Benign prostatic hyperplasia, also called an enlarged prostate, is incredibly common, especially among men over 40. While it's not the same as prostate cancer, an enlarged prostate can cause significant quality of life issues.

Dr. Scott Cheney, a Mayo Clinic urologist, says there are ways to treat it and reduce the symptoms, including some lifestyle changes.

Watch: The Mayo Clinic Minute

Journalists: Broadcast-quality video (1:16) is in the downloads at the end of this post. Please courtesy: "Mayo Clinic News Network." Read the script.

"I like to tell patients that the prostate is kind of like an orange with a straw going right through the middle of it. And as we age, the prostate gets larger and larger. And the straw going through the middle gets compressed by the tissue of the prostate, makes it harder for the bladder to push urine through the urethra," says Dr. Cheney.

Enlarged prostate symptoms can include frequent or urgent urination, a weak urine stream and the inability to empty your bladder.

"I see men who get up at night to pee, and they get up again and again. They get poor sleep, It can really affect their lifestyle. So they're always looking for a restroom wherever they go, they can't drive long distances because they have to stop and urinate very frequently," says Dr. Cheney.

If you suffer from any of those symptoms, Dr. Cheney first recommends a few lifestyle modifications.

"You can tell a man to avoid excess fluids. Some men, they don't realize how much fluid they're drinking. The more fluid you drink, the more often you're going to have to urinate. The types of fluids also matter. So, if a man is drinking a lot of caffeine, a lot of alcohol, especially before bed, that can cause nighttime issues with urination," Dr. Cheney says.

He says talk to your healthcare team about your concerns. An enlarged prostate also can be treated effectively with medications or procedures.

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"I like to tell patients that the prostate is kind of like an orange with a straw going right through the middle of it. And as we age, the prostate gets larger and larger, and the urethra gets compressed by the tissue of the prostate. This makes it more difficult for the bladder to push urine through the urethra, making it harder to empty the bladder," says Dr. Cheney.

Watch: Dr. Scott Cheney talks about benign prostatic hyperplasia or enlarged prostate

Journalists: Broadcast-quality sound bites with Dr. Cheney are available in the downloads at the end of the post. Please courtesy: "Mayo Clinic News Network." Name super/CG: Scott Cheney, M.D./Urology/Mayo Clinic.

The prostate, situated just below the bladder, surrounds the upper part of the urethra — the tube responsible for draining urine from the bladder. The prostate's primary function is to facilitate the reproductive process and fertilization.

Enlargement of the prostate gland can give rise to uncomfortable urinary symptoms, including the obstruction of urine flow from the bladder, causing individuals to strain more to urinate.

Dr. Cheney says prostate enlargement, or BPH, does not mean cancer. "It is truly just enlargement, and the cells in the prostate are not cancerous. Prostate enlargement is much more common than prostate cancer," he says.

An enlarged prostate can cause troublesome symptoms and affect the quality of a person's life.

"It's a big quality of life issue for men," says Dr. Cheney. "I think a lot of men ignore their symptoms for a long time because we don't like to complain or think it is a normal part of aging. But, in reality, it's so common, and there are multiple ways that we can treat prostate enlargement and symptoms associated with it."

Symptoms of an enlarged prostate include:

• Frequent or urgent need to urinate.
• Urinating more often at night.
• Trouble starting to urinate.
• Weak urine stream, or a stream that stops and starts.
• Dribbling at the end of urination.
• Not being able to empty the bladder fully.

"Treatment can be something as simple as taking a well-tolerated medication that helps to open that channel through the prostate that can relieve symptoms, all the way up to surgery where we remove the obstructing tissue of the prostate to leave men with a more wide-open channel and better emptying," he says.

