Enlarged prostate: everything you need to know

We spoke to leading Essex-based consultant urologist, Mr Sam Datta about this condition, and how it can be treated.

What is enlarged prostate?

Benign prostate enlargement is used to describe when the prostate becomes enlarged seperate from cancer. It affects how you urinate and is non-cancerous and not a serious threat to health. 

Prognosis

If the symptoms you´re experiencing are mild and don't bother you then there is no need to visit a urologist. However, if symptoms become more severe and begin to impact your daily life then it may be time to visit a urologist.

If you are referred to a urologist, an assessment will be made and often this will be done by looking at your bladder diaries, your flow tests, and also how symptomatic you are.

Who is most likely to develop an enlarged prostate?

Lower urinary tract symptoms start in the 3rd decade of life with 10% of men affected. 25% of men in the 7th decade of life are affected by symptoms. Not all symptoms are caused by the prostate; some may be due to bladder overactivity, prostatitis or indeed scarring in the urethra (urine pipe). Approximately 20% of all men are affected by symptoms.

How serious is an enlarged prostate?

An enlarged prostate normally isn't that serious.It is making sure that there are no serious underlying conditions or red flags alongside an enlarged prostate. Your general practitioner or urologist will help in making this assessment.

Does having an enlarged prostate increase my risk of developing prostate cancer?

Many men worry that having an enlarged prostate will increase their risk of developing prostate cancer. However, there is no evidence to suggest that this is the case.

How is an enlarged prostate treated?

There are several types of treatments for bladder obstruction caused by the prostate. Treatments for an enlarged prostate may be altering your fluids that you take in, to medications that one would take, including prostate relaxers or even shrinkers of the prostate in the form of medication.

Lifestyle Changes

• Reduce intake of alcohol, caffeine, fizzy drinks and artificial sweeteners.
• Drink less fluids in the morning and avoid drinking 2 hours before bed.
• Go to the toilet regularly, ensuring that you go before a long journey or if you know you will be unable to go to the toilet for a long period of time.
• Double voiding- this is when you wait a few moments after peeing before trying to go again, as this empties your bladder properly.
• Eating more fibre – this can help to avoid constipation, which adds pressure to the bladder and worsens enlarged prostate
• Bladder training – this is the concept of training your bladder to hold off voiding for longer and therefore void less. Targets will be given e.g. to try and go 2 hours without voiding. The target will increase over time.

What medicines can help treat an enlarged prostate?

Medicines may be offered if lifestyle changes do not work well.

• Prostate relaxers or shrinkers.
• Alpha-blockers – these relax the muscle in the prostate gland muscle and at the base of the bladder, which makes urination easier.
• Anticholinergics- these relax an overactive bladder muscle.
• 5-alpha reductase inhibitors- these shrink the prostate glands.
• Diuretics-speed up the urination process.
• Desmopressin – this slows down urine production, reducing the amount of urine produced at night.

What surgical treatments are available for an enlarged prostate?

Normally surgical treatment for an enlarged prostate is unnecessary. However, surgical options are available. These include:

• Holmium laser prostate surgery- this shells out the prostate, leaving an outer rim of tissue support, the outer layer of the prostate, but the inner juicier layer causing the obstruction of the prostate being taken away.
• Transurethral resection of the prostate (TURP)- where the prostate is shaved down.
• Open prostatectomy- removal of the prostate gland via a cut in the body or indeed robotically.
• Prostatic urethral lift (PUL) implants- when implants are inserted to hold the enlarged prostate away from the urethra, preventing blocking.
• Prostate artery embolization- this is when a catheter is inserted into an artery in the groin or wrist. It is then passed into the blood vessels which supply the prostate gland.
• Botulinum toxin – botulinum toxin is injected into the bladder's walls and helps men whose bladder muscles contract before the bladder is full.
• Steam ablation –  steam is used to reduce obstructing prostatic tissue. 

Are all treatments invasive?

Treatments vary; some are more invasive than others. Treatment options are personal to each patient. Part of the treatments for an enlarged prostate will depend on your attitude towards risks such as some of the more invasive procedures, which may entail a certain degree of risk in terms of incontinence or problems with erections or ejaculation afterwards.

More minimally invasive treatments can be performed under local anesthesia e.g. Prostatic urethral lift devices and prostatic embolisation. Some of the more minimally invasive treatments such as steam (Rezume) of the prostate is performed as day case. Laser holmium enucleation can sometimes be performed as day case but usually performed with a one-night stay.
 

As mentioned, there are multiple treatment options available. Your urologist will discuss suitable options with you, assess your attitudes to risk, what your own priorities and goals are, and decide together the most appropriate treatment for you.

Are there complications associated with an enlarged prostate?

There can be complications linked to benign prostate enlargement. These include:

• Urinary tract infection (UTI)
• Stone formation in the bladder
• Bleeding from the prostate
• Chronic retention with high pressure on the kidneys.
• Acute urinary retention. This is the sudden inability to pass urine. 

Symptoms include:

• Suddenly being unable to pee
• Severe lower tummy pain
• Swelling of the bladder