Prostate Diseases

Care & Treatment

Treatments options for prostate diseases vary depending on your condition.  They can include everything from lifestyle changes and the use of medication to surgery.

 

Benign Prostatic Hyperplasia (BPH) Treatment

The treatment of BPH depends on how severe the symptoms are. Many men with mild symptoms do not need any treatment other than lifestyle changes. Men with more severe, bothersome symptoms may need medications or surgical procedures.

Lifestyle Changes

Small lifestyle changes can often significantly improve symptoms of BPH, and may be all that some men need. These changes include:

  • Avoiding or limiting drinking fluids a few hours before bedtime or going out.
  • Avoiding or limiting fluids that can worsen symptoms, including caffeine and alcohol.
  • Double voiding. This is where you wait a minute or two after urinating, then try to go again, without straining or pushing.
  • Avoiding medications that can make symptoms worse (some over-the-counter antihistamines and decongestants).

Medications

The two kinds of medications used to treat BPH are:

  • Alpha blockers
  • Alpha-reductase inhibitors

Alpha blockers work by relaxing the muscles in the prostate and bladder to help urine flow more easily. Alpha blockers often cause low blood pressure or dizziness, especially when standing up. Your provider may recommend taking the medication at bedtime to reduce these side effects.

Alpha-reductase inhibitors work by stopping the prostate from growing, or even causing it to shrink. This medicine is more helpful in men with very enlarged prostate glands, and is often used in combination with an alpha blocker. Alpha-reductase inhibitors may take up to six months to have their full effect. Some men experience problems with erections or ejaculation with these medications. Alpha-reductase inhibitors also cause PSA levels to decrease by about half.

Herbal Medicines

Saw palmetto is an herbal preparation that is commonly used to improve symptoms of BPH, but studies have not confirmed any benefits.

Although saw palmetto does not appear to have serious side effects, be sure to tell your healthcare provider if you are taking any non-prescription medications or supplements for prostate health. Many of these products contain multiple ingredients that could be harmful.

Surgery

If BPH symptoms are not relieved with medications, your healthcare provider may recommend a surgical procedure. There are a number of different procedures that can treat BPH by removing or destroying some of the prostate to decrease the size. Your healthcare provider and surgeon will help you figure out which procedure is best for you depending on the size of your prostate and your preferences for treatment.

Some of the treatments used to treat BPH are:

  • Trans-urethral resection of the prostate (TURP): Pieces of the enlarged prostate are removed through the urethra
  • Ablation of the prostate: Some of the prostate is destroyed with heat, light (laser), or electrical energy using special instruments through a scope in the urethra
  • Prostatectomy: Surgery to remove the prostate gland

Complications from these procedures can include sexual dysfunction (impotence) and urinary incontinence.

Less invasive procedures can treat BPH in some men in whom the prostate is not severely enlarged. These include:

  • Trans-urethral incision of the prostate (TUIP): Instruments are used to widen the urethra
  • Radiofrequency ablation: Heat is used to burn away areas of the enlarged prostate
  • Microwave thermotherapy: Heat is used to burn away areas of the enlarged prostate
  • Prostatic lift: An implanted device is used to widen the urethral opening and implants are placed to keep it open

These less invasive procedures tend to cause fewer problems with sexual dysfunction, can be done with local anesthesia, and do not require a hospital stay. However, symptoms are more likely to happen again after these less invasive procedures compared to the more invasive procedures. This means it might be necessary to repeat treatment.

Prostatitis Treatment

The treatment of prostatitis depends on the cause (if identified).

Medications

If the prostatitis is cause by a bacterial infection, you will be treated with antibiotics. Sometimes acute bacterial prostatitis can cause very severe symptoms, and require hospitalization for IV antibiotics. Oral antibiotics are often continued for four to six weeks to make sure the infection is fully treated. Antibiotics are also used to treat chronic prostatitis that is caused by bacteria. Chronic prostatitis is more difficult to treat, and some men have to take antibiotics for several months, or even take low-dose antibiotics indefinitely.

Alpha blockers are sometimes used to treat symptoms of prostatitis, such as difficult or painful urination. Alpha blockers work by relaxing the muscles of the prostate and bladder, to help urine flow more easily.