Treatment options

"Here's how I like to think about treatment of prostate enlargement. The first thing that you can do is lifestyle modifications, which takes no medicine and is low risk. You can tell a man to avoid excess fluids, especially before bed. Some men don't realize how much fluid they're drinking. The more fluid you drink, the more often you're going to have to urinate. The types of fluids also matter," Dr. Cheney says. "If a man is drinking a lot of caffeine, a lot of alcohol, especially before bed, that can cause nighttime issues to be worse. Some simple lifestyle tweaks can help men significantly and improve their symptoms."

"The next step in treatment of BPH is to try medications, and there are several different drug classes that we have to treat BPH. But essentially, they work on maximizing the channel through the prostate. They relax the muscle in the prostate to help open that channel or can shrink the prostate. Typically, those medications are not as effective as surgery, but they're also less invasive and less aggressive," he says.

Many types of surgeries and procedures may help with an enlarged prostate.

"If medications are not working well, we may suggest surgical management of an enlarged prostate. Less invasive surgical options include Rezum, UroLift and iTind. More definitive options would be transurethral resection of the prostate or holmium laser enucleation of the prostate," says Dr. Cheney. 

Any prostate procedure may result in side effects. Working with your healthcare team to determine the best option is essential.

Seek medical help

"It's sad to know that men are suffering out there and don't want to complain. They don't want to bring it up. It's embarrassing to admit that there's a problem there. But there are many wonderful, effective solutions to treat prostate enlargement," says Dr. Cheney.

Learn more about benign prostatic hyperplasia.

Related posts:

• Mayo Clinic Minute: Using steam to treat an enlarged prostate
• Consumer Health: Can diet ease enlarged prostate symptoms?
• Mayo Clinic Q and A: Prostate biopsies and elevated PSA

The post What does it mean to have an enlarged prostate? appeared first on Mayo Clinic News Network.

There are several effective treatments for an enlarged prostate, including using steam to reduce the size of the prostate and alleviate symptoms.

Watch: The Mayo Clinic Minute

Journalists: Broadcast-quality video (1:00) is in the downloads at the end of this post. Please courtesy: "Mayo Clinic News Network." Read the script.

It's a common problem for older men — benign prostatic hyperplasia, or BPH.

"BPH is a fancy way of saying the prostate is getting larger, and we don't want it to," says Dr. Tobias Kohler, a Mayo Clinic urologist.

Dr. Kohler says the enlarged prostate forces the urethra to narrow, causing a variety of urination problems. And, as men age, the symptoms occur more frequently. Treatment for BPH has long been medications and procedures, such as lasers or an electric loop, which burn the prostate from the inside out. But now a relatively new convective water therapy treatment uses steam to make the prostate smaller.

"For nine seconds, a steam ball is produced, and that kills all that prostate tissue that we don't want or that has grown out of control," says Dr. Kohler.

He says the procedure, performed right in the doctor's office, has a low risk for complications or sexual side effects.

"It does not carry heat outside the prostate, and it does not carry heat to areas we don't want it," says Dr. Kohler.

He says this next generation of BPH treatment may soon replace the need for costly medications.

Learn more about BPH services.

For the safety of its patients, staff and visitors, Mayo Clinic has strict masking policies in place. Anyone shown without a mask was either recorded prior to COVID-19 or recorded in a nonpatient care area where social distancing and other safety protocols were followed.

The post Mayo Clinic Minute: Using steam to treat an enlarged prostate appeared first on Mayo Clinic News Network.

DEAR MAYO CLINIC: I recently had a physical, which included a check of my PSA level. The doctor said my PSA level is elevated, as it has been in the past. I have undergone several biopsies that have not shown cancer. Do I need to continue with biopsies every year?

ANSWER: It may not be necessary for you to continue with annual prostate biopsies. But that depends in part on the overall level and rate of change of your prostate-specific antigen, or PSA, over time. Along with information about your PSA, your health care provider can use several other tools to determine if you need additional biopsies or if you can be monitored safely without further biopsies.

The PSA test measures the amount of prostate-specific antigen in your blood. PSA is a protein produced by both cancerous and noncancerous tissue in the prostate — a small gland that sits below a man's bladder.

