BENIGN PROSTATIC HYPERPLASIA (BPH)
Covering all aspects of prostate enlargement, including all treatments presently available, fills three UPDATE newsletters. What follows is from those newsletters in "digest" form. Anyone experiencing symptoms of prostate enlargement should get and read our information in its entirety. It is the most complete study of BPH generally available.
Diagnosis of non-cancerous prostate growth. This condition is normally identified by its symptoms. The most common include:
The prostate begins to enlarge in all men usually starting in their 40's. Once growth starts, it does not stop as long as life goes on. Effects of this growth vary from almost unbearable misery to minor annoyance, and points in-between. The general rule is that one man in four over age 60 will become so aggravated by BPH he will need physical relief.
Why doctors label this condition "benign," only they can explain, because it is anything but benign. If not properly cared for, it can lead to extremely serious consequences, including kidney damage and failure.
It is important to know that the prostate grows in two different ways. In one growth, cells multiply around the urine passageway through the prostate and squeeze it much like you could squeeze a straw in a cola.
The second type of growth is much worse. This is middle-lobe growth in which cells grow into the urine tube and even up and into the bladder. This type of growth, called "cork in a bottle," can be cleared up only through surgery.
So prostate enlargement is NOT simply a case of too many prostate cells. This growth involves hormones; it appears in different kinds of prostate cells; and it affects each man differently. As a result of these differences, nothing answers prostate growth problems for every man. "Nothing" refers to the well-known "roto-rooter" operation, drugs, heat treatments, and drug-free substances. There is NO cure for prostate growth. To repeat, once it starts it never stops.
What about this kind of growth and prostate cancer? People sometimes ask if an enlarging prostate increases the risk of prostate cancer. There is NO connection. A man can have prostate growth with no cancer. He can have prostate growth with cancer. And he can have prostate cancer with no enlargement.
TREATMENT OPTIONS HAVE INCREASED
Two available treatments will be named purely to be complete. One is dilation of the urine passageway. The second is cryoablation, or cryo-therapy, which freezes the prostate. Dilation or cryoablation may be suggested in "last resort" situations. However, we consider them rare and do not justify detailed discussion.
SURGERY. Years back, surgery included cleaning out the prostate through the bladder, and a retropubic operation. However, these have been almost entirely replaced by more advanced techniques.
TUIP: Shorthand for Trans-uretheral Incision of the Prostate. As it sounds (through the uretha), the physician inserts a cutting instrument through the prostate to reach the neck of the bladder. He makes two lengthwise cuts of tissue from the neck of the bladder and through the length of the prostate. Men interested in having children should consider it because it does not affect ejaculation or fertility provided the prostate is one ounce or smaller.
TURP: Trans-urethral Resection of the Prostate. Still accounts for about 95% of all prostate surgery, but has declined as alternatives have become more widely available. Urologists still call it "the gold standard" in treating prostate enlargement.
Negatives include the need for hospitalization, weeks of recovery, retrograde ejaculation, and the frequent need for a repeat operation (occurs for one man in 12 within 8 years).
Laser surgery: Two types are practiced. In rollerball laser surgery, direct contact with prostate tissue vaporizes it. Poof! It's gone. In "laser-induced" and "laser-assisted" surgery, high-energy instruments heat prostate tissue as high as 140 to 212 degrees (boiling). The heat kills the tissue and the body throws it off.
Note: Lasers, today, are first generation. Improvements may enhance their ability to treat excess prostate tissue with maximum effectiveness and minimum side effects.
MINIMALLY INVASIVE PROCEDURES: (All are outpatient treatments considered non-surgical.)
Indigo-Laser. The physician inserts a needle-shaped probe into the prostate, fires energy in the shape of a ball from the probe's tip. The blast of heat destroys prostate tissue. A relatively recent therapy, the manufacturer calls its results favorable to "gold-standard"` TURP. However, this is too new to be sure of its long-term value.
TUNA: Trans-urethral Needle Ablation. Published results of this procedure are quite impressive and worth consideration of men facing a treatment decision. Technique: insert an instrument through the penis into the prostate's urine tube. Apply heat to prostate tissues through needles which "ablate" (fancy for remove) excess tissue. Similar to Indigo Laser and other non-invasive techniques. Works best on moderately enlarged prostates; not very effective on very large ones.
TUMT: The "granddaddy" of heat therapy for prostate enlargement. Has a long track record, not all of it good. The basic difference between Indigo Laser, TUNA, and TUMT is the method of heat delivery. TUMT uses microwave energy; TUNA uses radio energy; Indigo uses laser energy. Simply put, TUMT has questions of overall effectiveness, but deserves consideration.
TARGIS: Approved by the FDA in late 1997, this is a variation of the TUMT microwave therapy. A main difference is the temperatures to 150 degrees generated by TARGIS compared to 125-140 degrees generated by TUMT's upgraded ProstaSoft 2.5. Like other new therapies, this has provided near-term relief but has yet to demonstrate long-term benefits.
ORAL ALTERNATIVES TO SURGERY
Hytrin, Cardura, Flomax: These prescription drugs were originally developed to relax heart muscles. Experience found they also relaxed prostate muscles, which in relieved the pressure on the urine channel through the prostate. They help about 70% of men who try them. Side effects include lowering blood pressure and dizziness. Flomax, the newest of the three, seems to have fewer side effects.
Proscar: This drug shrinks the tissue around the prostate's urine channel, and the prostate itself. It is controversial, but disputes aside, our information is that it helps about one man in three. However, it takes about six months for any benefits to appear.
Pure alcohol injections: This innovation had a burst of publicity in 2000, but since then nothing to demonstrate if it works has been reported.
Natural (non-prescription) substances. We originally reviewed these substances in 1993 and reported the following: Scientific support of their effectiveness is inadequate, but large numbers of men say they have gained relief from them. Since those sold in the U.S. appear completely safe and will not hurt men who want to try them, men with symptoms of prostate enlargement should feel free to try them.
More recently, a considerable amount of research has been published, including a review of saw palmetto by the Journal of the American Medical Association. We also reviewed two of the most popular products in Part III of our series on prostate enlargement symptoms.
Most popular individually are saw palmetto and pygeum africanum. These are sold either as plain products, or in combination with a number of other substances. The main ingredient in all of them is 160mg of saw palmetto to be taken twice a day. A major problem with all of them is making sure that what is on the label is contained inside. Other than the reputation of the manufacturer, there is no assurance of either strength or purity.
The main active ingredient in both saw palmetto and pygeum africanum is beta-sitosterol. Research of the effectiveness of 30mg of beta-sitosterol taken twice daily was reviewed in a 1995 report in the medical journal, The Lancet. A U.S. product, ProSina, contains the same amount of beta-sitosterol, 30mg, used in the Lancet-reported research. A stronger formula, Double Strength ProSina, contains 60mg per tablet.
Of interest, but not related to this review, is that beta-sitosterol has been found to have many and more far reaching results than relief from prostate growth symptoms. This substance is also the main ingredient in ProSina.
Personal considerations: Men today have a many options in seeking relief from the symptoms of prostate growth. It is up to you to consider the pros and cons of those options based on personal needs.
You cannot rely on your doctor to do this for you. If your doctor has a TUMT availability, you won't get TUNA as an option. If he is partial to TURP - and "roto-rooter" surgery is still "the gold standard" in treating prostate growth - you are not likely to receive a prescription for an oral drug…not to mention any thing for relief in the non-prescription category.
Part III of our series on prostate growth contains a chart which may help in identifying the choice best for long-term prostate health.