PROSTATE FOCAL THERAPY

PROSTATE FOCAL THERAPY

Prostate Gland Enlargement – BPH

Prostate Gland Enlargement – BPH

Benign prostatic hyperplasia (BPH), also known as prostate enlargement, is a common condition as men age. The prostate surrounds part of the urethra, the tube that carries urine and semen out of the body. An enlarged prostate gland can cause bothersome urinary symptoms, such as blocking the flow of urine out of the bladder. It can also lead to bladder, urinary tract, or kidney problems.

There are several effective treatments for prostate enlargement, including medications, minimally invasive therapies, and surgery. You and your doctor will consider your symptoms, the size of your prostate, any other health conditions you may have, and your preferences when choosing the best option.

How common is benign prostatic hyperplasia (BPH)?

BPH is the most common prostate problem in men. Nearly all men experience some prostate enlargement as they age. By the age of 60, about 50% of men will have some symptoms of BPH; by age 85, about 90% will have symptoms. Around half of these men will develop symptoms that require treatment.

Symptoms

The severity of symptoms in people with an enlarged prostate varies but tends to worsen over time. Common signs and symptoms of BPH include:

  • Frequent or urgent need to urinate
  • Increased frequency of urination at night (nocturia)
  • Difficulty starting urination
  • Weak urine stream or a stream that starts and stops
  • Dribbling at the end of urination
  • Inability to completely empty the bladder

The size of your prostate does not always determine the severity of your symptoms. Some men with only slightly enlarged prostates may have significant symptoms, while others with very enlarged prostates may have only minor urinary symptoms.

In some men, symptoms may stabilize or even improve over time.

You should see your doctor immediately if you have any of the following symptoms:

  • Pain in the lower abdomen or genital area while urinating
  • Inability to urinate
  • Painful urination accompanied by fever and/or chills
  • Blood in the urine

Does having benign prostatic hyperplasia (BPH) increase the risk of prostate cancer?

Research to date suggests that having BPH does not increase your risk of developing prostate cancer. However, BPH and prostate cancer share similar symptoms, and an undiagnosed cancer could be present in a man with BPH.

How is benign prostatic hyperplasia (BPH) diagnosed?

Your doctor will review your medical history and perform a physical exam.

Some tests may be done to help diagnose the condition, including:

  • Assessing the severity of your symptoms
  • A flow study to measure how slow your urine stream is compared to normal
  • A post-void residual test (using ultrasound) to see how much urine remains in your bladder after urination
  • A cystoscopy to examine the inside of the bladder

Treatment

There are a wide range of treatments available for an enlarged prostate, including medications, minimally invasive therapies, and surgery. The best treatment for you depends on several factors, such as:

  • The size of your prostate
  • Your age
  • Your overall health
  • The degree of discomfort or inconvenience your symptoms cause

If your symptoms are tolerable, you may choose to delay treatment and monitor your symptoms. In some men, symptoms may improve without treatment.

Medications

Medication is the most common treatment for mild to moderate symptoms of prostate enlargement. Options include:

  • Alpha blockers: These drugs relax bladder neck muscles and muscle fibers in the prostate, making urination easier. Alpha blockers such as alfuzosin (Uroxatral), doxazosin (Cardura), tamsulosin (Flomax), and silodosin (Rapaflo) often work quickly in men with relatively small prostates. Side effects may include dizziness and retrograde ejaculation—a harmless condition where semen enters the bladder instead of exiting through the penis.

  • 5-alpha reductase inhibitors: These drugs shrink the prostate by preventing hormonal changes that cause growth. They include finasteride (Proscar) and dutasteride (Avodart). These may take up to six months to be effective. Side effects can include retrograde ejaculation.

  • Combination therapy: If one medication alone is not effective, your doctor may recommend using both an alpha blocker and a 5-alpha reductase inhibitor.

  • Tadalafil (Cialis): Studies suggest this drug, often used to treat erectile dysfunction, may also help treat prostate enlargement.

