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Week of 13 March 1998

Vol. I, No. 23

Health Matters

Treatments developing rapidly for benign prostate condition

I am a man in my 50s and suddenly find myself having to go to the bathroom in the middle of the night. Is there anything I can do to stop this?

The condition you probably suffer from is called benign prostatic hyperplasia, or BPH, a painless condition characterized by the frequent urge to urinate, the inability to maintain a urine stream, and a feeling that the bladder has not completely emptied. According to Robert Krane, M.D., chairman of the Urology Department of Boston Medical Center and professor of urology at the Boston University School of Medicine, doctors now have more tools in their arsenal than ever before to combat BPH. These include medications as well as two minimally invasive procedures that may become the standard treatment in the near future.

BPH is the overgrowth of the prostate gland, a walnut-sized part of the male reproductive system responsible for producing semen, the fluid that carries sperm. The prostate surrounds the urethra, the tube that carries urine out from the bladder. If the prostate grows too large, the urethra is squeezed, making it difficult to urinate and producing the uncomfortable sensation of a full bladder. Consequently, men with BPH urinate often to reduce this feeling of a full bladder.

The most common form of treatment for BPH involves using one of two kinds of medicine, according to Krane. "One drug, called Finasteride, shrinks the prostate," he explains. "It's very well tolerated and isn't associated with many side effects, although a very small number of patients may experience impotence. The second type of drug is an alpha-blocking agent, which relaxes the muscle around the urethra so urination is easier. Patients who use this might experience dizziness or lethargy, but like the Finasteride, it produces side effects only in a small minority of cases." Medication relieves symptoms, but does not cure BPH, and symptoms will return upon stopping an oral regimen.

Within the last five years, however, two new kinds of nonsurgical treatments have become available that may relieve symptoms permanently. They require only one outpatient visit; clinical trials have shown that they are as effective as medication. Both involve inserting a catheter (or similar instrument called a cystoscope) into the urethra and heating parts of the prostate to about 120 degrees Fahrenheit to kill excess cells, eventually shrinking the gland. One procedure, called transurethral microwave thermotherapy (TUMT), uses a machine known as a Prostatron, which heats the prostate by sending microwaves through the gland. The second, called transurethral needle ablation (TUNA), inserts very tiny needles from a cystoscope into the prostate and heats it with radio waves. While these treatments may sound agonizing, they are actually relatively painless procedures that last one or two hours and produce minimal side effects.

If these therapies fail, the next course of treatment is surgery. Transurethral resection (TUR) is still the most effective form of treatment for BPH. "It shows the most marked decrease in symptoms of all the treatments," says Krane, "but surgery can have significant side effects, such as bleeding and incontinence. Also, it requires a short stay in the hospital."

Krane suspects that as the new procedures evolve and medications improve, operations like TUR will be used less. But at this point TUR remains the gold standard of care. "Eventually TUR will be very rare," predicts Krane. "The decision of whether or not a patient should take medication or undergo a procedure like TUMT or TUNA will probably involve his preference. Some men will say, 'Gee, I don't mind taking one pill every day for the rest of my life,' while others will say, 'If I could get long-standing symptomatic relief after only one hour with a catheter, why not do it?'"


"Health Matters" is written in cooperation with staff members of Boston Medical Center. For more information about benign prostatic hyperplasia or other health matters, call 617-638-6767.