Aging & Health A to Z

Prostate Diseases

Care & Treatment

Benign Prostatic Hyperplasia (BPH) Treatment

Your treatment will depend on how serious your BPH symptoms are and how much they are affecting your daily life. You may be referred to a urologist (a doctor who specializes in urinary tract diseases) who will assess your individual situation and suggest

• lifestyle changes (if symptoms are mild and not too bothersome)
• medication
• non-surgical removal of some of the prostate gland
• surgery. 

Lifestyle changes
Your healthcare team will tell you how to make small lifestyle changes that may make all the difference you need. These changes include:

• limiting the fluids you are consuming (being careful not to become dehydrated)
• avoiding caffeine (tea, coffee, caffeine-containing sodas or energy drinks)
• reviewing your medications with your healthcare professional, modifying treatment with anticholinergic medications or diuretics (water pills) if you are taking them. 

Medications 
The medications prescribed most often for BPH are:

• alpha-adrenergic antagonists (to relax muscles around the urethra)
• 5-alpha-reductase inhibitors (to reduce the size of the prostate by inactivating testosterone). 

Mild side effects such as dizziness, fatigue, and headaches may occur with the alpha-adrenergic antagonists. The 5-alpha-reductase inhibitors sometimes cause breast enlargement or tenderness, a rash, stomach aches, and sexual problems. Tell your healthcare professional right away if you experience any of these side effects while taking these medications. It may take a few months of treatment before you notice an improvement. 

Saw palmetto – a herbal approach
Saw palmetto is a herbal preparation that may improve symptoms of BPH, but scientists have not been able to confirm that it really works. It does not have serious side effects. 

Surgery
If you have recurring serious symptoms (i.e., complete urine blockage, infections, or kidney damage), surgery provides the best relief. However, it also has the highest complication rate. Depending on the size of your prostate and other considerations, your urologist may recommend:

• transurethral resection of the prostate (most effective treatment in most cases)
• transurethral incision of the prostate (if your prostate is not too large)
• open prostatectomy
• transurethral vaporization of the prostate
• placement of a device (such as a stent) to keep the urethra open. 

You may have general anesthesia or spinal anesthesia during these surgeries, which allows you to stay sedated but conscious. In some cases, much of the prostate is removed; other approaches are less aggressive. Occasionally, severe complications occur, including urinary incontinence and impotence or erectile dysfunction. 

Prostatitis Treatment

Lifestyle changes
Some people find that paying careful attention to a healthy diet, avoidance of caffeine and some medications, and taking warm baths (sitz baths) reduces symptoms. This may be very helpful in combination with other treatments. 

Medications
If your test results show that you have acute bacterial prostatitis, your healthcare provider will prescribe antibiotics. Chronic bacterial infections may require you to stay on the antibiotics for several months or even to remain indefinitely on low-dose antibiotic treatment. 

If you have nonbacterial prostatitis, medications to relax muscles in your prostate may be helpful. Antibiotics are also often prescribed in so-called “nonbacterial prostatitis” because the infection may be hidden. 

Medicines that can help keep pain under control include anti-inflammatories (aspirin, motrin, advil) and alpha-adrenergic antagonists. 

Surgery:
Repeated infections may signal a structural defect in your prostate that will have to be corrected surgically. Surgery such as transurethral resection may cure many stubborn cases, but the risk of complications (incontinence, scarring, impotence) is significant. 

Your healthcare professional may suggest imaging by MRI or CT scan to look for hidden abscesses or infections or if you do not seem to improve on antibiotics or other treatments. 

Prostate Cancer Treatment

Your decision about prostate cancer treatment must be made carefully, with your healthcare provider. The choice depends on the stage and grade of your cancer, your age and life expectancy, overall health, possible side effects, and your own personal preferences. 

Early Prostate Cancer
If the cancer is low-grade and has not spread, there is only a minor risk and you are likely to die of some other cause – not the prostate cancer – since it grows very slowly. On the other hand, the cancer can be completely cured although treatment at this stage has not been shown to prolong life compared to men who are not treated. Many men opt for “watchful waiting” or “active surveillance” when they are diagnosed at this stage – meaning they will not have treatment at this time but will be carefully monitored in case the cancer grows or spreads, and can opt for more aggressive curative treatment later. In “active surveillance”, monitoring may be as careful as:

• PSA test every 3 months
• DRE every 6 months
• Annual biopsy. 

If you decide to have treatment, surgery to remove the prostate or radiation with an x-ray beam or radioactive “seeds” planted into the prostate usually cures the disease. For a small number of men treated this way, side effects may include impotence, incontinence, or problems with the bladder or intestines. 

More Advanced Prostate Cancer
When cancer cells have grown beyond the capsule that surrounds the prostate or has spread to other parts of the body, treatment is designed to slow growth of the cancer cells. Your treatment options, which may be combined, include hormone therapy, surgery, and radiation.                                           

• Hormone therapy uses female sex hormones (estrogen) or hormone blockers to reduce testosterone levels as much as possible. This slows down the growth and spread of the cancer cells. Some people also have their testicles removed to eliminate testosterone production. Side effects include weakness and tiredness, hot flashes, muscle loss, erectile dysfunction, breast development, insomnia and osteoporosis. If you have no symptoms from your cancer, you may wish to delay the hormone therapy. 
• Surgery or radiation can decrease the size of your tumor and relieve some of your symptoms. Radiation can be especially helpful to relieve pain if the cancer has spread to your bones. You may encounter side effects such as inflammation and irritation in the radiated area, erectile dysfunction, urinary incontinence, diarrhea, and mild fecal incontinence. Many men have no or only very mild side effects and the symptoms often lessen with time. 

Monitoring

No matter what stage of prostate disease or prostate cancer you have, your healthcare professional or oncologist will want to monitor the disease to check how well the treatments are working. If you have cancer, periodic tests will also help to alert the healthcare professional if the cancer is spreading. For prostate cancer, the most common monitoring method is the PSA test. 

If your prostate cancer has spread to other organs, or to your bones, imaging tests such as CT scans or positron emission tomography (PET) scans can show where the cancer is. You may be injected with a dye or radioactive material for these tests. CT or PET scans let your oncologist target treatment to reduce pain and manage your disease in the best way possible.

Updated: May 2012
Posted:  May 2012