Prostate Conditions and Treatments

When a man has BPH the gland presses on the urethra and blocks the urine stream. This pressure causes urinary symptoms, such as:

• Weak urine stream
• Frequent or urgent need to urinate
• Waking up multiple times at night to urinate, a condition called nocturia
• Changes in color or smell of urine
• Not being able to fully empty the bladder
• Difficulty starting urination, despite straining or pushing
• Pain during urination or after ejaculation
• Dribbling, or leaking, after urination

BPH symptoms can start once a man’s prostate begins to grow, which is usually between ages 45 and 50. Nearly half of all men over age 60 experience BPH symptoms.

While uncommon, BPH complications can include:

• Inability to fully empty bladder
• Blood in the urine
• Recurring urinary tract infections
• Bladder or kidney damage
• Bladder stones
• Fatigue and exhaustion from loss of sleep

Doctors have several ways to diagnose BPH:

• Digital rectal examination
• Ultrasound imaging
• Inserting a thin tube in the penis to examine the bladder and urinary tract (Cystoscopy)
• Measuring urine flow
• Testing the amount of urine in the bladder after urination
• Urinary Symptom scores (surveys) and bladder diaries

When suggesting treatments, doctors will consider the size of your prostate, the severity of your symptoms, your age and your overall health. Treatments include:

• Prostatic urethral lift
  • This is a minimally invasive procedure that can be done in the office or as an outpatient surgical procedure. Your doctor will perform an exam to see if you are a candidate for this procedure. The doctor runs a small tube through the urethra and inserts four to six T-shaped steel implants on each side of the prostate, relieving pressure and allowing urine to pass more easily.
  • Most men can return to normal activities within a week. It also doesn’t cause side effects like some BPH medications, such as sexual dysfunction, dizziness and nasal congestion.
  • UroLift has fewer risks compared with a surgical procedure that involves removing a portion of the prostate to relieve BPH symptoms.
  • Although the UroLift implants are made of surgical steel, they won’t set off a metal detector. You can also safely undergo MRIs and other imaging tests.
  • Orlando Health is the only organization in the Orlando area with physicians who have been named as a UroLift Center of Excellence, which is a designation for urologists who have a high level of experience and training with the UroLift system.
• Prostate Steam Vaporization (Rezūm)
  • Rezūm is a minimally invasive outpatient therapy in which the doctor inserts a medical device into the urethra. The device delivers a series of nine-second water-vapor bursts directed at the enlarged portions of the prostate. The procedure is designed to use the body’s natural healing function to shrink unwanted prostate tissue in the targeted areas. Patients receive local anesthesia or can be sedated in the operation room for the short procedure.
  • The benefits of Rezūm include being able to begin normal activities within a few days, while experiencing relief from BPH symptoms within a couple of weeks. Unlike more invasive surgical prostate procedures and BPH medications, Rezūm does not affect sexual function.
• Prostate Laser Therapy
  • Most advanced urologic procedure to remove prostate tissue and cure the symptoms of BPH while preserving sexual and urinary function. With this minimally invasive procedure, a small scope is inserted into the tip of the penis and through the urethra to reach the prostate. A laser is then inserted through the scope to shrink or cut out portions of the enlarged prostate gland.
  • The type of laser used in this procedure may depend on how much the prostate is enlarged. A mild or moderately enlarged prostate may be treated with a laser designed to vaporize excess tissue. For a severely enlarged prostate, another type of laser therapy (known as HoLEP) may be used to slice the excess prostate tissue into small pieces, which are then removed from the body.
  • HoLEP can return urinary function in men who previously were catheter dependent. Depending on the procedure, anesthesia may be local, general or spinal, which numbs the body from the waist down. While some laser therapies are outpatient procedures, HoLEP may require hospitalization.
  • Laser procedures generally have several advantages over traditional surgical solutions to BPH. There’s likely to be minimal bleeding, can resume blood thinners sooner, faster time to remove a catheter, quickerrecovery times and, in many cases, no need to stay overnight in the hospital. Orlando Health Medical Group Urology has the latest laser technology at both inpatient and outpatient facilities.
• Single Port Robotic Surgery
  • Single-port robotic surgery represents a significant advancement in surgical techniques, leveraging robotic assistance to enhance precision and minimize invasiveness. This innovative approach utilizes the da Vinci SP surgical system, specifically engineered for intricate procedures such as prostatectomy, involving the removal of all or part of the prostate gland.
  • The single-port robotic surgery system is a new method for handling complex surgeries. It doesn't replace all other methods, but sometimes it's the best option.
• Transurethral Resections of the Prostate "TURP"
  • This procedure – known as transurethral resections of the prostate, or TURP – was more common until other therapies were developed. TURP can either be completed in same-day surgery or with an overnight stay.
  • Sections of the prostate are removed to relieve pressure on the urethra and improve symptoms of BPH.
  • As with other therapies, doctors pass a scope through the urethra to gain access to an enlarged prostate. The surgeon uses a loop of electrified wire to cut away small sections of the enlarged prostate, which are then removed.
  • Prostate resections are generally safe procedures. Risks of the procedure may include retrograde ejaculation, incontinence, bleeding, and infections.
• Medications
  • Oral medications can be a first line of treatment for men whose BPH symptoms are creating difficulty in everyday life, such as having to go to the toilet multiple times in the night.
  • Alpha blockers are commonly used as an initial treatment for BPH. They are designed to relax the muscles of the prostate gland and bladder. Another class of medications known as 5-alpha reductase inhibitors suppress an enzyme thatleads to a reduction in prostate size overtime. Other types of medications also can be prescribed by your doctor to help with early symptoms of enlarged prostate.
  • The side effects from medications can vary considerably. They can include a loss of sex drive, erectile dysfunction, dizziness and fatigue.

