Enlarged Prostate Treatment Options

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.

Enlarged prostate treatment options are vast and variable including:

• Observation
• Lifestyle modifications:
  Lifestyle modifications to manage enlarged prostate symptoms in general involves adjusting diet and/or fluid intake. Many urinary symptoms that might be caused by prostate enlargement can be further exacerbated by certain foods or activities. In addition, certain chronic medical conditions can also exacerbate urinary symptoms, and so should be treated and optimized.

• Medications:
  Medications for enlarged prostate are primarily focused on relaxing the muscles within the prostate gland, though others may decrease the prostate size gradually over time. The result is often easier passage of urine and alleviation of urinary symptoms, but to what degree and with certain secondary side effects can be somewhat variable. There are other medications that improve bladder storage and sensitivity, which also may improve urinary symptoms secondary to prostate enlargement.
• Alpha blocker medications
• Daily dose of Tadalafil or Mirabegron:
  Tadalafil can be used to treat both mild symptoms of erectile dysfunction and urinary symptoms from prostate enlargement. 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.

• Office-based procedures and surgery:
  In general, surgeries and office-based procedures to treat prostate enlargement and the resultant urinary symptoms are focused on either removing or diminishing the degree of obstruction caused by tissue overgrowth.
• TURP (transurethral resection of the prostate gland) procedure
• Water vapor thermal therapy:
  Water vapor thermal therapy is introduced via a small needle into the prostate gland, which injects steam to treat and ultimately shrink the tissue.

• Prostatic urethral lift:
  Prostatic urethral lift is a similar concept that deploys small sutures (strings) with metallic ends to compress and prop open the prostate, thus alleviating obstruction.

Patients often select one of these options based on the severity of their symptoms, goals of care, aversion to risk or risks specific to each treatment, and longevity of the treatment. The success of the treatment is evaluated on the patient’s improvement of urinary symptoms and so quality of life.

Similarly, any side effects from the treatment also need to be monitored and addressed if problematic and alternative treatment plans should be pursued if the patient is not satisfied with the quality of life as related to their prostate enlargement, urinary symptoms, or sexual function.