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Prostate, Treatments and drugs

Treatment for an enlarged prostate is determined by your signs and symptoms and their severity. If you have significant problems, such as urinary bleeding, persistent urinary tract infections, bladder and kidney damage, your doctor will probably recommend treatment. If your prostate is enlarged but your symptoms aren't too bothersome, treatment may not be necessary.

A wide variety of treatments are available to ease the signs and symptoms of an enlarged prostate. They include medications, other nonsurgical therapies and surgical procedures.

Medications
Medications are the most common method for controlling moderate symptoms of prostate enlargement and include:

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      Alpha blockers. These drugs were originally developed to treat high blood pressure. They relax muscles around your bladder neck and make it easier to urinate. Four alpha blockers have been approved by the Food and Drug Administration (FDA) for treatment of BPH: terazosin (Hytrin), doxazosin (Cardura), tamsulosin (Flomax) and alfuzosin (Uroxatral).

      All four alpha blockers are equally effective. These medications work quickly. Within a day or two, you'll probably have increased urinary flow and need to urinate less often. Doctors are uncertain about the long-term benefits and risks of alpha blockers. To reduce your risk of side effects, your doctor may start with a low dose of medication and gradually increase the dosage.

      Alpha blockers taken with drugs for impotence, such as sildenafil (Viagra), vardenafil (Levitra) and tadalafil (Cialis), may interact and cause low blood pressure. Discuss with your doctor the possible side effects of these medications before taking them.

      Alpha blockers can cause a pupil disorder that interferes with eye surgery. If you take tamsulosin or any other alpha blocker, be sure to tell your eye doctor if you're planning to have eye surgery. Some of the alpha blockers can cause dizziness and lightheadedness if you stand up too fast. In many cases simply changing from one type to another is all that needs to be done.
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      Enzyme (5 alpha reductase) inhibitors. These drugs shrink your prostate gland. Two that have been approved by the FDA for BPH are finasteride (Proscar) and dutasteride (Avodart).

      For some men with large prostates, these drugs may produce a noticeable improvement in symptoms. They're generally not effective for men who have only a moderately enlarged or normal-sized prostate.

      Enzyme inhibitors take longer to work than alpha blockers do. You may notice some urine flow improvement after a few months, but it can take up to a year for complete results.

      Finasteride and dutasteride lower prostate-specific antigen (PSA) levels in your blood. Your doctor needs to know that you're taking these medications to properly interpret your PSA test results.
    * Combination drug therapy. Taking an alpha blocker and an enzyme inhibitor at the same time can sometimes be more effective than taking just one type of BPH drug. Combination therapy can be more effective for relieving symptoms and preventing your symptoms from getting worse. It can also be more effective at lowering your long-term risk of developing acute urinary retention or needing surgery. The most tested combination is doxazosin and finasteride, though it's believed any combination of alpha blocker and enzyme inhibitor is equally effective.

Nonsurgical therapies
Also called minimally invasive treatments, several nonsurgical treatment methods are available to reduce the size of the prostate. These therapies focus on enlarging the urethra, making it easier for you to urinate. These include:
      Microwave therapy. Also called transurethral microwave therapy (TUMT), this procedure uses heat in the form of microwave energy to safely destroy the inner portion of the enlarged prostate gland.
      Your doctor will insert a catheter through the tip of your penis. A tiny internal microwave antenna inside the catheter delivers a dose of microwave energy that heats and destroys enlarged cells. A local anesthetic helps control pain. You may feel some heat in the prostate and bladder area and have a strong desire to urinate. These responses usually disappear after the treatment is finished. You can go home when you're urinating satisfactorily, usually the same day.
      The size and shape of an enlarged prostate is critical to the success of microwave therapy. If your prostate is very large or growing in an unusual shape into your bladder, this treatment generally isn't effective. TUMT isn't recommended if you have a pacemaker or any metal implants.
      It may take several weeks before you begin to see a noticeable improvement in your symptoms. Those who seem to respond best over time are men whose initial symptoms are mild. The long-term effectiveness of the procedure is uncertain.
      It's normal to have frequent, painful urination and small amounts of blood in your urine during recovery. You may ejaculate less semen after the procedure. However, unlike more invasive surgery, TUMT generally doesn't produce impotence, incontinence or retrograde ejaculation - semen flowing backward into the bladder instead of out through the penis during ejaculation.
      Transurethral needle ablation (TUNA). Also called radiofrequency therapy, this outpatient procedure uses radio waves to heat and destroy the part of your prostate that's blocking urine flow.
      During this procedure, a cystoscope is passed into your urethra and needles are placed into your prostate gland under visual guidance. Radio waves pass through the needles and heat the prostate and destroy the blockage.
      TUNA typically is less effective than is traditional surgery in reducing symptoms and improving urine flow. Its long-term effectiveness also isn't known. Another drawback of the procedure is that it doesn't work as well in men who have very large prostates. Side effects may include urine retention, blood in your urine, painful urination and a small risk of retrograde ejaculation.
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      Interstitial laser therapy (ILT). Also called interstitial laser coagulation, this procedure destroys overgrown prostate tissue by directing laser energy at the inside of your enlarged prostate gland.
      During ILT, a small tube containing a laser fiber is inserted through a cystoscope into the prostate tissue by puncturing through the part of the urethra that's next to your prostate. Several punctures are usually needed to treat the entire prostate. Once the laser fiber is inside the prostate tissue, laser energy is activated to heat and destroy the tissue and shrink the gland.
      You may be given spinal or general anesthesia to control pain. Or, you may be given a combination of local anesthetics in the urethra and intravenous sedation.
      You may have small amounts of blood in your urine for a few days after treatment. Most men resume routine activities and sexual activity in a week or two.
      Laser therapy is used less commonly than TUMT or TUNA. It's similar to other heat therapies, except it uses a laser instead of microwave energy, radio waves or electrical current to produce heat. It generally doesn't cause impotence or prolonged incontinence.
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      Prostatic stents. A prostatic stent is a tiny metal coil that is inserted into your urethra to widen it and keep it open. Tissue grows over the stent to hold it in place.
      Although this procedure produces little or no bleeding and doesn't require a catheter, in most cases doctors don't consider stents a viable long-term treatment. Usually, they are used only for men who are unwilling or unable to take medications or who are reluctant or unable to have surgery.
      While stents can provide immediate relief, some men find that stents don't improve their symptoms. A stent may shift positions, cause painful urination or frequent urinary tract infections. Stents often become obstructed by tissue growth and can be extremely difficult to remove. These side effects, along with the cost, have made stents a less popular treatment option. They're not the best choice for most men.