Benign Enlargement

We examine some of the recent research and improvements in treatment.

BPH (Benign Prostatic Hyperplasia) is much more common than prostate cancer.  To a rough approximation, 60% of men over sixty and 80% of men over eighty show some symptoms of BPH.  There are over ten times as many cases of BPH compared with prostate cancer seen each year by the average GP.  Yet BPH receives far less attention.  Research to improve the lot of BPH sufferers is more limited as well.  However, that does not mean that all is understood about BPH nor that the treatment options are not changing and improving over time.

Drug treatments

The main cause of BPH is growth of the prostate gland which as men get older eventually leads to some degree of urethral obstruction.  There is an ongoing study in the US to test whether the drugs finasteride, which inhibits the prostate growth hormone, and an alpha blocker (doxazosin), which relaxes the smooth muscle of the prostate, alone or together, can delay or prevent further prostate growth in men with BPH.  Seventeen US medical centres recruited 2931 BPH sufferers between 1996 and 1998.  The study has been following these men's progress on a quarterly basis and is scheduled to end with publishable results in November this year.  This is the largest and longest study ever to test whether such drugs can stop non-cancerous prostate growth.

Non invasive treatments

Because drug treatment is not effective in all cases, researchers have, in recent years, developed a number of procedures that relieve BPH symptoms but are less invasive than surgery.  One of these, which has been used in the US for five years or so is transurethral microwave thermotherapy.  This involves sending computer-regulated microwaves through a catheter to destroy (with heat) selected portions of the prostate and uses a cooling system to protect the urethra.  The procedure takes about 1 hour and can be performed on an outpatient basis without general anaesthesia.  It has not been reported to lead to impotence or incontinence.

Another similar approach to improving urine flow and relieving symptoms with fewer side effects than surgery is TUNA, not something one puts in sandwiches but an acronym for Transurethral Needle Ablation.  The concept is broadly similar to microwave thermotherapy but the burning of tissue is achieved with low-level radiofrequency energy.

Surgery

Most doctors recommend removal of the enlarged part of the prostate as the best long-term solution for patients with BPH.  A procedure called TURP (transurethral resection of the prostate) is the 'gold' standard used for 90 percent of all BPH surgery.   During a TURP operation, an instrument called a resectoscope is inserted through the penis.  The resectoscope, contains a light, valves for controlling irrigating fluid, and an electrical loop that cuts tissue and seals blood vessels.  The procedure to remove unwanted tissue takes about 90 minutes.

Laser Surgery

In the past four years, a surgical procedure that employs side-firing lasers to vaporise obstructing prostate tissue has been developed. This is known as TUVP (Trans-Urethral Vaporisation of the Prostate).  The technique is to pass a laser fibre through the urethra into the prostate and then to deliver several short bursts of energy.  The laser energy destroys prostate tissue and causes shrinkage. Like TURP, the patient requires anaesthesia and a hospital stay.  Advantages of the technique are that laser surgery causes little blood loss and allows a quicker recovery time.  A recent study which followed up 104 men over three years has shown the two techniques to be comparable.  The long-term effectiveness of laser surgery is, of course, not yet known, because its first use was so recent.