Enlarged Prostate

Enlarged Prostate

 Enlarged Prostate

Enlarged prostate, called benign prostatic hypertrophy (BPH), affects many men as they age, but it is usually treatable, allowing a quick return to normal activities. BPH is the most common cause of urinary problems for men over 40. This condition is not cancerous, and it does not increase a man’s risk of developing prostate cancer.

The prostate is a gland about the size of a walnut located just below the bladder and surrounding the urethra (the tube that allows urine to pass out of the body). The prostate produces about half of the seminal fluid that comes out of the penis during ejaculation.

As you age, your prostate continues to grow. In particular, tiny periurethral glands within the prostate next to the urethra swell. However, the outer layer of the prostate does not stretch enough to accommodate growth inside. This causes the inner prostate to squeeze the urethra.

When the urethra is narrowed, the bladder has to work harder to expel urine, and urination becomes difficult. Eventually, the bladder cannot empty completely, and there is not enough space in the bladder for new urine coming from the kidneys. This causes you to urinate more often.

A physical exam may reveal an enlarged prostate, but does not always distinguish between BPH and cancer. A blood test for prostate-specific antigen (PSA—a chemical present in the blood when the prostate is enlarged) is used to detect both BPH and prostate cancer.

If your PSA is elevated, which may be an indication of cancer, you may need a biopsy to make an accurate diagnosis. Sometimes more than one biopsy is necessary to conclude definitively that the problem is BPH and not cancer.

An enlarged prostate may disrupt your daily life. Fortunately, this condition can often be treated successfully. Indiana University Health is home to some of the country’s leading urologists and experts in advanced treatment of BPH. We are among the first to adopt effective new treatments.

Through our partnership with Indiana University School of Medicine, our physicians perform leading-edge research to make treatment of BPH more efficient and effective. Our focus is a new tool used in laser treatment of enlarged prostate. This tool may speed removal of enlarged prostate tissue, shortening surgery and reducing risk.

We were the first in the U.S. to use holmium laser therapy to remove BPH tissue from the prostate. Our publications in medical journals share our innovative techniques with physicians worldwide.

At IU Health, we provide comprehensive, patient and family-centered care for every patient. Our specialists work with you to ensure that your needs and preferences help shape your treatment plan.

How We Can Help

Enlarged Prostate Treatment Information

We use a range of diagnostic methods to diagnose this condition and determine its extent. These include:

  • Physical examination
  • Prostate-specific antigen (PSA—a substance present in the blood when the prostate is enlarged) testing
  • Urodynamic evaluation to test flow of urine and ability to empty the bladder completely
  • Biopsy (if PSA levels are elevated)

We often begin treatment conservatively to minimize impact on the patient. Our treatments include:

1 / Medicines. Different oral medicines available by prescription can ease the effects of an enlarged prostate without any other treatments or therapies.

  • Alpha blockers are often effective in allowing urine to flow freely through the urethra. These medicines relax the muscles around the prostate and bladder, making it easier to urinate completely. You may begin to see the effects of alpha blockers within just a few days.
  • 5-alpha-reductase inhibitor medicines affect the hormones that cause prostate enlargement and work by shrinking the prostate. They may take several months to have an effect and can possibly cause sexual side effects such as impotence.  
  • Tadalafil is commonly used for erectile dysfunction, but can also benefit an enlarged prostate.  It cannot be taken with alpha blockers or nitrates used for chest pain.

2 / Thermal therapy. When medicines do not fully restore urinary function, we may use thermal therapy. This is a non-surgical procedure in which we use a transurethral (through the urethra) tool to apply microwave heat directly to the prostate. Some short-term swelling results from this procedure. We leave a catheter in the urethra for a few days to drain urine from the bladder. When the swelling passes, BPH tissue shrinks and urine passes freely through the urethra. Most men have minimal sexual side effects from this treatment. BPH may recur after a long period of time passes.

3 / Surgery. Sometimes medicine and thermal therapy are not fully effective. Many urologists use a procedure called transurethral resection of the prostate (TURP) to treat BPH. However, we have found that minimally invasive surgery using a holmium laser (Holmium Laser Enucleation of the prostate (HoLEP) is more effective for treating BPH while preserving healthy prostate tissue. The laser technique works well for enlarged prostates of any size, but it is particularly effective when the prostate has grown very large. Often patients typically go home the same day of the procedure or the next morning with immediate improvement in urination. Laser treatment is a permanent treatment because we have removed the BPH tissue. Sexual side effects from this procedure are usually minimal.

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