Date: October 1st, 2004
As they get older, many men find themselves making more nightly trips to the bathroom. They may fear that this sort of problem is an unavoidable consequence of aging, or - worse - a sign that they have prostate cancer.
The good news is that urinary difficulties are most likely a sign of BPH - a common and treatable condition that affects half of men over 50. Benign Prostatic Hyperplasia is the technical term for prostate enlargement that is not caused by cancer or infection. The prostate is a gland that surrounds the urethra, the tube through which urine passes out of the body. Although scientists do not fully understand why, they know that the prostate naturally grows as men get older, after the age of about 25. In some men, this growth squeezes the urethra and irritates the bladder, causing urinary problems.
A "Quality of Life" Disease
Dr. Stuart Howards, M.D., is the Senior Scientific Advisor for Urology at the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). He said that BPH only needs to be treated if it bothers the patient or, in rare cases, the condition has produced back pressure that affects the kidneys.
"There's nothing to treat preventively," Howards said. "Treating BPH doesn't prevent cancer, and it doesn't prolong life."
Dr. Ralph Benson, M.D., Chief of Surgical Service and Chief of the Urology Section at Veteran's Administration Medical Center in West Palm Beach, Fla., agreed. "This is a quality-of-life disease," Benson said. "Patients are dealing with getting up at night, a lousy stream, and a bladder that feels like it doesn't empty."
A spectrum of effective treatments
Treatment for many men may begin with "watchful waiting." Occasionally symptoms will improve on their own, so doctors may recommend that someone with mild symptoms wait to see whether they get worse.
Those who are bothered enough to proceed can choose from a spectrum of effective treatments. A surgical procedure called TURP (transurethral resection of the prostate) has historically been the gold standard. TURP is quite effective but carries with it the risks and recovery period of surgery, so doctors are increasingly recommending medications and less-invasive outpatient treatments.
The FDA has approved two types of medications to treat BPH. Drugs known as alpha blockers relax the smooth muscle of the prostate to reduce the obstruction. Another class of drugs inhibits the hormone DHT, which may either shrink the prostate or prevent it from growing any larger.
"Medication is a 'forever' thing," Benson said, meaning that the medication - along with its associated cost and the inconvenience of compliance - must be continued or the symptoms will return.
Physicians may also recommend one of two minimally invasive treatments. Both TUNA (transurethral needle ablation) and TUMT (transurethral microwave thermotherapy) use heat to destroy excess prostate tissue. Benson refers to these as "single-event" therapies - procedures that correct the problem with one visit to the doctor.
Depending on the individual and the severity of his symptoms, doctors may recommend any one of these treatments, or a combination. Health experts do not yet know which treatment is the most effective in the long run, or which is best for which patient. The National Institutes of Health recently launched a comprehensive study to compare the long-term benefits and risks of TUNA and TUMT to drug therapies. But for now, finding the best treatment for one patient may require some trial and error.
It's important to be evaluated
While urinary symptoms in older men will most likely turn out to be BPH, they might also be caused by a bladder infection. And while prostate cancer is less likely - and often causes symptoms, such as localized pain, that BPH does not - it is still always a concern. So men experiencing urinary symptoms should be evaluated.
"Men should find a urologist they can trust who can give them good advice, and the urologist should be board-certified," Howards said.