When PSA is found to be above normal levels, a prostate biopsy may be recommended to check for cancer. Biopsies involve using a needle to collect several tissue samples from the prostate gland. Then the samples are examined in a lab to see if they contain cancer.

Although the PSA test is used primarily to screen for prostate cancer, other medical conditions can cause PSA levels to rise, as well. One of the most common is benign prostatic hyperplasia, or BPH. Basically, this condition is enlargement of the prostate gland that doesn't involve cancer. Benign prostatic hyperplasia is common as men get older.

To see if benign prostatic hyperplasia could be causing your elevated PSA, talk with your health care provider about getting an imaging exam, such as an ultrasound or an MRI, to assess the size of your prostate gland and look for suspicious areas. Then the PSA can be viewed in the context of the overall size of the prostate, a concept known as PSA density.

When the prostate gland is significantly enlarged in men with higher-than-normal PSA, it is often the case that benign prostatic hyperplasia is the source of the elevation. That's particularly true for men in that group who have had multiple negative biopsies for prostate cancer.

In addition to imaging, several in-depth blood tests have been shown to be useful for evaluating prostate cancer risk in men who have elevated PSA. The tests include the prostate health index, or PHI; free PSA test; and 4K score. These blood tests look at other proteins, in addition to PSA, and use mathematical algorithms to predict the likelihood of more aggressive forms of prostate cancer being present.

If it is determined that a man has an enlarged prostate and tests indicate that the risk for cancer is not high, it makes an elevated PSA less of an immediate concern. That allows the primary focus to shift from cancer detection to managing bothersome urinary symptoms that often accompany benign prostatic hyperplasia, such as frequent or urgent need to urinate, increased urination frequency at night, weak urine stream, difficulty starting urination or inability to completely empty the bladder. Treatment for these symptoms is available, including medication and, in some cases, surgery.

At this point, though, it's important that you be evaluated further to better understand your situation and guide your care going forward. Although a prostate biopsy can be a valuable tool for detecting prostate cancer in its early stages, having unnecessary biopsies can needlessly expose you to health risks, raise health care costs, and cause unwarranted worry and anxiety. Planning for future tests and procedures in a way that will avoid unnecessary prostate biopsies is in your best interest. — Dr. Chandler Dora, Urology, Mayo Clinic, Jacksonville, Florida

****************************

Related Articles 

• Consumer Health: Can diet ease enlarged prostate symptoms? published 12/1/20
• Should men be concerned about prostate cancer? published 11/17/20
• Mayo Clinic Minute: New prostate biopsy technique reduces infection risk published 10/17/19
• Mayo Clinic Minute: Steam treatment used for enlarged prostate published 6/11/19

The post Mayo Clinic Q and A: Prostate biopsies and elevated PSA appeared first on Mayo Clinic News Network.

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PLUS ADDITIONAL HIGHLIGHTS
Benign prostatic hyperplasia
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HEALTH TIP OF THE WEEK
Reduce tension through muscle relaxation
Progressive muscle relaxation can reduce muscle tension from stress. Find a quiet place free from interruption. Tense each muscle group for about five seconds and then relax for 30 seconds. Repeat before moving to the next muscle group. Practice this technique any time you feel stress.

Need practical advice on diet and exercise? Want creative solutions for stress and other lifestyle issues? Discover more healthy lifestyle topics at mayoclinic.org.

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The post Housecall: 10 tips for coping with holiday stress appeared first on Mayo Clinic News Network.

As men age, the prostate gland tends to grow larger. Benign prostatic hyperplasia, also called prostate gland enlargement, can cause uncomfortable urinary symptoms, such as blocking the flow of urine out of the bladder, or bladder, urinary tract or kidney problems. Fortunately, a wide variety of treatments are available for enlarged prostate, including medication, minimally invasive therapies and surgery.

