Enlarged Prostates Are Common, but Treatment Has Never Been Easier

This article was produced in partnership with Lumenis

You vaguely remember your father complaining about his prostate. But, hey, it’s nothing for you to worry about, right? An enlarged prostate is something that happens to older guys. Except one day peeing doesn’t come as easily as it used to, and you’re heading for the bathroom more times than you can count. Uh-oh.

It’s not a fun subject, but if you’re dealing with an enlarged prostate, know you’re not alone. In fact, you’re in very good company. The condition, known in medical terms as benign prostatic hyperplasia (BPH), is surprisingly common. More importantly, treatment options have improved dramatically since when your old man dealt with it. So no more hiding in the bathroom. Let’s bring this into the open and break it down.

What are the symptoms of an enlarged prostate—or BPH?

The prostate is a walnut-sized gland that sits below the bladder and surrounds the urethra. Its job is to create ejaculatory fluid. As men age, their prostates often get bigger, and compress the urethra. When this happens, urine doesn’t flow freely out of the bladder—which means the top signs of BPH are the need to urinate frequently with a stream that dribbles out like a leaky faucet. You might also be getting up multiple times during the night to pee. Sometimes, you may be straining during urination. BPH is incredibly common, affecting around half of men in their 50s, and 90 percent of men in their 80s.

To be clear, we’re not talking about cancer. An enlarged prostate isn’t always dangerous if asymptomatic. You can have an enlarged prostate without it impacting your life. However, if you begin to experience symptoms, they’re unlikely to resolve on their own.

“In general, it’s progressive, and guys will have gradual worsening symptoms,” says James R. Johannes, M.D., a urologist in the Lehigh Valley Health Network in Allentown, Pennsylvania. Left untreated, BPH can cause major damage to the kidneys and bladder, and require much more extensive treatment.

How is BPH diagnosed and treated?

If your general practitioner suspects you have an enlarged prostate, they’ll send you to a urologist for diagnosis and treatment. The doctor will perform a digital rectal exam, a urinalysis, and bloodwork. You may be asked to take a urinary flow and volume test to see if your bladder is emptying, and to track your urination over the course of a couple days.

For most men, the first-line intervention is medicine. Some prescriptions relax muscles in the bladder and prostate to help with urine flow, while others can help shrink the size of the prostate. Sometimes they’re prescribed together. That’s why you should head to the doc as soon as you suspect something’s not right.

“In general, the earlier the better,” Dr. Johannes says. “Sometimes we see people when the cat’s already out of the bag, and they have severe problems.”

At this point, surgery is often a good option. Luckily, we’ve moved past the days when the procedure meant a few nights in the hospital and seeing blood in the urine. Newer laser technology, like MOSES, makes reducing prostatic tissue faster and less invasive. This means less bleeding and often no need for a catheter. Odds are you’ll go home that same day—always a big relief to patients.

You may hear your doctor refer to it as a HoLEP procedure, which stands for holmium laser enucleation of the prostate. That’s been around for decades. What’s improved drastically is the MOSES laser technology. The minimally invasive HoLEP surgery happens in three parts.

First, a resectoscope is placed in the urethra and a small camera is threaded to the prostate so the surgeon can visualize the blockage. Next, a laser is threaded through the resectoscope and is used to core out the tissue that’s blocking urine flow. Finally, a cutting tool “chews up” tissue until it’s very small and removes it.

Throughout the procedure, a laser is used to reduce bleeding. The whole thing takes around 90 minutes and odds are you’ll go home that same day, which is always a relief to patients. Incontinence or urinary leakage risk is very low, as is the risk for erectile dysfunction. And if you’re worried about re-operation—that the surgery didn’t do enough to relieve the BPH—fear not. An 18-year study from McGill University in Montreal found that 98.6 percent of patients did not require another surgery.

If it’s so easy, why do men avoid it?

In a prostate-sized nutshell, going to the urologist is a drag. It’s no fun to talk about urination, less so to consider surgery in those parts. No surprise, it’s often a wife or partner who pushes for a prostate check.

But knowing that BPH is incredibly common—and that treatment is as swift and non-invasive as ever—can help.

Gary, a retired police officer from Illinois, was one of those people who waited too long. By the time his family forced him to visit the emergency room, he was already in renal failure and had to urinate using a catheter. He teamed up with Dr. Amy Krambeck, a urologist at Northwestern Medicine in Chicago, who used the MOSES technology. “My recovery was not bad at all,” Gary recalls. He experienced a week or two of bleeding, typically with urination. “I am doing great. I feel like I’m about 18 years old again.”

The other big hurdle is the fear of prostate cancer.

Here’s some surprising news. “Rarely does prostate cancer cause urinary symptoms,” says Dr. Johannes. The prostate has an inner, fleshy part, called the transitional zone, and an outer area, called the peripheral zone, he explains. Most BPH occurs in the transitional zone, while most cancers are in the peripheral zone.

Of course, for any prostate-related symptoms, your doctor should do blood work that tests for prostate cancer markers. If you do have a BPH procedure with MOSES, or any surgery to reduce prostate size, your surgeon can send tissue samples for analysis. Prostate cancer can be very treatable and slow-growing, so it’s best not to let any big-C fears prevent you from vital early detection and treatment.

Back to BPH. While surgery, of course, will always remain a big, informed decision, just know your options for dealing with a very common condition are that much easier these days. The latest technology in prostate care can alleviate the process of undergoing important treatment from start to finish. And that’s no small relief.

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