What is the latest treatment for enlarged prostate?

The prostate is a gland that sits at the bottom of the bladder and wraps around the urethra. The urethra is like a tube, where urine exits through from the bladder to the outside of the body. An enlarged prostate occurs primarily as function of genetics and time. As the prostate gets larger it may obstruct or block the flow of urine, resulting in a variety of problems or symptoms related to urination.

Urologists have long been treating urinary symptoms secondary to prostate enlargement for more than 50 years, combining both medical and surgical treatment strategies to address this common problem.

In the 1960’s, alpha blocker medications, which were initially developed and employed for the purpose relaxing muscles in the prostate gland, have gradually become more accessible and specific for the prostate tissue. Additional medications have also been developed and improved, but one of the newest is a daily dose of tadalafil. Tadalafil can be used to treat both mild symptoms of erectile dysfunction and urinary symptoms from prostate enlargement. In addition to this, other medications for urinary symptoms, such as mirabegron, can also be used to improve bladder storage and relaxation and alleviate the urinary symptoms of urgency and frequency that can sometimes co-exist or be a result of prostate enlargement.

One of the oldest surgical treatment strategies, the TURP (transurethral resection of the prostate gland) procedure, is still performed today. This minimally invasive procedure involves having a patient put to sleep under anesthesia and having a camera with special instruments that can be advanced through the urethra into the urinary bladder. These instruments can then be used to shave down the interior of the prostate gland. The newest treatment options all build upon this concept of removing and/or relieving the obstruction that is blocking the flow of urine.

Some of the newest treatment options, such as water vapor thermal therapy and prostatic urethral lift, can be done in the office without putting the patient to sleep, though these still employ medications to diminish discomfort with these relatively shorter procedures. With each, a camera is inserted into the urethra, and with water vapor thermal therapy a small needle is introduced into the prostate gland which injects steam to treat and ultimately shrink tissue. Prostatic urethral lift is a similar concept that deploys small sutures (strings) with metallic ends to compress and prop open the prostate to alleviate obstruction.

The newer surgical techniques, building upon the concept of removing tissue from the interior of the prostate gland, can either use lasers or water to destroy or remove the obstructing tissue. In addition, there is another newer procedure performed by intervention radiologists to stop the blood flow to portions of the prostate gland, and to decrease prostate size and improve urinary symptoms.