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New Treatment for Enlarged Prostate

By Michael Lasalandra
Beth Israel Deaconess Medical Center Correspondent

If you are a man age 50 or older, chances are you have to go to the bathroom a lot.

"The prostate gets bigger as we get older," says Abraham Morgentaler, MD, a urologist at Beth Israel Deaconess Medical Center and director of Men's Health Boston, a urology practice. "It is extremely common. The passageway becomes compressed. Men have a weaker stream, have to go to the bathroom frequently, often wake up in the middle of the night several times, may have difficulty emptying their bladder or may feel like they have to go in a hurry."

No matter how an enlarged prostate - known as benign prostatic hyperplasia or BPH - affects a man, it is definitely a nuisance. It interferes with life. And it can be downright embarrassing. If the condition is severe enough, it can be dangerous, sometimes leading to urinary tract infections or even kidney failure if the urethra becomes completely blocked.

In years past, the condition was usually treated with surgery known as a trans-urethral resection of the prostate or TURP, often termed a "roto rooter" procedure. In it, the surgeon carves out the inner part of the prostate gland to allow more room for urine to pass through the urethra. But the operation requires general anesthesia, a hospital stay of one or two nights and comes with the risk of complications, including the potential for permanent problems with ejaculation or potency.

In recent years, BPH has been treated more often with medications. You see the commercials on television all the time, usually during sporting events. Drugs such as Flomax are known as alpha blockers and work to relax the muscles around the prostate and bladder to help the flow of urine. Newer drugs such as Avodart or Proscar, in the category known as 5a-reductase inhibitors, actually work to shrink the prostate itself.

"They work reasonably well, but all medications can have side effects and many men don't want to take pills for the rest of their lives," says Dr. Morgentaler.

Now, several relatively new minimally invasive interventions are available to take care of the problem of BPH for many men without surgery or pills.

One procedure, called trans urethral needle ablation or TUNA, uses radio frequency energy to generate heat to ablate or destroy excess prostate tissue.

"It is very effective," says Dr. Morgentaler. "It is an in-office procedure and requires only a local anesthetic around the prostate. The patient is ready to go home in an hour with minimal discomfort. The results in all studies are better than pills. And it is a one-time procedure; the patient doesn't have to take medication every day for the rest of his life and he doesn't have side effects."

In the TUNA procedure, a needle is inserted through the prostate, heating the spot for several minutes. Usually, five to eight spots need to be done. The procedure is guided by looking into the prostate with a scope and is geared more to men who don't have uniform growth of excess tissue, Dr. Morgentaler says. The procedure also takes a month or two before improvement is noticed.

Side effects are minimal, he says. "I haven't seen any serious complications with the modern version of this procedure. No infection or bleeding, and no sexual complications."

The procedure works well in about 80 percent of men, he says. About 10 percent of patients are required to have the procedure done again in about five years as tissue can grow back.

"This procedure is a true advancement," Dr. Morgentaler says. "It may not work quite as well as TURP, but it is much less invasive and doesn't cause any sexual problems. A lot of my patients who are very pleased with their heat treatment would never have consented to a procedure that would have required general or spinal anesthesia and a stay in the hospital."

"The TUNA procedure is ideal for men who want to urinate more freely and less often, are reluctant to consider a more invasive procedure, and don't want to take a pill as treatment for the rest of their lives," he says.

Finally, another advance in the treatment of BPH is the use of lasers. For some men with more advanced symptoms, a laser variation on the tried and true TURP can be performed, often with reduced bleeding. However, the procedure still requires general or spinal anesthesia, and usually requires at least an overnight hospital stay.

Above content provided by Beth Israel Deaconess Medical Center. For advice about your medical care, consult your doctor.

Posted October 2011

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Prostate Cancer Center
Beth Israel Deaconess Medical Center
Shapiro Clincial Center
330 Brookline Avenue
Boston, MA 02215
Phone: 617-667-7777
Fax: 617-667-7292