The gradual enlargement of the prostate gland with age is “the most common benign disease of mankind,” says Dr. Kevin R. Loughlin, director of urologic research at Brigham and Women’s Hospital in Boston.
And while many men now try to treat it with herbal remedies, many still prefer the traditional therapies, for which there are considerably more data. Some combine both approaches.
Although benign prostatic hyperplasia, or BPH, does not lead to prostate cancer, both BPH and prostate cancer are hormone-driven. Testosterone drives prostate cancer. A hormone called DHT, or dihydrotestosterone, made from testosterone, drives BPH.
Several types of prescription drugs are used to treat BPH. For mild cases, doctors often use “alpha blocking” drugs such as Hytrin, Cardura or Flomax that improve urination by relaxing the muscles in the urethra, the tube through which urine flows. Hytrin and Cardura are also used to treat high blood pressure, and in some men being treated for prostate problems, may cause a sharp drop in pressure.
For men with more advanced BPH, a drug called Proscar, which blocks the conversion of testosterone to dihydrotestosterone, can help. In theory, because Proscar blocks DHT but not testosterone itself, libido and potency are not affected, but in practice, some men taking Proscar do encounter these side effects.
Proscar can also muddy the results of the PSA, or prostate specific antigen, test used to detect prostate cancer. (The PSA test is imperfect to begin with: a high score may indicate cancer, BPH or even just a prostate infection; conversely, a man can have cancer, BPH or an infection with a normal score.)
After several months on Proscar, PSA levels often drop by half. In general, a normal PSA score is 0 to 4 (nanograms per milliliter); but age counts, so this is often refined so that normal for a man in his 40s is 0 to 2.5; in his 50s, 0 to 3.5, in his 60s, 0 to 4.5 and in his 70s, 0 to 6.5.
If a man takes Proscar and his PSA score drops, his doctor should mentally double the score so as not to underestimate the risk of prostate cancer, Loughlin says.
If drugs fail, four surgical options are available:
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TURP, or transurethral resection of the prostate. With the patient under regional or general anesthesia, the surgeon inserts a cystoscope (viewing instrument) into the urethra. A wire-like scoop at the tip is then pushed through into surrounding tissue. This takes about an hour and can cause bleeding. After healing, a man can have normal sex, including orgasm, but usually has retrograde ejaculation, in which sperm flows backward into his bladder, which is not harmful. A TURP has excellent longterm efficacy: 7 years later, 80 to 90 percent of men still have relief from BPH.
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Laser TURP. This is like a regular TURP except that laser energy, delivered through a fiber optic tube, is used to destroy prostate tissue. The laser heats tissue, causing it to contract over several weeks. The surgery takes 20 minutes and causes less bleeding than a standard TURP and less likelihood of retrograde ejaculation. But longterm efficacy has not been proved.
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TUNA, or transurethral needle ablation. This is like a laser TURP except that radiofrequency energy is used instead of lasers. And unlike a TURP, the surgeon does not operate through a viewing tube, so the procedure is “blind.” Longterm efficacy has not been proved.
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TUMT, or transurethral microwave therapy. This is like TUNA, except that microwave energy is used to destroy prostate tissue. Longterm efficacy has not been proved.