Hello Yogaman,
My first question must be - Did your doctor order a PSA test? Do a
digital rectum exam? While an enlarged prostate (BPH or benign
prostatic hyperplasia) does not automatically mean prostate cancer,
some cases do become malignant. In order to have an accurate PSA, you
will need to have stopped the herbal and supplemental ?remedies? you
have been taking for at least a week before blood is drawn.
?Prior to diagnosis and treatment of BPH, a prostate-specific
antigen (PSA) test and digital rectal examination (DRE) are performed
to rule out prostate cancer. A transrectal ultrasound and cystoscopy
also may be performed to determine if prostatectomy or TURP is
indicated.?
http://www.urologychannel.com/prostate/bph/minimallyinvasive.shtml
?As the prostate enlarges, the layer of tissue surrounding it stops
it from expanding, causing the gland to press against the urethra like
a clamp on a garden hose. The bladder wall becomes thicker and
irritable. The bladder begins to contract even when it contains small
amounts of urine, causing more frequent urination. Eventually, the
bladder weakens and loses the ability to empty itself. Urine remains
in the bladder. The narrowing of the urethra and partial emptying of
the bladder cause many of the problems associated with BPH.
Many people feel uncomfortable talking about the prostate, since the
gland plays a role in both sex and urination. Still, prostate
enlargement is as common a part of aging as gray hair. As life
expectancy rises, so does the occurrence of BPH. In the United States
in 2000, there were 4.5 million visits to a physician for BPH.?
http://kidney.niddk.nih.gov/kudiseases/pubs/prostateenlargement/
http://kidney.niddk.nih.gov/kudiseases/pubs/prostate_ez/#4
?Diagnosis of BPH usually requires blood tests, a rectal exam,
ultrasonography and/or a minimally invasive endoscopic procedure
called cystoscopy. If a positive diagnosis is made, several
nonsurgical treatment procedures for BPH are available at Huntington
Hospital, including drug intervention and transurethral microwave
therapy (TUMT). During a TUMT procedure, the urologist passes a thin
tube?(catheter)equipped with a tiny microwave-emitting device?through
the urethra to the prostate. Once in place, microwaves are precisely
directed to heat and destroy excess prostate tissue.
If surgery is required to correct BPH, minimally invasive
transurethral resection of the prostate (TURP) is typically a safe and
effective option. TURP involves introducing microsurgical equipment
through the urethra to gently excise and remove excess prostate
tissue. Another minimally invasive transurethral procedure involves
the use of a laser-equipped catheter to safely destroy excess tissue.
In the few cases when transurethical procedures can not be used,
genitourinary surgeons may use open surgery techniques to remove
affected prostate tissue.?
http://www.huntingtonhospital.com/body.cfm?id=37655
?Treatment will depend on your age, overall health, and the severity
of the disease. BPH clears up by itself in one-third of mild cases. It
is important to receive regular check-ups to monitor the progression
of symptoms. Treatment will begin as soon as your symptoms become
bothersome, interfering with your lifestyle. There are lots of ways to
successfully treat BPH, including some simple lifestyle changes if
your symptoms are mild and some very good herbal remedies and
medications. IF no other therapies work and the symptoms are severe
enough, there are also several types of surgery to correct the
condition.?
?The choice of a specific surgical procedure is usually based on the
severity of your symptoms and the size and shape of your prostate
gland.
· TURP: Transurethral resection of the prostate (TURP) is the most
common surgical treatment for BPH. The TURP is performed by inserting
a scope through the penis and removing the prostate piece by piece.
· TUIP: Transurethral incision of the prostate (TUIP) is similar to
TURP, but is usually performed in men who have a relatively small
prostate. This procedure is usually performed as an outpatient without
need for a hospital stay. Like the TURP, a scope is inserted through
the penis until the prostate is reached. Then, rather than removal of
the prostate, a small incision is made in the prostatic tissue to
enlarge the opening of the urethra and bladder outlet.
