What you need to know about benign prostatic hyperplasia treatment

What is benign prostatic hyperplasia (BHP)?

Adenoma or prostatic hyperplasia is a disease associated with age that occurs in many men after 40 years. The average age of patients in whom the first symptoms of prostate adenoma usually develop is 55-65 years. Prostate adenoma is the most common cause of impaired urination in men.

The causes of this disease have not yet been fully established, however, there are theories regarding the effect of hormonal levels and the receptor status of tissues on the development of the pathological process.

Symptoms of prostate adenoma

At the stage when the prostate adenoma is small, clinical symptoms may be completely absent. For early diagnosis, the comprehensive examination appointed by a physician or a urologist is important.

With further progression and growth of prostate adenoma, typical clinical symptoms appear:

- Difficulty urinating, with a sluggish stream, up to acute urinary retention (inability to urinate if there is an urge to urinate);
- Frequent urination, in small portions, accompanied by sharp urges, often many times at night.

Diagnostics of benign prostatic hyperplasia

Given that in the early stages of prostate adenoma (prostatic hyperplasia) does not clinically manifest itself, we recommend that all men after 45 years of age undergo annual screening to detect the disease early. There are certain protocols that urologists follow for the diagnosis of men of this age group. The diagnostics/screening protocol includes all the necessary tests that allow assessing the health status of not only the prostate gland but also men's health in general.

When handling complaints, after examination by a urologist, an examination plan will be drawn up, including a blood test for tumor markers and visual diagnostic methods (ultrasound, if necessary - MRI with contrast). If there is a suspicion of a neoplasm in the prostate, in order to exclude a malignant process, under the conditions of a hospital, experienced urologists should perform a prostate biopsy followed by a morphological examination of the material. Based on the results of the examination, an individual treatment program should be developed.

Diagnostic methods for suspected BHP

Treatment of prostate adenoma

If the disease is diagnosed at an early stage, the treatment is based on certain drugs use and lifestyle changes. There are different medications used for BHP, they are chosen based on the primary cause of the disease:

- Adrenoreceptor inhibitors;
- 5-alpha reductase blockers;
- Antibiotics;
- Drugs that change the level of male sex hormones;
- Herbal drugs.

The selection of any drugs from this list is made only by a urologist based on the patient's indications and contraindications, as well as the severity of the clinical symptoms of the disease.

Antibacterial agents

Antibiotics should be taken if a man has symptoms of a bacterial infection. A similar complication is very common in men in advanced cases of prostate adenoma against the background of a pronounced delay in eliminating the prostatic secretion or narrowing of the urinary tract.

Among antibacterial agents, the most popular drugs are the cephalosporins, Azithromycin, and Amoxiclav. They have a wide spectrum of action and are able to destroy the most common types of bacterial microorganisms. To choose the optimal antibiotic, it is preferable to bacterial culture analysis that shows the responsiveness of present bacteria to different antibiotics, which allows increasing the effectiveness of therapy.

With the rational use of antibiotics, the bacterial infection disappears within 5-7 days, the man has a disappearance of the inflammatory process and edema, as well as an improvement in urodynamics, which positively affects the general state of health.

Alpha-adrenergic blockers

The mechanism of action of drugs is based on their ability to relax smooth muscle fibers, providing normalization of urination in men. It is important to note that the positive effects of the use of alpha-blockers develop very quickly.

In medicines, this group has the most pronounced side effect in the form of lowering blood pressure, which makes it impossible to use them in men with low blood pressure.

However, drugs, where the active ingredient is tamsulosin, do not change blood pressure and therefore can be used in this category of patients.
Alpha-adrenergic blockers used for prostatic hyperplasia, besides Tamsulosin:

- Flosin;
- Omnic;
- Fokusin, and others.

It must be said that despite the high effectiveness of alpha-blockers in eliminating clinical symptoms, these medications are not able to eliminate the adenoma itself, and therefore should be used in combination with other drugs that inhibit tumor growth. The medicines from this group, on average, after 14 days of regular use, ensure a decrease in the severity of the symptoms of the disease. If therapy is started at the initial stages of the development of adenoma, then the effect may appear against the background of a single medication. This not only ensures high treatment efficiency but also reduces the risk of side effects, including lowering blood pressure.

An alternative to alphablockers is PDE-5 inhibitors that are more often prescribed for erectile dysfunction. They can be also effective in the treatment of BHP because they improve the blood circulation in the pelvic area, facilitate urination, and reduce the frequency of urges to urinate. The medicines include Cialis (Tadalafil), Viagra (Sildenafil), and Levitra (Vardenafil).