Many of the symptoms of prostate cancer are the same as those for an enlarged prostate. They include:

• Weak urine stream
• Frequent or urgent need to urinate
• Not being able to fully empty the bladder
• Difficulty starting urination
• Pain during urination or after ejaculation
• Blood in urine or semen
• Loss of appetite or weight

One of the differences in symptoms may be back, hip or pelvic pain, a possible indication that the cancer has spread to other parts of the body.

Doctors have several ways to detect the presence of prostate cancer, including:

• Digital rectal examination of the prostate to detect abnormal nodes or lumps
• Blood tests to measure PSA levels
• Ultrasound imaging
• Biopsy of tissue from the prostate, including a procedure called an MRI-fusion biopsy
• Urinary tests to check for prostate cancer markers

• Cryosurgery/cryoablation for prostate cancer: Cryotherapy is a minimally invasive procedure that uses extremely cold temperatures to destroy malignant and benign tumors.
• Robotic Radical Prostatectomy: Compared to traditional, long incision surgery for prostate cancer, robotic prostatectomies result in fewer complications, less blood loss, less need for blood transfusions, lower mortality rates, shorter hospital stays and faster recoveries. The robotic procedure involves smaller incisions and requires fewer sutures, resulting in less chance of tearing and infection. Robotic prostate surgery also allows for a cleaner removal of malignant tissue and reduces damage to healthy tissue.
• Brachytherapy: Radioactive devices are placed in the prostate to kill cancer cells. It can be delivered by placing high doses of radioactive sources in the prostate briefly, or by placing low-dosage radioactive seeds in the prostate permanently. This is typically a treatment used for people whose prostate cancer hasn’t spread to other parts of the body. For more information, visit this site.
• External Beam Radiation: Various precision radiation treatments are available to specifically target cancer cells, including proton therapy, photon therapy, and sterotactic body radiation therapy.
• Hydrogel implant: SpaceOAR hydrogel is a soft, gel-like implant that is injected between the prostate and rectum during radiation treatments for prostate cancer. A key benefit is protecting the rectum from radiation and reducing bowel complications. The gel also reduces the risk of urinary and sexual problems from radiation. For more information, visit this site.
• For more information, visit our prostate cancer site.

Symptoms may vary depending on the specific type of prostatitis, but they include:

• Blood in urine (hematuria) or semen
• Pain between the scrotum or anus, lower abdomen, penis or lower back
• Pain during urination or ejaculation
• Frequent urination (eight or more times a day)
• Urgent need to urinate
• Weak urine stream or trouble starting a urine stream
• Fever or chills

In addition to asking about your medical history, and your family’s, your doctor may do the following to diagnose prostatitis:

• Perform a digital rectal exam of your prostate
• Check urine, blood or semen for signs of infection
• Order imaging tests to check for abnormalities including ultrasound or MRI

Depending on your age, overall health and other factors, your doctor may treat prostatitis with:

• Medications designed to reduce pain and inflammation
• Antibiotics if the prostatitis is related to a bacterial infection
• Heat therapy using warm baths, hot water bottles or heating pads
• Physical therapy to improve bladder function