Treating BPH
Among medical therapies used to treat BPH, alpha-adrenergic blockers tend to be used most. There are 4 alpha blocker drugs used to treat BPH: Cardura, Flomax, Hytrin, and Uroxatral.
Alpha blocker therapy is based on the idea that the LUTS associated with BPH are caused partly by obstruction resulting from the contraction of smooth muscle cells in the prostate. The alpha blockers inhibit the process by which this contraction occurs and, thereby, relieve the obstruction. According to the 2006 update of the AUA Guideline on the Management of Benign Prostatic Hyperplasia, clinical studies show these drugs to be similarly effective in reducing LUTS, improving patients’ BPH Symptom Score Index by 4 to 6 points on average.
The other drugs used to treat BPH are the 5 alpha-reductase inhibitors. Two are available: Avodart and Proscar. These drugs work by bringing about hormonal changes that actually shrink the prostate.
The AUA guideline recommends that these drugs be used only by men with clear signs of prostate enlargement, not simply LUTS. According to the AUA guideline, in men with substantially enlarged prostates, these drugs can increase urinary flow rate and lower both the risk of acute urinary retention and the need for BPH-related surgery. In such men, they also can reduce LUTS, producing on average a three-point improvement in the BPH Symptom Score Index. They are, however, less effective in relieving LUTS than alpha blockers and ineffective against LUTS in patients without enlarged prostates.
MINIMALLY INVASIVE PROCEDURES
The minimally invasive procedures used to treat BPH tend to be more effective than medical options, but carry greater risks. They include transurethral microwave therapy (TUMT), transurethral needle ablation (TUNA), visual laser ablation of the prostate (VLAP), transurethral vaporization of the prostate (TUVP), and stenting. These procedures may be performed within a doctor’s office or in a hospital with a one-day stay. Either local anesthesia or intravenous sedation is required.
Heat treatments, such as TUMT and TUNA, use high temperatures to cause the prostate tissue to shrivel and become less tense. The result is that the obstructive mass of the prostate is reduced.
Similar to the heat treatments, VLAP uses laser energy to cause prostate tissue to shrivel and slough away, and TUVP uses laser energy to vaporize prostate tissue. Both procedures relieve prostatic urinary obstruction.
Some patients have metal stents inserted into the urethra to keep it open. It is unclear, however, whether stents are appropriate for men whose medical conditions permit other forms of treatment.
SURGICAL TREATMENT
Surgery for BPH—transurethral resection of the prostate (TURP), transurethral incision of the prostate (TUIP), and prostatectomy—are the traditional and most effective but are the riskiest treatment options. All 3 require spinal or general anesthesia with at least a 1-night hospital stay.
With TURP, the inner portion of the prostate is cut out through the urethra using an endoscope, whereas TUIP reduces urethral constriction by inserting an instrument through the urethra to make 1 or 2 cuts in the prostate. The most radical option, prostatectomy, removes the inner portion of the prostate through open surgery. Usually, prostatectomy is reserved for patients with a prostate volume greater than 80 g.
WEIGHING YOUR OPTIONS
When discussing possible treatments with your doctor, weigh the severity of your symptoms against the likelihood that treatment will noticeably reduce your symptoms. Be sure to consider the potential risks as well as the unwanted effects that may occur and the length of time they may last.
