BPH > Treatment
Active surveillance
Active surveillance (watchful waiting) may be recommended if your symptoms are mild or if you are not too troubled by them. Your doctor will advise you about small changes that you can make to your lifestyle that might help; for example, try not to drink large volumes of fluid in the evenings. Tea, coffee and alcohol can worsen symptoms. At regular intervals (usually yearly), you will have a check up that will usually include a digital rectal examination and a PSA test.
Newer minimally invasive treatments
As has already been said, minimally invasive treatments are relatively new. While greeted with enthusiasm by some urologists - and many patients - it has to be said that, currently, minimally invasive techniques do not always work as well (or as definitively) as the more traditional treatments. Two that particularly deserve a mention are transurethral microwave thermotherapy and laser therapy.
Transurethral microwave thermotherapy involves using microwave energy to generate heat, which then destroys some of the prostate tissue. Under local anaesthetic, the microwave device is inserted up through the urethra inside a rigid catheter; the temperature of surrounding tissues is monitored using a probe inserted in the rectum. A catheter may be necessary for a few days because of the swelling of the gland in response to the heat.
Laser therapy is carried out under general anaesthetic. A laser probe is inserted up through the penis, and the laser energy it generates destroys some of the prostate tissue. Green-light laser vaporizes the prostate so that no tissue is available for examination under the microscope. A new holmium laser technique - so=called holmium laser enucleation of the prostate or HoLEP - allows the prostate to be cut away, and the pieces are then broken down into a paste and removed from the bladder by suction. Bleeding is minimal after laser therapy, but catheterization is usually necessary for a short time afterwards. For a while, a burning sensation may be experienced on passing urine, which may be prolonged and quite troublesome. If this persists, a urine specimen should be sent to the laboratory for culture to rule out a urinary tract infection. The laser techniques are especially suitable for patients taking anticoagulants because they cause virtually no bleeding and are becoming more popular as more and more specialized laser machines become available. What is not quite clear yet is how durable this treatment is in the longer term.
Plant extracts (phytotherapy)
There is an increasing range of plant extracts available that supposedly alleviate BPH and many claims have been made for their effectiveness. However, scientific data from properly conducted, long-term studies to support their safety and usefulness are limited. A recent report on saw palmetto suggested that it was no more effective than inactive placebo; however, some patients swear by it. Nevertheless, phytotherapy almost certainly does no harm, it is relatively cheap and most urologists do not actively discourage its use.