Prostate Enlargement (Benign Prostatic Hyperplasia) - Diagnosis & Treatment

How is prostate enlargement (BPH) diagnosed?

The doctor will first check your medical history and ask about your symptoms.

Further investigations will include diagnostic tests such as:

• Digital rectal examination, in which the doctor will insert a gloved, lubricated finger into your rectum to feel the prostate, so as to evaluate its size and any abnormalities.
• Urine flow test (uroflowmetry), to measure the speed and strength of your urinary stream.
• Post-void residual volume test, to see if you are able to empty your bladder completely and measure how much urine remains in the bladder after you finish urinating.
• Urine analysis test, to screen for bladder cancer and rule out other possible causes for your symptoms.
• Cystoscopy, a scope to examine your bladder and urethra.
• Prostate-specific antigen (PSA) blood test, to check if PSA levels are elevated, which might indicate an inflammation or prostate cancer. A PSA test will allow you to detect prostate problems early, even when there are no symptoms.

How is prostate enlargement (BPH) treated?

It may not be necessary to receive immediate treatment for BPH. If your symptoms are minimal, your doctor may recommend to wait and watch your condition over regular check-ups to see if it has progressed.

Should treatment become necessary, there are several options, which include medication, minimally invasive procedures, and surgery. Your doctor will draw up a suitable treatment plan for you based on your age, the size of your prostate, the severity of your symptoms, and your overall health.

Medication

For mild to moderate cases, medication can help to relieve your symptoms. An estimated 30 – 60% of patients find relief through prescribed medicines such as:

• Alpha blockers, which help to relax the prostate and bladder muscles, making urination easier.
• 5-alpha reductase inhibitors, which prevent hormonal changes that contribute to prostate growth.
• Antimuscarinics, which reduce bladder muscle spasms and relieve the symptoms of an overactive bladder.

Minimally invasive and surgical procedures

For moderate to severe symptoms, or for patients who find that medication is insufficient to relieve their symptoms, the doctor may recommend minimally invasive treatment instead.

Treatment options include:

• Transurethral resection of the prostate (TURP). Performed under general or spinal anaesthesia, TURP removes most of the prostate, leaving only the outer part. This relieves symptoms and improves urine flow.
• Transurethral microwave thermotherapy (TUMT). TUMT uses an electrode that emits microwave energy to destroy the inner portion of the prostate, shrinking it to to allow easier urine flow. This procedure may need to be repeated for better efficacy and is generally recommended in cases where more invasive surgery is not suitable.
• Transurethral incision of the prostate (TUIP). An electric current or laser beam is used to make small cuts in the prostate near the bladder, to allow the easier passage of urine. Unlike TURP, prostate tissue is not removed.
• Laser prostatectomy. This procedure passes high-powered laser beams through a flexible fibre tube to heat up and vapourise excess prostate tissue. It has fewer side effects than non-laser surgery and is suitable for men on blood-thinning medications.
• Water vapour therapy. A relatively new minimally invasive treatment, water vapour therapy uses the thermal energy in water vapour to target and shrink enlarged prostate tissue. It is performed as a day surgery without the need for anaesthesia.
• Prostatic urethral lift (PUL). It is a day surgery procedure that uses small permanent implants to pin apart enlarged prostate tissue that is blocking urine flow.
• Holmium laser enucleation of the prostate (HoLEP). For men with urine retention or recurrent UTIs, HoLEP may be recommended to remove excess prostate tissue using laser energy.
• Prostatectomy. A procedure to remove part or all of the prostate, prostatectomy can be performed as an open or robotic-assisted surgery. It is usually recommended only if the prostate is very large or if there are complicating factors such as bladder damage.