the prostate continues to grow, serious complications can develop. “If you ignore the symptoms, you run the risk of bladder failure and kidney failure — of having a catheter or needing dialysis.”

Diagnosis and treatment

When patients see Herrera Caceres, he asks about their symptoms and how severe they are. He also measures urine flow to learn how weak or strong it is and examines the prostate to determine its size and shape to help guide him in finding the appropriate treatment.

Prescription medications are the most common treatment for mild to moderate benign prostatic hyperplasia. Some relax the bladder neck muscles and muscle fibers in the prostate, making urination easier, Herrera Caceres explains. Others can shrink the prostate by decreasing the amount of the active form of testosterone, though these might take up to six months to be effective and may also reduce sexual desire.

Having benign prostatic hyperplasia in itself does not cause erectile dysfunction, but some treatments might.

Can you take Viagra if you have an enlarged prostate? Herrera Caceres says he has no concerns. In fact, for some patients he’s prescribed a different type of medication for erectile disfunction — Cialis — to control their enlarged prostate symptoms.

For those with moderate to severe benign prostatic hyperplasia, or those who don’t respond to medication, surgery may be advised. “The classic option is a transurethral resection of the prostate,” Herrera Caceres said, explaining that it involves a surgeon going in with a heated loop into the prostatic urethra — the portion of the urethra that goes through the prostate — “and scraping from the inside. Basically, we’re digging a hole and opening the prostate so there’s a better flow.”

Other surgical procedures include using heated water or vapor to burn the prostate from inside to open it and using a laser to enucleate the gland. These treatments require hospitalization for a day and a catheter for up to five days, Herrera Caceres said. “They may also cause retrograde ejaculation, in which the seminal vesicles fail to squish the semen into the prostate and instead it goes into the bladder.”

New outpatient treatment

One new treatment option that Herrera Caceres calls “a game changer” is the minimally invasive procedure iTind. It involves placing a temporary stent in the prostatic urethra and having it slowly expand over the course of a week.

“Patients are asleep for the 15-minute procedure and don’t need a catheter at all,” Herrera Caceres said. There’s also no hospital stay. Patients will return a week later to have the stent removed.

The technology is new, with patients only tracked for three years thus far, Herrera Caceres says. Those results show continued relief from the symptoms of an enlarged prostate. Patients have reported mild to moderate discomfort during the week that the iTind device is in place, but once it’s removed, they don’t experience the side effects caused by the medications and other procedures used to treat, the urologist says.

No matter what surgical procedure is used to treat the condition, as long as the body produces testosterone, the prostate will grow. “It may take eight or 10 years, but when it happens, patients should discuss their symptoms with their doctor to see if they should be treated with medication or another surgical procedure,” Herrera Caceres said.

To learn more about iTind and other treatments for enlarged prostate, call 717-981-8160.

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The Medical Minute is a weekly health news feature produced by Penn State Health. Articles feature the expertise of faculty, physicians and staff, and are designed to offer timely, relevant health information of interest to a broad audience.

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