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

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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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Dr. Matthew Tollefson, a Mayo Clinic urologic oncologist, explains how a growing prostate can cause problems.

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.

Prostate cancer affects more than 250,000 people in the U.S. with about 60% of cases diagnosed in people over 65.

"The prostate gland is a gland that sits around the urethra in men, just below the bladder," says Dr. Tollefson. "That gland then is responsible for producing semen."

But cancer isn’t the only problem that can occur in prostates.

"Men basically urinate through the middle of the prostate – kind of like through the hole in a doughnut," says Dr. Tollefson. "As that doughnut gets larger, that starts to pinch off the urinary stream."

The result is a tough time emptying the bladder and a need to go more frequently. Infections of the prostate are also common and can have similar symptoms, which is why it's important to share information with your health care team.

And even though those symptoms can be embarrassing for some patients, Dr. Tollefson says it's important to see a health care professional.

"There's no reason to really suffer and go through side effects of progression and that type of thing when, really, these things are generally very well-treated and with very little side effect," says Dr. Tollefson.

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.

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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.

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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.

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.

"Anytime a physician prescribes a medication, there are going to be some risks associated with that medication," says William Young, Jr., M.D., the chair of Mayo Clinic's Division of Endocrinology.

Dr. Young says advertising for testosterone medications to treat so-called low T, particularly during televised sporting events, is prompting men to seek out prescriptions for a medication most of them don't need. "So successful has the marketing for this testosterone therapy been that, according to Drugs.com, an independent medicine website, sales of the testosterone gel Androgel in 2013 exceeded sales of Viagra," according to a statement from the UCLA newsroom regarding a new study of the cardiovascular risks of testosterone therapy.

Journalists: Sound bites with Dr. Young are available in the downloads.  

The joint study by UCLA, the National Institutes of Health and Consolidated Research Inc., found the risk of a heart attack shortly after beginning testosterone therapy roughly doubled for men under 65 with a history of heart disease. The study, in the Jan. 29 online edition of the journal PLOS ONE, is the largest to date examining heart disease in men using testosterone supplements.

"In terms of truly low testosterone, it’s actually a very small fraction of the male population in the Unites States that’s truly affected by this. One of the problems of making this distinction is that testosterone levels fall with age."  TRT :14

Dr. Young says, although only a small percentage of men may actually need testosterone medication, there are some symptoms which signal that it might be worth having a conversation with your doctor.

 /// SOT - Symptoms of Possible Low T (Dr. William Young Jr., Mayo Clinic Endocrinologist)

"I think men who have a definite change in their sex drive, libido, men who need to shave less frequently, are losing muscle mass, body hair, are noticing their testicles are getting smaller or if they’re noticing the enlargement of their breasts, these are signs and symptoms that they should talk about the possibility of low testosterone with their physician."  TRT :24

On the other hand, Dr. Young says, boosting testosterone levels unnecessarily may raise a man's risk of other health problems besides heart attacks.

 /// SOT -  Health Risks of High Testosterone (Dr. William Young Jr., Mayo Clinic Endocrinologist)

"If the levels are too high, that triggers the bone marrow to make more red blood cells, which makes the blood more thick and can predispose to stroke. High testosterone levels can also promote the growth of the prostate gland."  TRT :15

Dr. Young says patients suspected of having low male hormone levels may be put on a temporary treatment trial of testosterone medication to see if it brings improvement. However, he says, it’s common to discover that patients with complaints of severe fatigue do not get the desired boost in their energy levels with testosterone therapy,  because low testosterone was not the cause of their fatigue.

The post Mayo Clinic Expert Says Heart Risks From Unnecessarily Treating “Low T” Serious Concern appeared first on Mayo Clinic News Network.

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VIDEO ALERT: PSA: To Test or Not To Test
To download broadcast quality video of this report, please register for the Mayo Clinic News Network.

Mayo Clinic urologists recommend a personalized approach to determining whether or not a patient should consider PSA screening for prostate cancer. This approach should begin at age 40 and include:

• Individual and family medical history.
• The patient's age, recognizing the age-related increase in cancer risk.
• The patient's ethnic background, noting that African-American men have the highest risk of prostate cancer.
• A discussion of the pros and cons of PSA screening.
• Other medical conditions that can affect PSA score.

Organizations that recommend PSA screening generally encourage the test between ages 40 and 75 and in men with a higher risk of prostate cancer, says Mayo urologist Jeffrey Karnes, M.D. "It may be a simple test but it's not a simple decision," Dr. Karnes says. "A PSA test is something you should decide after discussing it with your doctor, considering your risk factors and weighing your personal preferences."

Cancer overall is the No. 2 health threat to men. June is Men's Health Month, highlighting health issues of particular concern to men and strategies for prevention and treatment.

Dr. Karnes and other Mayo Clinic urologists are available for media interviews about prostate cancer screening strategies for men in their 40s, 50s, 60s and 70s that take into account the pros and cons of PSA testing. They're also available to talk about new gene-based prostate cancer screening tests on the horizon.

To interview Dr. Karnes or another Mayo Clinic urologist, please contact Joe Dangor in Public Affairs at 507-284-5005 or email newsbureau@mayo.edu.

About Mayo Clinic Cancer Center

As one of the leading institutions funded by the National Cancer Institute, Mayo Clinic Cancer Center promotes basic and clinical research on the incidence, causes and progression of cancer and translates discoveries into improved methods for prevention, detection, diagnosis, prognosis and therapy.

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About Mayo Clinic:

Recognizing 150 years of serving humanity in 2014, Mayo Clinic is a nonprofit worldwide leader in medical care, research and education for people from all walks of life. For more information, visit 150years.mayoclinic.org, www.mayoclinic.org and newsnetwork.mayoclinic.org.

Media Contact: Joe Dangor in Public Affairs at 507-284-5005 or email newsbureau@mayo.edu.

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