As men age, certain health issues become increasingly common, and an enlarged prostate, or benign prostatic hyperplasia (BPH), is one of them.
While BPH isn’t life-threatening, it can lead to uncomfortable symptoms and, if left untreated, serious complications. Taking a proactive approach to understanding and managing prostate health is essential for men aiming to maintain quality of life as they age.
Here, we’ll explore the symptoms, potential risks, and treatment options available to help men take control of their prostate health.
What is a Prostate?
The prostate is a small, walnut-sized gland located below the bladder.
Its main function is producing seminal fluid, which is a component of semen.
As men age, the prostate grow naturally.
“50% of men aged 50 will have an enlarged prostate. It can increase up to 80% of patients reaching the age of 80,” shared Dr. Ronny Tan, Specialist Urologist at Advanced Urology, Singapore.
For some, this may not cause any issues, while some may experience urinary problems due to the pressing of enlarged prostate against the urethra (the tube that transports urine out of the body).
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Understanding the Signs and Symptoms of BPH
BPH often presents through lower urinary tract symptoms (LUTS).
These symptoms include:
- Difficulty to start urinating
- Weaker or slower urine stream than usual
- Dribbling at the end of urination
- Feeling incomplete emptying of the bladder
- Sudden urgency to urinate
- Frequent urination particularly at night
Severity varies widely, and while some men may only experience mild discomfort, others might find their daily routines significantly impacted. The severity of these symptoms varies depending on the size of the prostate and its effects on the bladder and urethra.
Nevertheless, sometimes, the size of the prostate cannot determine the severity of symptoms. Some people with enlarged prostates have no symptoms at all, while some with slightly enlarged prostates can be more affected.
Why Ignoring BPH Can Be Dangerous
BPH itself is not dangerous, but its complications can be harmful if the condition goes unmanaged or becomes severe.
It is critical to recognize that most men with an enlarged prostate do not experience severe complications, but when they do occur, they can include:
1. Urinary Retention
Severely enlarged prostate can hinder the flow of urine entirely, leading to acute urinary retention or sudden inability to pass urine. This can be painful and uncomfortable – and result is further damage over time.
2. Urinary Tract Infections (UTIs)
Difficulty emptying the bladder can increase the risk of infections. The urine remaining in the bladder becomes a breeding ground for bacteria, often leading to frequent and recurrent UTIs.
3. Bladder Damage
The bladder works harder to push urine past the obstructed urethra from the pressing effect of the bigger prostate. The bladder muscles can weaken over time, resulting in poor bladder function even after the obstruction is relieved.
This can lead to chronic urinary retention.
4. Kidney Damage
With urinary retention and bladder damage, the urine flows back up into the kidneys, leading to hydronephrosis, or swelling of the kidneys.
This can eventually result in kidney failure if left untreated.
5. Bladder Stones
When urine remains in the bladder for extended periods, bladder stones can form. This is due to the hardening of the minerals in the urine, and adds to the risks of infection and irritation.
6. Blood in the Urine
This is a less common complication, but men with BPH may experience haematuria (blood in the urine) due to enlarged blood vessels on the surface of the prostate.
Treatment Options for Every Stage of BPH
The good news: BPH is manageable with a variety of treatment options tailored to symptom severity. The treatment options encompass medicines, surgery and other procedures.
The types of treatment recommended depends on the severity of symptoms, the size of the prostate and individual’s overall health.
1. Watchful Waiting
For men with mild symptoms, no treatment may be necessary right away. Doctors may recommend “watchful waiting” approach or active surveillance, involving close monitoring of symptoms over time to ensure they do not worsen.
During this time, lifestyle changes such as reducing fluid intake before bed or avoiding caffeine and alcohol can help manage symptoms. One can also consider taking supplements for prostate health, such as those contain saw palmetto or beta-sitosterol. There are some studies that show promise for these ingredients when it comes to BPH symptoms.
Medications
Medications are often the first line of treatment for mild to moderate BPH.
Before starting any medication for BPH, consult with your doctor. Medications can have side effects or interact with other treatments you might be taking, so avoid self-medicating. Your doctor will help tailor the treatment to ensure the best results and monitor for any potential complications.
Alpha Blockers
Function to relax the muscles of the prostate and bladder neck, making it easier to urinate.
Provide quick relief for muscles tension but do not reduce the prostate size.
Examples: Tamsulosin, Terazosin, Alfuzosin, Doxazosin
5-Alpha Reductase Inhibitors
Slow down the prostate growth by preventing hormone production that stimulates the growth.
May take several months to show results but are effective in reducing prostate size and improving symptoms.
Examples: Finasteride, Dutasteride
Combination Therapy
A combination of alpha blockers and 5-alpha reductase inhibitors to address both symptom relief and prostate size reduction, especially if a single class of medication use did not show its desired effects.
Example: DUODART (a capsule combining dutasteride and tamsulosin)
3. Surgery for BPH
Men with large and highly obstructing prostate may be recommended with surgical options if the lifestyle modifications, and medications are ineffective or with unbearable side effects.
Transurethral Resection of the Prostate (TURP)
This is the most common and effective surgery for BPH, where part of the prostate is removed to relieve obstruction. This surgery often requires 1 to 2 days of hospital stay for post-procedure observation.
Minimally Invasive Surgical Therapy (MIST)
Advanced surgical options such as minimally invasive surgical therapy (MIST) can provide long-lasting relief. These procedures are less damaging to the healthy tissues as compared to normal surgery. In addition to time-saving as an outpatient procedure, it also allows quicker recovery.
Water Vapor Therapy (Rezūm)
A technique that delivers heat via water vapour directly to prostate tissues, causing cell death to the targeted tissue and shrinking the prostate.
UroLift (Prostatic Urethral Lift) Implants
A procedure of inserting implants through the urethra to push the prostate tissues, opening the obstructed urethra channel.
Transurethral Microwave Therapy (TUMT)
Insertion of a small antenna through the urethra and emission of microwave energy that heats and destroys the excess prostate tissue that is blocking urine flow.
Others
“Not all prostates can be treated by minimally invasive surgery techniques.” shared Dr. Lee Fang Jann, urologist at URODOC, Singapore.
“Very large prostate of men who have complications from BPH, such as urinary retention, bladder stones or blocked kidneys may need surgery that can relieve large amounts of prostate tissue.”
In these rare occasions, open prostatectomy, an invasive surgery may be needed to remove obstructing tissue from greatly enlarged prostates.
Take Charge of Your Prostate Health
An enlarged prostate doesn’t have to control your life, but it’s essential to stay proactive. Recognising the signs and exploring treatment options early can help you manage symptoms effectively and prevent complications.
Treatment options range from lifestyle changes and medications to surgical options, making it possible to tailor care based on the individual’s conditions and symptoms.
“The choice needs to be individualised and carefully selected by the treating urologists based on the size and configuration of the patient’s prostate.” Dr. Lee cautioned.
Prioritise your health by scheduling regular check-ups with a urologist and learning more about how to protect your prostate for years to come.
Read more: My Prostate Health