In the early 1990s, a patient came to me with an advertisement torn out of a hunting magazine. It read: "Are you tired of getting out of your deer stand to urinate? Talk to your doctor about new medical treatments for BPH (Benign Prostatic Hyperplasia)."
The advertisement showed a middle-aged man working his way down a tree with an empty deer stand above. Perfect ad.
Active, healthy men saw it.
It present the question: "Why not come see your doctor?"
At that time the only real solution for men with significant symptoms from an enlarged prostate was surgery. Now, 20 years later, multiple options are available.
BPH is something men can develop as they get older. As the prostate enlarges, some patients have no symptoms, but others might present with urinary retention, the inability to urinate. This growth is not associated with prostate cancer.
As the prostate gets bigger, most men will develop some symptoms, including urinary frequency, waking up at night, or slowing of their stream. Having these symptoms does not mean treatment is needed. The only times I feel treatment for BPH is absolutely needed is when there is prostate bleeding, because the bladder is not emptying, there are urinary tract infections and/or there is renal damage occurring. When none of those problems are evident there should be a discussion with the patient. Intervention in some cases might mean simply observation.
Evaluating a man with BPH symptoms will include obtaining a history, performing a rectal exam and ensuring the bladder is emptying well. Assuming there is no evidence of cancer in the prostate, options for treatment include observation, medication, or surgery.
Two types of medication may be used: one will relax the muscles in the prostate allowing urine to flow easier; the other will actually shrink the prostate over time. Typically, the former will work quickly, within a two-week period, but over time will do nothing to keep the prostate from growing. The latter might take up to six months before a decrease in symptoms is noticed. Many times urologists will use both types of medication at the same time.
Surgical options can range from minimally invasive office procedures using microwaves or lasers, to formal surgery by removing prostate tissue. As a prostate increases in size, minimally invasive treatment might not be an option. Even in those situations the procedure is typically done on an outpatient basis.
If symptoms of BPH are present, the only way to know what treatments will work for you is to talk to your physician.