DEAR MAYO CLINIC: Recently, I was diagnosed with BPH. This is all new to me, and I hope you can help me better understand the condition and how it's treated. 

ANSWER: Now that you've been diagnosed with benign prostatic hyperplasia (BPH) — noncancerous tissue growth within the prostate — it's time for you and your healthcare team to talk about treatment options. 

These options depend on the severity of your symptoms, which can range from having a weak urine stream to not being able to urinate at all. Most treatments are done in the outpatient setting, including your clinician's office, while others may require a hospital stay. Wherever you are on the range of symptoms, there are treatment options that can relieve them, including:   

Behavior modifications

If you're experiencing bothersome, but not severe, symptoms, such as having a weak urine stream or frequently getting up at night to urinate, your treatment may start with:

• Changes to your diet
  Some foods, such as chocolate, citrus, carbonated beverages and caffeine, can irritate your bladder, which can increase your urge to urinate. Cutting back on these foods may ease your symptoms.
• Fluid intake
  Reducing the amount of fluid you drink before bedtime can decrease your need to urinate during the night.
• Timed urination (voiding)
  Holding your urine can also irritate your bladder, so making a point to urinate every hour and a half to two hours can reduce the urge to go "now."

Medications for BPH

If these behavior modifications are no longer effective, your clinician may prescribe a medication, which you'll need to take every day. These include:

• Alpha blockers
  These drugs relax muscles in the bladder and prostate, and they open up the urinary channel to reduce blockage. Side effects include a decrease in blood pressure, dizziness and lightheadedness. They also can cause semen to go back into the bladder instead of the penis, which may be startling, but is harmless.
• 5-alpha reductase inhibitors
  These medications work to shrink the prostate by lowering the production of a specific hormone. There are more side effects, and it may take six to nine months to see any results. Men may have a lower sex drive, and some will experience erectile dysfunction.

Surgical procedures

You and your healthcare team may decide that in-office therapies or surgery to shrink or remove overgrown prostate tissue would be the best treatment option for you. Some treatments work better than others, depending on your symptoms, treatment goals and the size of your prostate. Most preserve sexual function and have little or no effect on erectile or ejaculatory function. 

These treatments include:

• Temporarily implanted nitinol device
  This procedure reshapes the tissue of the prostatic urethra and the bladder neck to create a wider channel through which urine can flow. A narrow, folded nickel titanium device is inserted into the prostatic urethra. As the device expands, gentle pressure reshapes the urethra and bladder opening. After five to seven days, the device is removed.
• Prostatic urethral lift (PUL)
  This procedure reshapes the prostate using a small, permanent implant to compress and lift the side of the enlarged prostate to increase the urethra opening.
• Steam therapy
  During the treatment, a tiny needle is inserted into the urethra and positioned in the prostate gland. In nine seconds, the needle produces a 2-centimeter-wide steam ball that shrinks the surrounding prostate tissue.
• Transurethral resection of the prostate (TURP) and photo-selective vaporization (PVP)
  During a TURP, a lighted scope is inserted into the urethra and the surgeon uses an electric loop to remove all but the outer part of the prostate. TURP generally relieves symptoms quickly, and most men have a stronger urine flow soon after the procedure. 

PVP is laser therapy performed in an operating room under anesthesia. A surgeon inserts a thin, tube-like instrument into the urethra. This instrument has a lens, light and tool that sends out an electrical current to destroy prostate tissue. Heat from the current seals small blood vessels, reducing the risk of bleeding. This procedure destroys or removes overgrown prostate tissue and is a good choice if you need to stay on blood thinners.

• Prostate enucleation (BipoLEP or HoLEP)
  This procedure removes nearly the entire prostate without an incision. It is often a good option for patients with especially large prostates, the inability to stop blood thinners or in significant urinary retention. A thin instrument is inserted into the urethra. Then, a laser cuts the prostate tissue into small, removable pieces. 
• Simple prostatectomy
  This minimally invasive surgery removes tissue blocking the flow of urine. It usually requires a one-night stay in the hospital and is done laparoscopically through a small incision in your side, most often using a surgical robot.

Ross Avant, M.D., Urology, Mayo Clinic Health System, Austin and Red Wing, Minnesota; Mayo Clinic, Rochester, Minnesota

The post Mayo Clinic Q and A: What are your options for managing BPH? 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.

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

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For men over 50, prostate problems are common. The prostate gland is located just below the bladder and surrounds the top portion of the urethra, which is the tube that drains urine from the bladder. The prostate's primary function is to produce the fluid that nourishes and transports sperm. 

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.

On the next Mayo Clinic Radio program, 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.

To hear the program, find an affiliate in your area.

Use the hashtag #MayoClinicRadio, and tweet your questions.

Mayo Clinic Radio is on iHeartRadio.

Access archived shows or subscribe to the podcast.

Mayo Clinic Radio produces a weekly one-hour radio program highlighting health and medical information from Mayo Clinic.

The post Treatment options for enlarged prostate 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.

On the next Mayo Clinic Radio program, 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.

To hear the program, find an affiliate in your area.

Miss the show? Here's your Mayo Clinic Radio podcast.

Use the hashtag #MayoClinicRadio, and tweet your questions.

Mayo Clinic Radio is on iHeartRadio.

Access archived shows or subscribe to the podcast.

Mayo Clinic Radio produces a weekly one-hour radio program highlighting health and medical information from Mayo Clinic.

The post Mayo Clinic Radio: Prostate health / sex after a heart attack / COVR Medical 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.

On the Mayo Clinic Radio podcast, Dr. Rekha Mankad, a Mayo Clinic cardiologist and director of the Women’s Heart Clinic, joins us to discuss women's heart health. Also on the podcast, Dr. Tobias Kohler, a urologist at Mayo Clinic, explains a promising new treatment for benign prostatic hyperplasia, or BPH. And Dr. Brent Bauer and Dr. Anja Jamrozik share findings of the first study done by Mayo Clinic's Well Living Lab. Dr. Bauer is director of the Mayo Clinic Complementary and Integrative Medicine Program and medical director for the Well Living Lab. Dr. Jamrozik is the Delos behavioral science consultant.

The post #MayoClinicRadio podcast: 2/24/18 appeared first on Mayo Clinic News Network.