What you should know about benign prostate enlargement

Benign prostate enlargement (BPE) is a condition that commonly affects ageing men -- nearly 80 per cent of men over 70 years old in the UK have it. It is when the prostate, a gland that sits below the bladder in the male anatomy, increases in size. Normally it should be the size of a walnut, but it may grow to three times that size, causing the urinary tract to be obstructed. This can lead to discomfort and urinary issues. Miss Jean Macdonald, a celebrated urologist, discusses aspects of the condition and the available options for treatment.

Symptoms of BPE:

• incontinence
• increased urgency to urinate in the day and during nighttime (nocturia)
• difficulties or hesitating when initiating urination
• difficulties maintaining a steady stream or intermittent stream
• blood in the urine

What causes BPE?

There is no known certain cause for BPE. It is more likely to occur in men who have a personal or family history of heart disease, use medications to lower blood pressure (beta-blockers), or do not maintain their physical fitness. It is thought that exposure to testosterone over time may contribute to the growth of the prostate; thus, it’s a condition common in ageing men due to continued exposure over many years.

BPE shouldn’t arouse any panic at the initial diagnosis — it’s called “benign” for a reason. When diagnosed and treated in an appropriate time frame, BPE will only cause difficulties with urination. However, if unaddressed for too long, patients might suffer from sexual dysfunction, complete urethral blockage, urine infections, and even kidney stones and failure.

When the prostate enlarges, there is also an increase in prostate-specific antigen (PSA) in the blood, something that also happens with prostate cancer. Whilst patients might be fearful of prostate cancer, there is no proof of a direct relationship between BPE and prostate cancer; however, it is always a good idea to be screened for cancerous concerns when the opportunity becomes available.

How can BPE be treated?

There are several ways to tackle BPE. Medicinal therapy treatments such as the prescription of tamsulosin, to relax the muscles in the prostate, and finasteride, to shrink the tissue of the prostate, can help ease the obstruction and allow urine to flow normally. These treatments are not suitable for all patients, so the doctor may instead recommend a form of surgery instead, like a prostatectomy (where the inside of the prostate is removed) or the most common transurethral resection (where a resectoscope is used to remove a portion of the prostate using a laser and a catheter). The technology of surgical interventions for BPE has made leaps and bounds in the last decades and many methods are minimally invasive, such as:

• Aquablation, which uses a high-pressure water jet to remove excess tissue in the prostate. The surgery lasts around an hour and is precise to the anatomy of each patient due to the assistance of a robot. This may require the patient to be under a local or general anaesthetic
• Rezūm, a transurethral procedure in which thermal water vapour is injected into the urethra to make the prostate shrink away from the sides of the urethra. This is a shorter process and can be done with light sedation or under a local anaesthetic.
• Holmium laser enucleation of the prostate (HoLEP) uses a laser beam to burn away and cauterise the tissue causing the obstruction. This procedure requires general anaesthesia and can be done within three to four hours.

All three of these methods have reported high rates of satisfaction from patients and quick recovery time. Your doctor will discuss the best option for you with consideration of your lifestyle, medical history, and current condition.

If you are currently struggling with urinary or prostatic issues, Miss Jean Macdonald is an experienced urologist in London and Essex and is available for consultation via her Top Doctors profile.