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Should I be worried if my prostate is enlarged?

Many people worry that having an enlarged prostate means they have an increased risk of developing prostate cancer. This isn't the case. The risk of prostate cancer is no greater for people with an enlarged prostate than it is for those without an enlarged prostate.

nhsinform.scot - Benign prostate enlargement - Illnesses & conditions - NHS inform

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The treatment for an enlarged prostate gland will depend on how severe your symptoms are.

The three main treatments are:

lifestyle changes

medication

surgery

If your symptoms are mild to moderate, you may not receive any immediate medical treatment, but you'll have regular check-ups to carefully monitor your prostate gland. This is often referred to as "watchful waiting". You may also be advised to make lifestyle changes to see whether they improve your symptoms. The various treatments for prostate enlargement are outlined below. You can also read a summary of the pros and cons of the treatments for prostate enlargement, allowing you to compare your treatment options.

Lifestyle changes

If your prostate gland is enlarged, you may be advised to:

avoid drinking any liquids for one to two hours before going to bed – this will reduce your chances of waking up during the night to pass urine (nocturia) experiment with the time you take prescribed medication – for example, taking it at 7pm may help prevent nocturia stop drinking alcohol and caffeine, or limit your consumption of them – these drinks can irritate your bladder and make your symptoms worse exercise regularly – research shows moderate exercise, such as walking for 30 to 60 minutes a day, can improve symptoms, although it's unclear exactly why this is the case join a patient support group – your doctor should be able to recommend one, which may help you manage mild symptoms without the need for medication

Bladder training

Bladder training is an exercise programme that aims to increase the time between urination and the amount of urine your bladder can hold. You'll be given a target, such as waiting at least two hours between each time you urinate. It's a good idea to use a bladder training chart, which allows you to record each time you pass urine and the volume of urine passed – you'll need a plastic jug to measure this. Your doctor should give you a chart to take home. You'll also be taught a number of exercises, such as breathing, relaxation and muscle exercises, to help take your mind off the need to urinate. Over time your target time will be increased, and at the end of the programme you should find that you're able to go for longer without urinating.

Bladder training should only be carried out under medical supervision.

Medication

Medication, in combination with the lifestyle changes above, is usually recommended to treat moderate to severe symptoms of benign prostate enlargement.

Finasteride or dutasteride

Finasteride and dutasteride are widely used to treat benign prostate enlargement.

They block the effects of a hormone called dihydrotestosterone (DHT) on the prostate gland, which can reduce the size of the prostate and improve your associated symptoms.

Find out about the causes of prostate enlargement

If you're prescribed one of these medications, you may experience an immediate improvement in symptoms. However, you'll need to take it for at least six months to get the maximum benefit, and your doctor will need to monitor you every year. Use condoms if you're sexually active – both finasteride and dutasteride can have an adverse effect on your sperm. If you get a woman pregnant, there's a risk the baby could develop birth defects. Other possible side effects can also include impotence and little or no sperm when you ejaculate. In many cases, these side effects will improve as your body gets used to the medication. See your GP if the side effects are troubling you.

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Alpha blockers

Alpha blockers help relax the muscles of your bladder, making it easier to pass urine. You may be prescribed alpha blockers as your primary treatment or in combination with finasteride. Tamsulosin and alfuzosin are two alpha blockers commonly used to treat benign prostate enlargement. Side effects of tamsulosin and alfuzosin are uncommon and usually mild.

They include:

dizziness

headaches

weakness

little or no sperm when you ejaculate

You should only begin taking alpha blockers over a restful weekend when you're not planning to drive, as there's a risk they could cause low blood pressure (hypotension) and fainting. Generally, if you experience dizziness while taking this medication, avoid driving or operating heavy machinery until it's passed.

Surgery

Surgery is usually only recommended for moderate to severe symptoms of benign prostate enlargement that have failed to respond to medication.

Various procedures can be used to reduce the pressure on your bladder.

