Lifestyle changes
Often BPH can be ignored with no ill effects. However, the following situations cannot be overlooked and need immediately medical attention:
In some men, the herb saw plametto is very effective for BPH (see above) . Discuss this option with your doctor and try it for two to three months. If your symptom's don't improve in that time, you may need medical or surgical treatment instead.
Medications
The drugs for treating an enlarged prostate fall into two categories: alpha-blockers and 5-alpha reductase inhibitors. No medications offer a cure for BPH; they can only relieve symptoms. However, be warned: Once medication is stopped, BPH symptoms will eventually return in most men.
Alpha-blockers were designed to treat high blood pressure by reducing the tension of the muscles in blood vessel walls. By coincidence, the so-called nonselective drugs (Minipress, Hytrin) also relax smooth muscle tissue within the prostate. A selective alpha blocker (marked as Flomax) was then developed to target the smooth muscle of the prostate. When you take it daily, an alpha-blocker may increase urinary flow and relieve symptoms of urinary frequency and night-time urination (called nocturia). Possible side effects include dizziness upon standing as blood pressure drops (less so with selective alpha-blockers), fatigue and headaches.
Of the 5-alpha reductase inhibitor drugs only one is currently available, called finasteride (brand name Proscar). This drug works by reducing the size of the prostate by as much as 30 percent but it
takes time if it works at all. This medication is useful only if you have a large prostate (more than 40 g as determined with a digital rectal examination by your doctor). Finasteride also has limitations:
it takes three to six months to work, it must be taken daily and it has only a moderate ability to improve symptoms. You may find that your ejaculator volumes are reduced and with long-term use of the drug you may develop erectile dysfunction. These side effects, however, disappear when the drug
is discontinued. Also, since after six months finasteride lowers PSA levels (see on later) by 50 percent, your doctor will have to adjust your PSA value in order to assess your prostate cancer risk.
If your symptoms are significantly unchanged after trying medications, you have three choices: keep taking the medicine, have a minimally invasive therapy or undergo surgery (a trans-urethral resection of the prostate), which is generally the last choice.
Procedures
Surgery is considered if your symptoms have not improved after other treatments. Transurethral resection of the prostate, or TURP (pronounced 'terp'), is considered the 'gold standard' of BPH
TREATING BPH WITH SAW PALMETTO
A growing number of men are turning to natural therapies to treat their BPH. Routinely prescribed in Europe, complementary BPH medications (plan extracts or botanicals) have been largely ignored by Australian and New Zealand medical establishments until recently because of a lack of good clinincal studies confirming their benefit.
One exception, however, is the herb saw palmetto, botanically known as Serena repens.
A study published in the journal Urology reported that saw palemetto pills (160 mg taken twice daily) might be an effective BPH treatment. Men in the study who took saw palmetto experienced significant improvement in symptoms compared to those not using it.
Saw palmetto is available in most pharmacies and health food stores. It's best to choose supplements made from extracts standarised to contain 85% to 95% fatty acids and sterols.
If you're interested in going the herbal route, buy the least expensive brand of saw palmetto and use it for several months. If no improvements occurs, try another brand. If, after three or four months on the herb, your symptoms have not improved, then standard prescription medications or surgery may be indicated for you.
For further information and to check out the evaluation of the evidence for saw palmetto, go to www.cochraneconsumer.com
treatment, the one against which other therapeuctic measures are compared. TURP involves removing the inner core of the prostate with an instrument called a resectoscope that's passed through the urethra into the bladder. A wire attached to the resectoscope removes prostate tissue and seals blood vessels with an electric current. A catheter remains in place for one to three days, and a hospital stay of one to two days is generally required. There is little or no pain associated with TURP and you can expect a full recovery by three weeks after surgery.
Transuerthral resection of the prostate tends to be reserved for those men who have obstructive prostate problems. This means that they are unable to urinate and are at risk of damaging their kidneys or bladder. While most men benefit from TURP, there is the potential for pain and suffering. There is also a high risk for bleeding; a minimal but serious risk for incontinence; and a small risk of erectile dysfunction.
Newer, minimally invasive heat therapies are now being evaluated for their safety and efficacy in Australia and are becoming more widely available. One nonsurgical procedure called transuretheral needle ablation (TUNA) uses low-level radio frequency waves to burn away extra tissue blocking the flow of urine. TUNA requires local anaesthesia and takes less than an hour; most men can return to their normal activities with in 24 hours. Another option is innovative microwave technology called cooled thermotherapy (see above), which offers a treatment that is less invasive and less risky than surgery. Performed in a doctor's surgery or on an outpatient basis, cooled thermotherapy, once called transurtheral microwave thermotherapy (TUMT), is a half-hour procedure that uses microwave energy to heat and destroy enlarged prostate tissue while a unique cooling system protects surrounding healthy, sensitive tissue. Relief from symptoms usually occurs 4 to 12 weeks after treatment. However, it is not yet known how long the relief gained from these two procedures will last.
Does diet make any difference with BPH?
Indeed it may. Researchers are beginning to point a finger at high-fat, junk food diets that are lacking in fruit and vegetables as a cause of BPH. When men don't consume enough fresh fruit, vegetables and whole grains, it is thought that they lose out on the unique ability of these foods to fight off free-radical molecules that ultimately damage the prostate and may cause it to enlarge.
- Avoid all over-the-counter antihistamines and decongestants. These can worsen your BPH by preventing muscles in the bladder and prostate from relaxing to let urine flow out.