In this next Mayo Clinic Radio podcast, Dr. Mitchell Humphreys, a Mayo Clinic urologist, will highlight prostate health and treatment options for benign prostatic hyperplasia. Also on the program, Dr. Francisco Lopez-Jimenez, a Mayo Clinic cardiologist, will discuss sex after a heart attack. And Dr. Bruce Levy, a Mayo Clinic orthopedic surgeon, will share how his patients' experiences with lack of privacy during surgery led him and his wife to found a new company, COVR Medical.

Here's your Mayo Clinic Radio podcast.

Learn more about BPH (benign prostatic hyperplasia) services

The post Treatment options for enlarged prostate: Mayo Clinic Radio appeared first on Mayo Clinic News Network.

ANSWER: It may not be necessary for you to continue with annual prostate biopsies. But that depends in part on the overall level and rate of change of your prostate-specific antigen, or PSA, over time. Along with information about your PSA, your health care provider can use several other tools to determine if you need additional biopsies or if you can be safely monitored without further biopsies.

The PSA test measures the amount of prostate-specific antigen in your blood. PSA is a protein produced by both cancerous and noncancerous tissue in the prostate — a small gland that sits below a man’s bladder.

When PSA is found to be above normal levels, a prostate biopsy may be recommended to check for cancer. Biopsies involve using a needle to collect several tissue samples from the prostate gland. The samples are then examined in a lab to see if they contain cancer.

Although the PSA test is used primarily to screen for prostate cancer, other medical conditions can cause PSA levels to rise, as well. One of the most common is benign prostatic hyperplasia, or BPH. Basically, this condition is enlargement of the prostate gland that doesn’t involve cancer. Benign prostatic hyperplasia is common as men get older.

To see if benign prostatic hyperplasia could be causing your elevated PSA, talk with your health care provider about getting an imaging exam, such as an ultrasound or an MRI, to assess the size of your prostate gland and look for suspicious areas. Then the PSA can be viewed in the context of the overall size of the prostate, a concept known as PSA density.

When the prostate gland is significantly enlarged in men with higher-than-normal PSA, it is often the case that benign prostatic hyperplasia is the source of the elevation. That’s particularly true for men in that group who have had multiple negative biopsies for prostate cancer.

In addition to imaging, several in-depth blood tests have been shown to be useful for evaluating prostate cancer risk in men who have elevated PSA. The tests include the prostate health index, or PHI; free PSA test; and 4K score. These blood tests look at other proteins, in addition to PSA, and use mathematical algorithms to predict the likelihood of more aggressive forms of prostate cancer being present.

If it is determined that a man has an enlarged prostate and tests indicate that the risk for cancer is not high, it makes an elevated PSA less of an immediate concern. That allows the primary focus to shift from cancer detection to managing the bothersome urinary symptoms that often accompany benign prostatic hyperplasia.

Common benign prostatic hyperplasia symptoms include frequent or urgent need to urinate, increased urination frequency at night, a weak urine stream, difficulty starting urination or inability to completely empty the bladder. Treatment for these symptoms is available, including medication and, in some cases, surgery.

At this point, though, it’s important that you have further evaluation to get a better understanding of your situation to help guide your care going forward. Although prostate biopsies can be a valuable tool for detecting prostate cancer in its early stages, having unnecessary biopsies can needlessly expose you to health risks, raise health care costs, and cause unwarranted worry and anxiety. Planning for future tests and procedures in a way that will avoid unnecessary prostate biopsies is in your best interest. — Dr. Chandler Dora, Urology, Mayo Clinic, Jacksonville, Florida

****************************

Related Articles

• One size does not fit all in benign prostatic hyperplasia treatment published 11/8/18
• Men should know about prostate cancer screening guidelines published 5/10/18
• Mayo Clinic Q and A: New steam treatment for benign prostatic hyperplasia published 5/8/18

The post Mayo Clinic Q and A: Annual prostate biopsies may not be necessary, even with elevated PSA appeared first on Mayo Clinic News Network.

