THE CHANGING MANAGEMENT OF BENIGN PROSTATIC
HYPERTROPHY (BPH)
Seventy-five
percent of men over the age of 50 have some symptoms arising from BPH.
Essentially 20-40% of these men will require some form of therapy, most
commonly transurethral resection of the prostate (TURP). The etiology of BPH
has yet to be defined.
Although TURP
is an ideal therapy for BPH, there is considerable impetus for the
development of alternative therapies for this disease. Current and future
alternatives are being discussed.
CURRENT TREATMENT
ALTERNATIVES
Watchful Waiting
Patients
adopting a "watchful waiting" strategy are those who are generally tolerant
of their symptoms and elect no treatment after being informed of all the
options and associated risks. This is a decision made by the patient, his
physician, and his urologist after he has been evaluated as an unlikely
candidate for an occult malignancy or "silent prostatism".
Transurethral Resection of the
Prostate (TURP)
TURP is the
"gold standard" to which all forms of BPH therapy must be compared. Although
the procedure is considered extremely safe, there is a finite postoperative
mortality or morbidity associated with it as there is with any surgical
procedure. The overall safety and efficacy of TURP remains quite high.
Transurethral Vaporization of the Prostate
This therapy
is very similar to transurethral resection of the prostate except a higher
energy is used along with a different resecting instrument that actually
vaporizes the prostatic tissue with only minimal bleeding. The advantage of
this procedure is that it requires a shorter hospital stay (usually 24 hours
or less) and continues to produce good long-term results.
Open Prostatectomy
Open removal
of the BPH is an effective and safe alternative usually reserved for
patients with extremely large obstructing glands.
Medication Therapy for BPH
Medication
can be effective in the early stages of prostatic enlargement. Terazosin (Hytrin)
and doxazosin (Cardura) are selective alpha-1 blocking agents which can
provide objective relief of BPH symptoms by relaxing the bladder neck. These
medications may obviate the need for surgery in some patients with BPH.
Proscar (finasteride) is a potent alpha reductase inhibitor which reduces
the concentration of dihydrotestosterone in the prostate cell. The prostate
cell "shrinks" and plasma levels of testosterone remain normal. In clinical
trials, the prostate will shrink an average of 30% and will help many
patients avoid surgery. Indications should be discussed with your physician.
Combination Medical Therapy
Combination
medical therapy is possible with an alpha-1 blocking agent and Proscar.
Microwave Thermotherapy
Microwave
thermotherapy is available now that the FDA and Medicare have approved
Prostatron.. This is a one-hour outpatient microwave energy treatment
performed using only local anesthesia that is extremely safe. The Prostatron
has been widely used in Europe and Japan for many years. For many patients,
the Prostatron has proven to be an effective alternative to surgery and
long-term medications. Physician evaluation is necessary before a patient
can be determined eligible for this treatment.
TransUrethral Needle Ablation of the Prostate (TUNA)
The
TransUrethral Needle Ablation of the Prostate, or TUNA, procedure utilizes
low levels of radiofrequency energy to selectively ablate the obstructing
portion of the prostate. This can be done as a simple and quick outpatient
treatment and is easily tolerated by patients. Also, studies have shown that
the TUNA procedure can be as effective as the TURP in relief of symptoms.
Laser Surgery
Laser fibers
heat the prostate gland and cause the tissue to die and be sloughed off in
the urine. There appears to be less postoperative bleeding with this method
when compared to traditional surgical methods; the symptom relief seems
comparable. The long-term efficacy of the treatment remains unknown at this
time.
Transurethral incision of the
prostate (TUIP)
TUIP is used
when the enlargement of the prostate and the obstruction to the urethra are
moderate. TUIP involves making one or two small cuts in the prostate to
reduce pressure on the urethra.
Which Treatment is for Me?
This is best
determined after a urologic consultation. F.U.S. offers all the above
options and has pioneered some of the new therapies offered. An evaluation
by a urologist is essential to rule out occult malignancy or "silent
prostatism" before treatment begins.
A patient
with symptomatic BPH should be evaluated by a urologist who can inform him
of all the treatment alternatives.
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