Anti-inflammatory medications may be used to treat pain and inflammation. Non-steroidal anti-inflammatory medications (NSAIDs) should be used cautiously in older people, as they are associated with increased blood pressure, kidney damage, and increased risk of bleeding. Common NSAIDs are ibuprofen, motrin, naproxen, and aspirin. Ask your healthcare provider about what type of pain medication is best for you to use.

Herbal Medicines

Several herbal remedies are used to treat symptoms of prostatitis, including rye grass (cernilton), quercetin (found in green tea, onions, and other plants), and saw palmetto. There is no evidence that any of these treatments are effective.

Be sure to tell your healthcare provider if you are taking any non-prescription medication or supplements for prostatitis.  Many of these products contain multiple ingredients that could be harmful.

Other Treatments

Some treatments including acupuncture, physical therapy, and sitz baths may help symptoms in some men with chronic prostatitis.

Surgery

Surgery is rarely needed for prostatitis. You may need surgery if your prostatitis is due to an abnormality in the bladder or urethra that is causing chronic, recurrent prostatitis.

Prostate Cancer Treatment

The treatment for prostate cancer depends on the stage and grade of your cancer, your age and life expectancy, overall health, possible side effects, and your own personal preferences. Your healthcare provider will work with you to help decide how to treat the cancer.

Active Surveillance

Not all prostate cancer needs immediate treatment, and some never need any treatment.  Early prostate cancer, where the cells are not aggressive and have not spread, may not need treatment. These cancers tend to grow very slowly, and most men die of other causes, not the prostate cancer. Also, treating these early stage cancers, which can be completely cured, has not been shown to reduce death from prostate cancer compared to men who are not treated.

Many men with this early stage cancer choose “active surveillance”, or “watchful waiting.” Active surveillance means that they will not have treatment at this time, but will be carefully monitored in case the cancer grows or spreads, when they may choose more aggressive treatment. Active surveillance may include regular prostate-specific antigen (PSA) tests, digital rectal examinations, and periodic biopsies. Active surveillance is also used for some men with more advanced disease if they have health problems that make treating the cancer more risky. Active surveillance can help many men avoid unnecessary treatment and complications, but also carries the risk that the cancer may grow during this time of waiting, and become more difficult to treat.

When cancer cells have grown beyond the prostate or spread to other parts of the body, treatment is designed to slow the growth of the cancer cells.

Hormone therapy

Hormone therapy is treatment to stop your body from producing testosterone, the male sex hormone that helps prostate cancer cells grow. Reducing testosterone levels may cause cancer cells to die or to grow more slowly. Some hormone therapies stop your body from producing testosterone. Others block testosterone from reaching cancer cells. Hormone therapy can be used to shrink the cancer and slow its growth before other types of therapy are tried.  Men with advanced disease may also try hormone therapy. Side effects of hormone therapy can include hot flashes and sexual problems, such as loss of libido and problems with erections.

Radiation

Radiation therapy can be used to kill cancer cells. External beam radiation is when the radiation is delivered to your prostate cancer from a machine. Brachytherapy is when the radiation is delivered from tiny radioactive “seeds” that are implanted in the prostate using a needle. These seeds deliver a low dose of radiation over a long period of time to kill the cancer cells. Side effects from radiation can include problems with urination (such as pain, having to go frequently or urgently, loss of control, etc.), bowel movements (such as diarrhea, pain, loss of control), and erections.

Surgery

Surgery for prostate cancer involves removing the prostate gland (prostatectomy), and some of the surrounding tissue and lymph nodes that may contain cancer cells. Prostatectomy can cause urinary incontinence and erectile dysfunction, so it is important to talk with your healthcare provider about the risks you may face based on your individual situation.

Monitoring

No matter what stage of prostate disease or prostate cancer you have, your healthcare provider or oncologist (cancer specialist) 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 your provider 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 PET scans can show where the cancer is. CT or PET scans let your oncologist target treatment to reduce pain and manage your disease in the best way possible.

Click here to read the Choosing Wisely recommendations "Tests and treatments for prostate cancer: the latest advice for men"

Updated: March 2018