Transurethral resection of the prostate (TURP)

Transurethral resection of the prostate (TURP) involves inserting a small instrument called a resectoscope into your urethra, the tube that carries urine from the bladder to the penis. A wire loop heated by an electric current is used to remove excess tissue from your prostate. TURP is carried out using either a general anaesthetic, where you're asleep, or a spinal anaesthetic, where you're awake, but the lower half of your body is numbed. The procedure can take up to an hour, depending on how much tissue needs to be removed. Most people are well enough to leave hospital two to three days after the operation. After surgery, you'll be unable to urinate normally at first because of your swollen urethra. A thin tube called a catheter will be inserted into your urethra and up into your bladder to allow urine to drain away. This will usually be removed 24 to 48 hours after surgery. A common complication of TURP is you'll no longer produce semen when you ejaculate. This is known as retrograde ejaculation. It causes sperm to go into your bladder rather than out of your penis during ejaculation. However, you'll still experience the physical pleasure associated with ejaculation (the climax).

Bladder neck incision (TUIP)

Bladder neck incision involves widening the urethra so it is easier to pass urine. It is also known as transurethral incision of the prostate (TUIP). Like TURP, the surgeon will insert a resectoscope into your urethra. The resectoscope has a heated wire loop at the end and is used to make small cuts (incisions) in the muscle where the prostate meets the bladder. This type of surgery relaxes the opening to the bladder, helping urine flow out of it. As with TURP, TUIP is carried out under a spinal or general anaesthetic. After surgery, you may not be able to urinate and a catheter may be needed to empty your bladder. Like TURP, you'll only need to use a catheter for a short time until you're able to urinate normally. There's less of a risk of retrograde ejaculation with TUIP compared with TURP, although it can sometimes still occur.

Holmium laser enucleation of the prostate (HoLEP)

Holmium laser enucleation of the prostate (HoLEP) is similar to a TURP. Excess prostate tissue is removed using an instrument inserted through the urethra. However, it uses a laser, rather than a wire loop. There are some advantages to using this technique rather than a TURP, but also some disadvantages.

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If you have been offered a HoLEP, you may want to ask your surgeon to explain why this was chosen for you, and the risks and benefits compared with TURP.

Insertion of prostatic urethral lift implants

The insertion of prostatic urethral lift implants is a new surgical procedure that can help relieve urinary symptoms.

The procedure can be carried out under local anaesthesia or general anaesthesia.

It involves inserting tiny implants through the urethra. The implants are then positioned to hold the enlarged prostate away from the urethra so it isn't blocked. One of the big advantages of prostatic urethral lift implants compared with TURP and TUIP is a reduced risk to your sexual function – there is less chance of erectile dysfunction and ejaculation problems. There's also less tissue injury, which means your recovery will be quicker and you won't need to stay in hospital as long. However, prostatic urethral lift implants are unlikely to provide permanent symptom relief in all cases. And as it's a new procedure, the long-term outcomes are unknown and availability may be limited.

Transurethral vaporisation of the prostate (TUVP)

Transurethral vaporisation of the prostate (TUVP) is similar to a TURP, but parts of the prostate are destroyed (vaporised) rather than cut away. Studies have shown that TUVP is as effective as TURP at improving symptoms. But some men and anyone with a prostate may need more treatment in the future.

Greenlight laser surgery (PVP)

A laser can sometimes be used to destroy the prostate tissue. This particular form of TUVP is called photoselective vaporisation of the prostate (PVP), or Greenlight laser surgery. A thin, flexible instrument called a cytoscope is inserted into the urethra. A laser fibre is then passed through the cytoscope to destroy the excess prostate tissue that is blocking the urine flow. The procedure is recommended for those who don't have a high risk of developing complications from treatment, such as men and anyone with a prostate who:

doesn't have urinary retention

doesn't have an increased risk of bleeding

has a prostate smaller than 100ml

In these "low-risk" groups, Greenlight laser surgery is thought to be as effective as TURP, but also has several benefits.

These include:

a shorter hospital stay – the procedure is often carried out as a day case

the catheter can be removed sooner

recovery is quicker

there's a lower risk of complications

The National Institute for Health and Care Excellence (NICE) website has more information about GreenLight XPS for treating benign prostatic hyperplasia.

Open prostatectomy

An open prostatectomy is a procedure that may be more effective than TURP if you have severe benign prostate enlargement. However, it's now rarely used, even for larger prostates, because other techniques have been developed, such as HoLEP. During an open prostatectomy, an incision will be made in your tummy and the outer portion of your prostate will be removed. The procedure carries a higher risk of complications, such as erectile dysfunction and urinary incontinence. There's also a greater chance that these complications will become permanent than if they occur after TURP.

nhsinform.scot - Benign prostate enlargement - Illnesses & conditions - NHS inform

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