PROSTATE ENLARGEMENT

GENERAL INFORMATION

The prostate is part of the male reproductive system and is a small, walnut-sized gland that sits below the bladder and in front of the rectum. The prostate gland secretes fluid that makes up part of the semen. Prostate enlargement is a normal part of ageing, due to hormonal factors.

SYMPTOMS

Prostate enlargement may cause blockage of urine flow from the bladder during urination. Initially most men notice weakening of the stream and waking more frequently at night to urinate. As the condition worsens, the bladder may become more irritable, causing urgency and frequency.

Men often complain of the following symptoms:

  • Weak stream with lack of pressure
  • Intermittent stream (starting and stopping)
  • Straining to initiate urination
  • Hesitancy (waiting a long time for the flow to start)
  • Incomplete emptying of the bladder
  • Urgency (difficulty holding on)
  • Frequency (urinating every 2 hours or less)
  • Nocturia (waking up more than once at night to urinate)
  • Dull pain in the lower pelvic area
  • Blood in the urine, especially at the start or end of the stream

CAUSES

The prostate may enlarge naturally, due to ageing. Other conditions that cause enlargement are infection, inflammation and cancer.

DIAGNOSIS

  • Digital rectal exam – your doctor will check your prostate by inserting a lubricated, gloved finger into the bottom end
  • Uroflowmetry – measurement of the flow rate during urination
  • PSA - blood sample is sent to the lab to measure the level of PSA, a substance produced by the prostate
  • Prostate biopsy – if there is suspected cancer due to an abnormal feeling prostate or high PSA, tissue is taken from different areas in the prostate with a fine needle and checked for cancer cells by a pathologist
  • Cystoscopy – a minimally invasive test to visualise the shape of the prostate within the channel and bladder lining

TREATMENT

Prostate enlargement can be managed with observation, medication or surgery.

If the enlarged prostate causes minimal symptoms or bother, then observation is appropriate.

If you are bothered by the symptoms, then the following medications may be prescribed.

  • Prazosin (Minipress)
  • Terazosin (Hytrin)
  • Tamsulosin (Flomaxtra)
  • Dutasteride (Avodart)
  • Tamsulosin and Dutasteride combination (Duodart)

They work in two ways:

  1. Alpha blocker – relaxes the muscle within the prostate gland, to open up the channel for urine passage
  2. 5-alpha reductase inhibitor – suppresses conversion of the male hormone testotsterone to its active form within the prostate gland, depriving the growth stimulation and reducing prostate size

Sometimes, if your symptoms are predominantly due to bladder irritability, your specialist may add a bladder suppressing drug such as Oxybutynin. There are many herbal preparations sold over the counter for prostate health. These may contain natural compounds that alleviate symptoms of prostate enlargement, by working in similar ways to the above medications.

If medications are not working, or you have a complication from prostate enlargement such as urine retention, persistent bleeding, recurrent infections or bladder stones, your specialist will recommend surgery. The following options are available, and should be discussed with you.

  • TURP (transurethral resection of prostate) – using electric current to shave the prostate gland from inside
  • HoLEP (Holmium laser enucleation of prostate) – using laser energy to remove the lobes of the prostate from inside
  • Green light laser prostatectomy – using laser energy to vaporise the prostate gland from inside
  • TUNA (transurethral needle ablation)
  • Simple prostatectomy (Millen's procedure) – to remove the prostate glands through an incision in the lower abdomen

RESOURCES

Swan Urology TURP information sheet

NKUDIC Benign Prostatic Hyperplasia fact sheet
kidney.niddk.nih.gov is the official website of the National Kidney and Urologic Diseases Information Clearinghouse, a service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health (NIH)

USANZ Benign Prostatic Hyperplasia fact sheet
usanz.org.au is the official Web site of the Urological Society of Australia and New Zealand

Useful Information

NKUIDC Fact Sheet

USANZ Fact Sheet

AUA Fact Sheet

TURP

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