Minimally invasive or surgical therapy

Minimally invasive or surgical therapy may be recommended if:

  • You have moderate to severe symptoms
  • Medications fail to relieve your symptoms
  • You have urinary tract obstruction, bladder stones, blood in your urine, or kidney problems
  • You prefer a definitive treatment

Minimally invasive or surgical therapy may not be an option if you have:

  • An untreated urinary tract infection
  • Urethral stricture disease
  • A history of prostate radiation or urinary tract surgery
  • A neurological disorder such as Parkinson’s disease or multiple sclerosis

All prostate procedures can cause some side effects. Depending on the procedure, complications may include:

  • Retrograde ejaculation
  • Temporary difficulty urinating
  • Urinary tract infection
  • Bleeding
  • Erectile dysfunction
  • Rarely, loss of bladder control (incontinence)

There are many types of minimally invasive or surgical treatments:

Transurethral resection of the prostate (TURP)

A lighted scope is inserted into your urethra, and the surgeon removes all but the outer part of the prostate. TURP usually relieves symptoms quickly, and most men have a stronger urine stream soon after. A temporary catheter may be needed to empty your bladder after the procedure.

Transurethral incision of the prostate (TUIP)

A scope is inserted into your urethra, and the surgeon makes one or two small cuts in the prostate to ease urine flow. This procedure is an option for men with smaller to moderately enlarged prostates, especially those with other health issues that make other surgeries riskier.

Transurethral microwave thermotherapy (TUMT)

A special electrode is inserted into your prostate through the urethra. Microwave energy destroys the inner part of the enlarged prostate, reducing its size and improving urine flow. TUMT may only partially relieve symptoms, and results can take time. Repeat treatment may be needed, so it’s usually reserved for special cases with small prostates.

Transurethral needle ablation (TUNA)

A scope is inserted into the urethra, allowing the doctor to place needles into the prostate. Radio waves pass through the needles to heat and destroy excess tissue. TUNA is rarely used today but may be an option in specific cases.

Laser therapy

High-energy lasers destroy or remove excess prostate tissue. Laser treatments typically relieve symptoms immediately and have a lower risk of side effects than non-laser surgeries. They are especially useful for men who can’t undergo other procedures due to blood-thinning medications.

Laser treatment options include:

  • Ablative procedures: These vaporize obstructive prostate tissue to increase urine flow. Examples include photoselective vaporization (PVP) and holmium laser ablation of the prostate (HoLAP). These may cause urinary symptoms after surgery and may require repeat procedures.
  • Enucleation procedures: Procedures such as holmium laser enucleation of the prostate (HoLEP) remove all obstructive tissue and prevent regrowth. Removed tissue can be tested for cancer or other conditions. These are similar to open prostatectomy.

Prostatic urethral lift (PUL)

Special implants compress the sides of the prostate to increase urine flow. This may be recommended if you have lower urinary tract symptoms and are concerned about sexual side effects. Compared to TURP, PUL has fewer impacts on ejaculation and sexual function.

Rezum

Rezum is a treatment for benign prostate enlargement using steam (water vapor) to shrink the overgrown prostate tissue. It can be done without general anesthesia. A special device is inserted through the tip of the penis into the urethra to reach the enlarged tissue. Steam is delivered through a needle using radiofrequency energy to destroy the excess tissue. It can be applied to the right, left, and middle lobes as needed. Each application lasts about 9 seconds. The procedure takes 10–30 minutes and can be done on an outpatient basis.

Embolization

This experimental procedure involves selectively blocking blood flow to or from the prostate, leading to shrinkage. Long-term data on its effectiveness are not yet available.

FOCAL THERAPIES (Cryoablation, HIFU, IRE)

Focal therapy for BPH uses various energy sources to ablate (destroy) specific parts of the prostate without entering through the penile urethra, unlike other invasive techniques.

These methods can treat BPH effectively with minimal side effects, comparable to standard methods like TURP or HoLEP. A major advantage is avoiding urethral interventions, which reduces the risk of strictures.

Energy sources used include Cryoablation, Irreversible Electroporation (IRE), and HIFU.

Cryoablation: Thin metal probes are inserted through the skin into the prostate. A gas freezes the nearby prostate tissue, destroying it without harming surrounding structures like sperm ducts, nerves, bladder, or urethra.

IRE (Irreversible Electroporation): Thin metal probes are inserted through the skin into the prostate. Strong electric fields are generated between the probes, causing cell death in targeted areas. This destroys prostate tissue without affecting surrounding structures.

HIFU (High-Intensity Focused Ultrasound): Uses focused ultrasound waves to heat and destroy prostate tissue. The heat reaches about 90°C in seconds at the focal point, destroying the tissue without damaging surrounding healthy areas.

Open or robot-assisted prostatectomy

A surgical incision is made in the lower abdomen to access and remove the prostate tissue. This is typically done if the prostate is very large or there is bladder damage or other complications. It usually requires a short hospital stay and carries a higher risk of blood transfusion.

Follow-Up

Follow-up care depends on the specific technique used to treat your enlarged prostate.