Easing symptoms of enlarged prostate
In the 19th century, men who suffered from symptoms caused by an enlarged prostate often carried canes with secretly hollowed-out shafts. If a man felt the sudden and urgent need to urinate and couldn’t reach a bathroom in time, the cane doubled as an emergency urinal.
Fortunately, physicians today can offer men far more practical and effective ways to cope with the annoyance of an enlarged prostate.
The walnut-sized prostate produces a fluid found in semen; the gland surrounds the urethra, a slender tube through which urine passes from the bladder to the penis. The prostate begins to enlarge at around age 25; some grow only a little, while others can become as big as a baseball. This change usually goes unnoticed until a man reaches middle age. (Many men never develop symptoms of prostate enlargement.)
By age 50, about one-third of males have problems urinating, caused by the growing tissue. Doctors call the condition benign prostatic hyperplasia (or hypertrophy), or BPH for short. The symptoms can range from mildly bothersome to serious; each year, the condition accounts for about 375,000 hospital stays in the United States. Some evidence suggests that smoking, obesity and high-fat diets may increase the risk for BPH.
The problem starts when a bulging prostate begins to crimp the urethra, obstructing the flow of urine. A man may notice that it takes longer to get a urine stream started and he may have to strain to drain his bladder. In fact, he may not empty the bladder completely, meaning it fills up faster, which requires more frequent trips to the bathroom. Some men get out of bed several times a night to urinate.
If the prostate grows larger, it may press against the bladder, leading to more trouble. The bladder can become irritated and go into spasm, producing an uncontrollable need to urinate. Some men even become incontinent. In severe cases, the bladder weakens and can no longer empty itself. When urine backs up in the bladder, the kidneys may be damaged.
After ruling out other conditions that can cause men to develop problems urinating (including prostate cancer and infections caused by sexually transmitted diseases), doctors usually start treating BPH with drugs known as alpha-blockers. These drugs (brand names include Cardura, Flomax and Hytrin) relax the muscle in the “neck” of the bladder, allowing urine to flow more freely. Alpha-blockers help about two-thirds of men with BPH, says UCLA urologist Jacob Rajfer. “Their symptoms are markedly, if not totally, improved,” he says.
However, the relief isn’t always permanent; symptoms often worsen in men whose prostates grow to be very large. So doctors will often prescribe another type of medication designed to shrink the prostate, or at least slow its growth. The drug Proscar blocks an enzyme in the body that converts the male hormone testosterone into dihydrotestosterone, or DHT. Scientists believe that DHT promotes the growth of prostate cells. Men with BPH who take Proscar are about half as likely to require symptom-relieving surgery as men who don’t take the drug.
In addition, a new prostate-shrinking drug called Avodart became available in the United States this year. GlaxoSmithKline, the company that makes it, says the drug provides a double whammy. It acts like Proscar but also knocks out a second enzyme that converts testosterone to DHT.
The National Institutes of Health recently launched a study involving 3,000 subjects to examine the benefits of the herbs saw palmetto and pygeum, which some men use to self-treat BPH. Urologist Aaron Katz, director of Columbia University’s Center for Holistic Urology, sometimes recommends herbs and believes they can help with mild BPH problems. But “when you get into severe symptoms,” he says, “[herbs] may be used as a complement, but they’re not strong enough to be used alone.”
When BPH symptoms don’t respond to drugs, doctors recommend surgery. The “gold standard” procedure is known as transurethral resection of the prostate. During this surgery, instruments are inserted through the urethra and used to cut away portions of the prostate. Nearly 90% of men who undergo it say their symptoms are significantly improved. The surgery may not be the right choice for younger men, because it interferes with fertility. What’s more, says Rajfer, about 8% develop erectile dysfunction and fewer than 1% become incontinent. Other procedures carry fewer risks but aren’t as effective.
Fewer men are opting for BPH surgery these days. A national survey found that the number of transurethral resection procedures performed in the United States dropped by 43% between 1986 and 1998, in part because today’s improved treatments give men with BPH a stronger crutch to lean on. Which sure beats using a cane.
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Massachusetts freelance writer Timothy Gower can be reached by e-mail at tgower@attbi.com. The Healthy Man runs the second Monday of the month.
