Modern treatments for BPH: what is available for me?

A big worry for men of a certain age is the health of their prostate. It isn’t just cancer that can be cause for concern – with age, the prostate grows larger and this growth is more pronounced in some than others. This enlargement – benign prostate hyperplasia, or BPH, can cause a number of symptoms, including affecting urination. How can this be treated? Top urologist and BPH expert Mr Jeremy Crew provides the answers.

How can benign prostate enlargement be treated?

Management of benign prostatic hyperplasia depends upon the severity of the symptoms and the presence or risk of complications, such as inability to void (acute urinary retention). Management options include lifestyle changes (e.g. reducing what you drink in the evenings), oral pharmacotherapy (such as alpha blockers or 5-alpha reductase inhibitors tablets) and then interventional procedures from minimal intervention to more serious intervention.

How was BPH traditionally treated?

If conservative management (e.g. lifestyle changes and tablets) failed previously, the only option was a TURP (transurethral resection of the prostate) which carried with it significant risks, including bleeding and fluid absorption as well as a minimum of two nights’ stay in hospital.

How has the treatment of BPH evolved?

Over the past 10 years a number of new and exciting additions to our management options have emerged. These now allow patients to choose what is right for them. There is no one size that fits all and the decision over the most appropriate treatment option depends upon a number of features including:

1. Severity of symptoms
2. The patient’s age and health
3. Size of the prostate
4. The patient’s choice and lifestyle options

What do the different treatments and management systems offer?

Urologists should be in a position to discuss a range of management options. If lifestyle changes and tablets have failed then the main options for discussion would be:

1. Ablative endoscopic surgery – the most complete ablative procedure and the option associated with the least complications is HoLEP (Holmium Laser Enucleation of the prostate)
2. Prostatic Artery Embolisation – this has newly been approved by NICE. Initial research from high volume centres such as Oxford is showing good results. It has the advantage of being a minimally invasive procedure which can be done under local anaesthetic as a day case. The procedure involves the radiologists inserting a small catheter into the arteries supplying the prostate. Microscopic pellets are inserted through the catheter into the artery causing it to block. This reduces the blood supply to the prostate and causes it to shrink. Good results have been achieved with this technique with minimal complications.
3. Urolift – this is a minimally invasive procedure done as a day case under either general or local anaesthetic. It does not remove any tissue and relies on stapling the obstructive lobes of the prostate to the capsule. This opens the urethra and improves urinary symptoms. One of the major advantages of this form of treatment is that it perseveres sexual and ejaculatory function.

Can BPH be cured?

BPH cannot be cured. The enlargement of the prostate is a normal part of ageing. However not every man who has an enlarged prostate will develop significant, troublesome symptoms. It is estimated that at age 75 over 90% of men will have evidence of BPH and over 50% of men will have ‘troublesome’ lower urinary tract symptoms associated with this.