5-Alpha reductase inhibitors

The enzyme alpha-reductase is involved in the normal process of the formation of dihydrotestosterone in the male body, which is necessary to maintain various functions.

However, against the background of the development of prostate adenoma, dihydrotestosterone stimulates the growth of tumor cells, causing a constant progression of the disease and an increase in the size of the tumor node.

Medications from the alpha-reductase blocker group reduce the level of this substance, thereby stopping the progression of BPH.

Scientific studies show that with the use of these drugs, more than 50% of patients achieve complete control of the disease without surgery.

The average time for the appearance of the clinical effects of treatment is 4-6 months of regular medication use.

The following drugs are most popular among doctors: Finasteride, Alfinal, Avodart, etc. All of them contain finasteride or dutasteride as the active substance, which can block the alpha-reductase enzyme.

The use of these medicines should be under constant medical supervision. The effectiveness of therapy is monitored by ultrasound examination of the size of the tumor node every six months.

The tablet of Finasteride is used once a day. The specified medication should not be used for those patients who are allergic to its components, have symptoms of liver failure or a large amount of urine in the bladder.

In addition, Finasteride should be excluded in cases where a child is planned, since the active component of the drug negatively affects the genetic apparatus of sperm.

The use of drugs from the group of alpha-reductase inhibitors is the "gold standard" in the treatment of BPH, as it allows stopping the growth of the tumor node and achieving control over its increase.

Hormonal drugs

Urologists use various hormonal drugs that either increase or decrease the content of male sex hormones. The following medicines are most popular:

- Roveron at the beginning of tumor growth;
- Prostatilen improves blood flow in the tissues of the prostate gland, reduces the severity of the outflow and normalizes the outflow of urine;
- Indigal blocks the effect on the prostate cells of testosterone and other growth factors, which allows for the complex effect of the drug;
- Monthly administration of a single dose of Sustanon provides similar therapeutic effects.
The use of hormonal drugs requires constant monitoring of the condition of the man, since such medications often lead to the development of side effects.

Additional treatment measures

The quality of the drug course largely depends on the characteristics of the patient’s lifestyle.

In particular, the following factors influence the success of recovery:

- Strict adherence to the diet prescribed by the doctor;
- Mobility (e.g. walking, doing moderate physical exercises);
- Avoidance of hypothermia (especially the inguinal region);
- Refusal of alcohol;
- Quit smoking;
- Normal sleep patterns.

Failure to comply with the above recommendations very often becomes the reason that triggers the growth of organ tissues. They are also factors that cause the prostate to rapidly grow in size when the deviation in question is already present in the body.

Keep in mind that none of the drugs should be used without an appropriate prescription. In some cases, their intake may not only not lead to improvements, but also exacerbate the course of the disease.

Recommended screening intervals of BHP dynamics/treatment assessment after use of prescribed treatment

Surgical treatment of prostate adenoma

Surgical treatment is appointed if the tumor isn’t responsive to drug therapy or is large. The following surgical treatments are possible:

- Transurethral resection of the prostate gland (TURP) - during this operation, a special instrument is inserted along the urethra. With the help of a loop through which a high-frequency electric current passes, the tissue of the hyperplastic prostate that protrudes into the lumen of the urethra and makes urination difficult is cut. The operation is performed under general anesthesia;

- Holmium enucleation of the prostate gland - this operation is also performed endoscopically (i.e. without skin incisions). Using a holmium laser, prostate adenoma is hatched in a single block and displaced into the bladder, where it is crushed, and then removed using a special tool. This operation can be performed even if large-sized prostate hyperplasia is observed, in which radical surgical intervention with classical laparotomy access is usually suggested;

- Laser vaporization of prostate adenoma - indicated for elderly or debilitated patients with severe concomitant diseases. During this operation, adenomatous tissue is not removed, but is evaporated using a laser;

- Installation of prostatic stents - may be an alternative to cystostomy (installing a drainage tube into the bladder through the stomach) in extremely severe patients. During this manipulation, a metal stent is introduced into the prostatic urethra, which is a spiral or mesh frame that mechanically extends the adenomatous tissue and restores the lumen of the urethra. As a result, patients can urinate naturally and live without drainage.

Post by: Rachel Lewis, Senior Medical Advisor at Medibank, Sydney, New South Wales, Australia