Enlarged Prostate

Understanding an Enlarged Prostate

If you are a male over the age of 40, enlarged prostate is the most common cause of urinary problems. This condition is not cancerous, and does not increase your risk of developing prostate cancer.

The prostate is a gland about the size of a walnut located just below your bladder and surrounding the urethra (the tube that allows urine to pass out of the body). The prostate produces about half of the seminal fluid that comes out of the penis during ejaculation.

As you age, your prostate continues to grow. In particular, tiny glands within the prostate next to the urethra swell. However, the outer layer of the prostate does not stretch enough to accommodate growth inside. This causes the inner prostate to squeeze the urethra.

When the urethra narrows, the bladder has to work harder to expel urine, and urination becomes difficult. Eventually, the bladder cannot empty completely, and there is not enough space in the bladder for new urine coming from the kidneys. This causes you to have to urinate frequently.

How is an Enlarged Prostate Diagnosed?

A physical exam may reveal an enlarged prostate, but does not always distinguish it from cancer. A blood test for a prostate-specific antigen called PSA (a chemical present in the blood when the prostate is enlarged) detects both enlarged prostate and prostate cancer.

An elevated PSA may prompt your physician to get a biopsy in order to make an accurate diagnosis. Sometimes your physician needs more than one biopsy to conclude definitively that you have an enlarged prostate and not cancer.

IU Health physicians use a range of diagnostic methods to diagnose this condition and determine its extent. These include:

• Physical examination
• Prostate-specific antigen (PSA—a substance present in the blood with an enlarged prostate) testing
• Urodynamic evaluation to test flow of urine and ability to empty the bladder completely
• Biopsy (if you have elevated PSA levels)

Treatment Options for Enlarged Prostate

An enlarged prostate may disrupt your daily life. Fortunately, physicians can often treat this condition successfully. Through IU Health’s partnership with Indiana University School of Medicine, our physicians perform leading-edge research making treatment of an enlarged prostate more efficient and effective.

IU Health physicians often begin treatment conservatively to minimize the impact on you. Treatments may include:

Medicines

Different oral medicines available by prescription can ease the effects of an enlarged prostate without any other treatments or therapies.

• Alpha blockers often effectively allow urine to flow freely through the urethra. These medicines relax the muscles around the prostate and bladder, making it easier to urinate completely. You may begin to see the effects of alpha blockers within just a few days.
• 5-alpha-reductase inhibitor medicines affect the hormones that cause prostate enlargement and work by shrinking the prostate. They may take several months to work effectively and can possibly cause sexual side effects such as impotence.
• Tadalafil is commonly used for erectile dysfunction, but can also benefit an enlarged prostate. You cannot take it with alpha blockers or nitrates used for chest pain.

Thermal Therapy

When medicines do not fully restore urinary function, we may use thermal therapy, a non-surgical procedure using a tool through the urethra to apply microwave heat directly to the prostate. Most men have minimal sexual side effects from this treatment. An enlarged prostate may recur after a long period of time passes.

Aquablation Therapy

Aquablation therapy is a minimally invasive treatment for an enlarged prostrate. It uses imaging alongside a surgical robot to remove excess prostrate tissue with a heat-free waterjet. This robotic technology ensures the prostrate tissue is removed precisely, consistently and predictably. Aquablation therapy provides a high degree of symptom relief with extremely low risk of complications.

Surgery

Your IU Health physicians use a new procedure with laser treatment of enlarged prostate called holmium laser enucleation of the prostate or HoLEP. This may speed removal of enlarged prostate tissue, shorten surgery and reduce risk.

IU Health physicians were the first in the U.S. to use holmium laser therapy. Often patients go home the same or following day of the procedure with immediate improvement. It permanently removes the enlarged prostate tissue with minimal sexual side effects.