An enlarged prostate gland can cause uncomfortable urinary symptoms, including slowing or blocking the flow of urine from the bladder. It also can cause bladder, urinary tract and kidney problems.

Benign prostatic hyperplasia affects approximately half of men over 50 and almost 90 percent of men over 80, according to American Urological Association.

There are various treatments to address benign prostatic hyperplasia, including medications, minimally invasive therapies that use lasers, steam, radio waves and microwave energy, and traditional surgery to remove the overgrown portion of the prostate.

“BPH is not a one size fits all treatment approach,” says Dr. Chandler Dora, a Mayo Clinic urologist. “The right treatment for each patient may depend on many variables, including your symptoms, your urine flow rate, the size of your prostate and your lifestyle. It’s important to review all of those pieces together to make a recommendation for what the best procedure is for each patient.”

Watch: Dr. Dora discusses enlarged prostate and treatment options.

Journalists: Broadcast-quality sound bites from Dr. Dora are in the downloads at the end of the post. Please ‘Courtesy: Mayo Clinic News Network.’

Mayo Clinic is one of the only centers in the Southeast to offer holmium laser enucleation of the prostate or HoLEP surgery. While patients often initially lean toward minimally invasive procedures, many men are surprised to learn that holmium laser enucleation of the prostate surgery provides the most complete removal of prostate tissue of any of the available procedures.

Holmium laser enucleation of the prostate surgery involves inserting an instrument into the urethra and separating the overgrowth from the shell of the prostate with a laser. Then that excess tissue is removed from the bladder. Patients remain in the hospital overnight and require a catheter for 24 hours.

“All treatments for enlarged prostate require catheter placement,” says Dr. Dora. “The amount of time a patient wears a catheter varies from procedure to procedure, so this may be an important factor to consider when deciding which treatment option to pursue.”

Link between benign prostatic hyperplasia and cancer

For some men, elevated levels of prostate-specific antigen or PSA, a protein produced by tissue in the prostate, is often the first indication of an enlarged prostate. When the prostate grows, prostate-specific antigen levels increase. When the entire prostate is removed, these protein levels fall close to zero.

“If a man comes in with an elevated PSA level, it does not necessarily mean that they have prostate cancer. And in fact, PSA is probably a better predictor of prostate size than it is the presence of prostate cancer,” Dr. Dora says.

Nonetheless, it’s important that a man with an elevated prostate-specific antigen be evaluated by a urologist who then can decide whether a biopsy is appropriate, adds Dr. Dora. Increased levels of prostate-specific antigen can occur for men who have undergone partial prostate removal for benign prostatic hyperplasia. Remaining prostate tissue might continue to grow, leading to increased prostate-specific antigen levels, or it could be a sign of infection.

“We take several factors into consideration when deciding on a biopsy: the presence of enlarged prostate symptoms, the size of the prostate estimated on digital rectal exam, and also, very importantly, what we call the PSA kinetics – what was the PSA last year? What was the PSA five years ago?” explains Dr. Dora.

The American Urological Association recommends routine prostate cancer screening for all men 55 to 69.

Men who are at an increased risk of having an aggressive prostate cancer due to a strong family history or African-American men who tend to have more aggressive prostate cancer are encouraged to have a baseline prostate-specific antigen screening prior to age 55.

The post One size does not fit all in benign prostatic hyperplasia treatment appeared first on Mayo Clinic News Network.

ANSWER: There are several procedures available to treat benign prostatic hyperplasia, or BPH, including a relatively new treatment that uses steam to reduce the size of the prostate and ease symptoms. This treatment has been shown to effectively eliminate excess prostate tissue, while carrying a low risk of side effects.

Benign prostatic hyperplasia is enlargement of the prostate gland that’s not related to cancer. It’s a common condition in men as they age. The prostate gland is beneath the bladder. The tube that transports urine from the bladder, called the urethra, passes through the center of the prostate. When it first starts, benign prostatic hyperplasia may cause few, if any, symptoms. But, as the prostate grows larger over time, it can block urine flow through the urethra, and that can cause problems.