Often BPH can be ignored with no ill effects. However, the following situations cannot be overlooked and need immediately medical attention:
- Bladder 'backup'. If your bladder is full but can't empty completely, urine can collect in the kidneys, causing damage.
- Inability to urinate. This condition called acute urinary retention may cause pain and serious kidney damage.
- Urge incontinence. The feeling you have 'to go right now' or you'll have an accident means the bladder may be damaged. You need to see a doctor.
In some men, the herb saw plametto is very effective for BPH (see above) . Discuss this option with your doctor and try it for two to three months. If your symptom's don't improve in that time, you may need medical or surgical treatment instead.
Medications
The drugs for treating an enlarged prostate fall into two categories: alpha-blockers and 5-alpha reductase inhibitors. No medications offer a cure for BPH; they can only relieve symptoms. However, be warned: Once medication is stopped, BPH symptoms will eventually return in most men.
Alpha-blockers were designed to treat high blood pressure by reducing the tension of the muscles in blood vessel walls. By coincidence, the so-called nonselective drugs (Minipress, Hytrin) also relax smooth muscle tissue within the prostate. A selective alpha blocker (marked as Flomax) was then developed to target the smooth muscle of the prostate. When you take it daily, an alpha-blocker may increase urinary flow and relieve symptoms of urinary frequency and night-time urination (called nocturia). Possible side effects include dizziness upon standing as blood pressure drops (less so with selective alpha-blockers), fatigue and headaches.
takes time if it works at all. This medication is useful only if you have a large prostate (more than 40 g as determined with a digital rectal examination by your doctor). Finasteride also has limitations:
it takes three to six months to work, it must be taken daily and it has only a moderate ability to improve symptoms. You may find that your ejaculator volumes are reduced and with long-term use of the drug you may develop erectile dysfunction. These side effects, however, disappear when the drug
is discontinued. Also, since after six months finasteride lowers PSA levels (see on later) by 50 percent, your doctor will have to adjust your PSA value in order to assess your prostate cancer risk.
If your symptoms are significantly unchanged after trying medications, you have three choices: keep taking the medicine, have a minimally invasive therapy or undergo surgery (a trans-urethral resection of the prostate), which is generally the last choice.
Procedures
Surgery is considered if your symptoms have not improved after other treatments. Transurethral resection of the prostate, or TURP (pronounced 'terp'), is considered the 'gold standard' of BPH
TREATING BPH WITH SAW PALMETTO
A growing number of men are turning to natural therapies to treat their BPH. Routinely prescribed in Europe, complementary BPH medications (plan extracts or botanicals) have been largely ignored by Australian and New Zealand medical establishments until recently because of a lack of good clinincal studies confirming their benefit.
One exception, however, is the herb saw palmetto, botanically known as Serena repens.
A study published in the journal Urology reported that saw palemetto pills (160 mg taken twice daily) might be an effective BPH treatment. Men in the study who took saw palmetto experienced significant improvement in symptoms compared to those not using it.
Saw palmetto is available in most pharmacies and health food stores. It's best to choose supplements made from extracts standarised to contain 85% to 95% fatty acids and sterols.
If you're interested in going the herbal route, buy the least expensive brand of saw palmetto and use it for several months. If no improvements occurs, try another brand. If, after three or four months on the herb, your symptoms have not improved, then standard prescription medications or surgery may be indicated for you.
For further information and to check out the evaluation of the evidence for saw palmetto, go to www.cochraneconsumer.com
treatment, the one against which other therapeuctic measures are compared. TURP involves removing the inner core of the prostate with an instrument called a resectoscope that's passed through the urethra into the bladder. A wire attached to the resectoscope removes prostate tissue and seals blood vessels with an electric current. A catheter remains in place for one to three days, and a hospital stay of one to two days is generally required. There is little or no pain associated with TURP and you can expect a full recovery by three weeks after surgery.
Transuerthral resection of the prostate tends to be reserved for those men who have obstructive prostate problems. This means that they are unable to urinate and are at risk of damaging their kidneys or bladder. While most men benefit from TURP, there is the potential for pain and suffering. There is also a high risk for bleeding; a minimal but serious risk for incontinence; and a small risk of erectile dysfunction.
Newer, minimally invasive heat therapies are now being evaluated for their safety and efficacy in Australia and are becoming more widely available. One nonsurgical procedure called transuretheral needle ablation (TUNA) uses low-level radio frequency waves to burn away extra tissue blocking the flow of urine. TUNA requires local anaesthesia and takes less than an hour; most men can return to their normal activities with in 24 hours. Another option is innovative microwave technology called cooled thermotherapy (see above), which offers a treatment that is less invasive and less risky than surgery. Performed in a doctor's surgery or on an outpatient basis, cooled thermotherapy, once called transurtheral microwave thermotherapy (TUMT), is a half-hour procedure that uses microwave energy to heat and destroy enlarged prostate tissue while a unique cooling system protects surrounding healthy, sensitive tissue. Relief from symptoms usually occurs 4 to 12 weeks after treatment. However, it is not yet known how long the relief gained from these two procedures will last.
Does diet make any difference with BPH?
Indeed it may. Researchers are beginning to point a finger at high-fat, junk food diets that are lacking in fruit and vegetables as a cause of BPH. When men don't consume enough fresh fruit, vegetables and whole grains, it is thought that they lose out on the unique ability of these foods to fight off free-radical molecules that ultimately damage the prostate and may cause it to enlarge.
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