urinate. Some of the drugs in this category include terazosin (Hytrin), doxazosin (Cardura), tamsulosin (Flomax), and alfuzosin (Uroxatral). The FDA issued a warning in 2005 for alpha blockers because they may cause a pupil disorder that can complicate cataract surgery.
Another class of drugs enzyme (5-alpha-reductase) inhibitors works to ease BPH by shrinking the prostate. In February 2009, the American Society of Clinical Oncology and the American Urological Association announced joint prostate cancer guidelines recommending men and their doctors discuss taking 5-alpha-reductase inhibitors to reduce the risk of prostate cancer. Two of these drugs have been approved by the FDA: finasteride (Proscar) and dutasteride (Avodart). Because it inhibits the production of PSA, which in levels higher than 2.6 nanograms per milliliters of blood is associated with prostate cancer, researchers believe finasteride may also help prevent or delay that disease as well.
In a seven-year, double-blind study of almost 19,000 men reported in the New England Journal of Medicine, researchers found that finasteride reduced the risk of prostate cancer by about 25 percent. Not all of the results were positive, though. Although fewer men on finasteride developed prostate cancer than those on a placebo, those who did get the disease were more likely to develop more serious tumors, which tended to grow quickly. However, a follow-up study, published in the Journal of the National Cancer Institute, showed that finasteride did not cause tumors. In fact, researchers in the follow-up study discovered that finasteride increased the overall sensitivity of PSA testing to detect tumors, including high-grade ones.
Doctors caution that no medication is a sure cure. Although taking these drugs usually improves symptoms, they may not be enough to bring about a return to normal. For this reason, many men eventually need more serious treatment.
Surgery used to be the most common treatment for enlarged prostate, but its use is declining because of the availability of new medications and less invasive treatments. In the most common procedure, a surgeon inserts a special wire down the urethra and removes a small section of the prostate. This is called transurethral resection of the prostate or TURP. The procedure only takes about 90 minutes, but most patients have to recover in the hospital for several days. The operation carries a small risk of impotence and infection. Surgery tends to be used when other treatments fail, or when the patient has frequent complications, such as urine retention, urinary tract infections, or bladder stones.
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If the prostate is extremely large, or if the bladder needs surgical repair, a surgeon may need to operate through an incision. This is a major operation, and surgeons will avoid it if possible.
Several alternatives to surgery have come along in the past 15 years. In a procedure called transurethral microwave thermotherapy (TUMT), a doctor inserts a tube into the urethra that emits carefully aimed microwaves to destroy a section of the prostate. TUMT is more effective than medications at improving urine flow, but less effective than surgery. Most men require a catheter for a few days after the procedure. A similar procedure, called transurethral needle ablation (TUNA), does the same job with radio waves. This procedure is also considered more effective than medications, but less effective than surgery. Both these treatments are best for men with mild to moderate obstructions. They don’t work well for men with very large prostates. Neither of these procedures is known to cause impotence, but they may temporarily cause frequent or painful urination or urinary tract infections.
Whatever treatment your doctor recommends, be sure to get a clear explanation of the risks, benefits, and goals of the treatment. With so many options available, you and your doctor should be able to find an approach that works for you.