Common benign prostatic hyperplasia symptoms include a frequent or urgent need to urinate, difficulty starting urination, weak urine stream, a stream that stops and starts, increased urination at night or inability to completely empty the bladder.

Treatment for benign prostatic hyperplasia focuses on managing symptoms, so delaying treatment until symptoms appear, as in your situation, is common. Medication can be effective for mild to moderate benign prostatic hyperplasia. If symptoms become severe, or if medication is not enough to manage your symptoms, then a surgical procedure may be recommended.

A variety of procedures can treat benign prostatic hyperplasia. Most involve removing or destroying excess prostate tissue. Examples include procedures that use lasers or an electric loop, which burn the prostate from the inside out. Now, a convective water therapy treatment that uses steam to make the prostate smaller also is available.

Steam treatment for benign prostatic hyperplasia is performed in a health care provider’s office, and the procedure itself usually takes less than 15 minutes. It doesn’t require a hospital stay. During the treatment, a tiny needle is inserted into the urethra and positioned within the prostate gland. In nine seconds, the needle produces a steam ball within the prostate that is about 2 centimeters wide. All the tissue the steam touches is destroyed. That eliminates the extra prostate tissue that causes benign prostatic hyperplasia symptoms.

Possible side effects from prostate treatment depend on the type of procedure that’s used. In general, complications from traditional therapy can include urinary tract infection, bleeding, semen flowing backward into the bladder instead of out through the penis during ejaculation, erectile dysfunction, and, rarely, loss of bladder control and prostate regrowth over time.

Many of these side effects happen because treatment damages the nerves that surround the prostate gland. With steam treatment, the risk of these complications is low because the heat from the treatment doesn’t reach the nerves, so they remain unaffected. A risk of infection still exists. For a period of time after the procedure is done, problems with urination may get worse temporarily. But, in most cases, that side effect does not last.

Steam treatment is relatively new, so long-term data regarding its success rate it not yet available. But, in the three years it has been widely available, studies show that in 90 to 95 percent of men who have steam treatment, benign prostatic hyperplasia symptoms are significantly reduced or eliminated. — Dr. Tobias Kohler, Urology, Mayo Clinic, Rochester, Minnesota

Learn more about BPH (benign prostatic hyperplasia) services

The post Mayo Clinic Q and A: New steam treatment for benign prostatic hyperplasia appeared first on Mayo Clinic News Network.

There are several effective treatments for an enlarged prostate, including a relatively new treatment that uses steam to reduce the size of the prostate and alleviate symptoms.

Jason Howland has more in this Mayo Clinic Minute.

Watch: The Mayo Clinic Minute

Journalists: Broadcast-quality video pkg (1:00) is in the downloads. Read the script.

It's a common problem for older men — benign prostatic hyperplasia, or BPH.

"BPH is a fancy way of saying the prostate is getting larger, and we don't want it to," says Dr. Toby Kohler, a Mayo Clinic urologist.

Dr. Kohler says the enlarged prostate forces the urethra to narrow, causing a variety of urination problems. And, as men age, the symptoms occur more frequently. Treatment for BPH has long been medications and procedures, such as lasers or an electric loop, which burn the prostate from the inside out. But now a relatively new convective water therapy treatment uses steam to make the prostate smaller.

"For nine seconds, a steam ball is produced, and that kills all that prostate tissue that we don't want or that has grown out of control," says Dr. Kohler.

He says the procedure, performed right in the doctor's office, has a low risk for complications or sexual side effects.

"It does not carry heat outside the prostate, and it does not carry heat to areas we don't want it," says Dr. Kohler.

He says this next generation of BPH treatment may soon replace the need for costly medications.

Learn more about BPH (benign prostatic hyperplasia) services

The post Mayo Clinic Minute: Steam treatment for enlarged prostate appeared first on Mayo Clinic News Network.