How can benign prostate enlargement be treated?

Written by: Mr Marc Laniado
Published:
Edited by: Emily Lawrenson

In his previous article for Top Doctors, leading urologist Mr Marc Laniado discussed benign prostate enlargement (BPE), a condition affecting up to 80% of men over the age of 70 in the UK. Here, he discusses how prostate enlargement can be treated, and how patients can make changes to manage the condition more comfortably. 

How is BPE treated?

There are many treatments for an enlarged prostate depending on the amount of bother the symptoms cause and the physical configuration of the prostate.

Changes in lifestyle

For men with mild symptoms, changes in lifestyle may be enough to make life comfortable again. These include:

  • avoiding caffeine and alcohol
  • preventing constipation
  • restricting fluid consumption before times when toilets are unavailable

Some medications can improve symptoms by relaxing some of the muscles that tense up as BPE occurs. These drugs are known generally as alpha blockers e.g. tamsulosin and alfuzosin. They improve symptoms mildly and make only a slight difference to the urinary flow rate.

Other drugs such as finasteride or dutasteride, which are in a class called 5 alpha reductase inhibitors, can shrink the prostate by around 10 to 20%. These take between 6 and 24 months to work. They do not alleviate urinary symptoms as much as alpha blockers, but do reduce the chance of urinary retention and other problems due to BPH. There are side-effects such as breast enlargement and erectile dysfunction.

The combination of both types works more effectively than either drug in isolation.

Operations for urinary symptoms due to prostate enlargement

If tablets are not enough, operations are usually considered. Traditionally an operation called TURP (transurethral prostatectomy) was performed. After this procedure, urinary symptoms are significantly improved, but there can be sexual side-effects such as no semen ejaculated on orgasm, loss of erections and bleeding. TURP has been improved upon by the following:

Urolift

The prostate is pulled open and held in place by an implant containing metal tags at each end – like a ‘treasury tag’. It can performed as a day case, improves symptoms rapidly, does not affect ejaculation or erections, and does not need a catheter. Symptoms are improved for at least 5 years. Men can return home and back to work quickly. Small to moderate prostates can be treated this way, but large prostates or prostate with a special configuration known as a median lobe cannot be treated this way.

Laser prostatectomy

In men with big prostates, lasers can be used to shrink or vaporise the prostate. Holmium laser enucleation of the prostate (HoLEP) improves the urinary flow more than any other laser or procedure for BPE. It can be done as a day case or as an overnight stay with a rapid recovery. Any type of prostate size or configuration can be treated with the laser. In some men, an ejaculation preserving procedure can be performed.  GreenLight laser is an alternative laser to the HoLEP.

What are the long-term effects of benign prostate enlargement?

Normally, urine flows from the bladder through a channel in the prostate into the urethra in the penis and onto the outside world. As the prostate enlarges, the channel becomes compressed, and the stream becomes weaker. The bladder tries to compensate for the restriction by squeezing more strongly. Consequently, the bladder muscles become thicker, and in turn become more sensitive to even small amounts of urine. The bladder tells the brain that it needs empty at lower and lower volumes, and so men need to pass urine more frequently and at night.

Can you prevent BPE?

Many of the risk factors such as age or your genes cannot be changed. However, having a healthy diet and being physically active can help. Being overweight increases the risk of BPH, so it helps to stay slim and healthy in general.

Drugs such as finasteride or dutasteride can slow the growth of the prostate and prevent BPE-related complications, but do have side-effects as described above.

There are no other ways to reduce the chance of BPH.

Learn more about benign prostate enlargement in Mr Laniado's first article looking at the signs and symptoms. 

By Mr Marc Laniado
Urology

*Please note that Mr Laniado is still consulting (both face-to-face and remotely) during COVID-19*

 

Mr Marc Laniado offers men with prostate enlargement or early prostate cancer treatments that benefit with less chance of side-effects. He uses the most advanced techniques that have a consistently better success rate. These are personalised to the individual needs and values of each man he sees.

 

Prostate cancer:

  • highly accurate diagnostic tests with the least side-effects (enhanced MRI, transperineal prostate biopsies, and genomic testing)
  • treatments for early prostate cancer that can preserve bladder control and erections more consistently than conventional treatments (focal therapy by HIFU, Retzius-sparing prostatectomy with nerve-sparing (NeuroSAFE), and seeds, a.ka. brachytherapy)
  • active surveillance: close monitoring for men who do not need immediate treatment

Prostate Enlargement (BPH):

  • minimally invasive treatments for small to medium-sized prostate that can improve urinary symptoms and maintain erections & ejaculation (Rezum and UroLift)
  • treatments for large prostates that improve urinary symptoms with a faster and more comfortable recovery (Aquablation, laser prostatectomy, HoLEP)
  • assessment for Prostate Artery Embolisation (PAE) 

 

He is a highly experienced urologist and works full time in the direct clinical care of men with prostate problems. Annually, he performs about 100 Retzius-sparing prostatectomies, as well as HIFU,  and 100 or more treatments for BPH.

 

He is the joint chairman of the prostate cancer multidisciplinary team for private patients at the Wellington Hospital and the Princess Grace Hospital where he operates and sees patients. He also sees patients at The London Clinic.

 

Mr Laniado was appointed as a consultant in 2002 and started performing conventional robotic prostatectomies in 2008. In 2016, He switched to the Retzius-sparing approach because of the much better bladder control and recovery of erections with similar cancer outcomes. He trains surgeons learning how to perform Retzius-sparing prostatectomies at the Royal Berkshire Hospital. NHS patients consult with him at the Royal Berkshire Hospital and Wexham Park Hospital (Frimley Health), where he is the lead for urological cancer.

 

Mr Laniado graduated from Guy's Hospital Medical School in 1989, having previously gained a BSc in physiology. Following specialist urology training in London, he became a Fellow of the Royal College of Surgeons (Urology) in 2000, going on to complete his MD in prostate cancer research, Fellow of the European Board of Urology in 2002, and become an international member of the American Urological Association. Before taking up his career as a consultant, Mr Laniado extended his knowledge and skills on a Visiting Fellowship at the Cleveland Clinic Foundation in the USA, where he trained in minimally invasive surgical techniques. 

 

Mr Laniado chooses treatments wherever possible for prostate problems that maximise the benefit-to-risk ratio, which are often less readily available. However, it is not possible to completely eliminate the chance or impact of after-effects after treatment, although the risk and impact are minimalised as much as possible.

 

 

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