· Open Prostatectomy: An open prostatectomy is usually performed using
general or spinal anesthesia. An incision is made through the abdomen
or perineal area (i.e., through the pelvic floor, including the region
from the scrotum to the anus). Then, the prostate is removed. This is
a lengthy procedure, and it usually requires a hospital stay of 5 to
10 days.?
http://www.umm.edu/altmed/ConsConditions/BenignProstaticHyperplasiacc.html
Is BPH a sign of cancer?
?No. It's true that some men with prostate cancer also have BPH, but
that doesn't mean that the two conditions are always linked. Most men
with BPH don't develop prostate cancer. However, because the early
symptoms are the same for both conditions, you should see a doctor to
evaluate these symptoms.?
http://kidney.niddk.nih.gov/kudiseases/pubs/prostate_ez/#4
Now, on to urinary frequency. Not only enlarged prostates can cause
frequency. A urinary tract infection, alcohol, diabetes, and
interstitial cystitis can be causes.
After the urodynamics testing, which will measure pressure and flow,
among other parameters, your doctor will have a clearer picture.
However, be prepared for some kind of procedure, be it minimally
invasive or not.
Here is a site that clearly explains theurodynamics testing process.
http://kidney.niddk.nih.gov/kudiseases/pubs/urodynamic/
There are three measures you can take with BPH:
· Watchful waiting. If your symptoms don't bother you too much, you
may choose to live with them rather than take pills every day or have
surgery. But you should have regular checkups to make sure your
condition isn't getting worse. With watchful waiting, you can be ready
to choose a treatment as soon as you need it.
· Medicines. In recent years, scientists have developed several
medicines to shrink or relax the prostate to keep it from blocking the
bladder opening.
· Nonsurgical procedures. A number of devices have been developed to
remove parts of the prostate. These procedures can usually be done in
a clinic or hospital without an overnight stay. The procedures are
transurethral, which means the doctor reaches the area by going
through the urethra. The doctor's devices use thin tubes inserted
through the urethra to deliver controlled heat to small areas of the
prostate. A gel may be applied to the urethra to prevent pain or
discomfort. You won't need general drugs that make you go to sleep.
These procedures are called transurethral microwave thermotherapy
(TUMT) and transurethral needle ablation (TUNA).?
You say your medication has not helped you. Flomax (Tamsulosin) is not
intended to shrink or decrease the swelling of the prostate, but to
relax the muscle.
?Tamsulosin helps relax the muscles in the prostate and the opening
of the bladder. This may help increase the flow of urine and/or
decrease the symptoms. However, tamsulosin will not shrink the
prostate. The prostate may continue to get larger. This may cause the
symptoms to become worse over time. Therefore, even though tamsulosin
may lessen the problems caused by enlarged prostate now, surgery still
may be needed in the future.
http://www.drugs.com/cons/Tamsulosin.html
?Finasteride, FDA-approved in 1992 (marketed under the name
Proscar), and dutasteride, FDA-approved in 2001 (marketed as Avodart),
inhibit production of the hormone DHT, which is involved with prostate
enlargement. The use of either of these drugs can either prevent
progression of growth of the prostate or actually shrink the prostate
in some men.
FDA also approved the drugs terazosin (marketed as Hytrin) in 1993,
doxazosin (marketed as Cardura) in 1995, tamsulosin (marketed as
Flomax) in 1997, and alfuzosin (marketed as Uroxatral) in 2003 for the
treatment of BPH. All four drugs act by relaxing the smooth muscle of
the prostate and bladder neck to improve urine flow and to reduce
bladder outlet obstruction. The four drugs belong to the class known
as alpha blockers. Terazosin and doxazosin were developed first to
treat high blood pressure. Tamsulosin and alfuzosin were developed
specifically to treat BPH.?
http://kidney.niddk.nih.gov/kudiseases/pubs/prostateenlargement/
Finasteride may take 6 months to see an effect, as it shrinks the prostate.
?Finasteride (fin-AS-tur-ide) belongs to the group of medicines called
enzyme inhibitors. It is used to treat urinary problems caused by
enlargement of the prostate (benign prostatic hyperplasia or BPH). In
men with very enlarged prostates and mild to moderate symptoms
(difficulty urinating, decreased flow of urination, hesitation at the
beginning of urination, getting up at night to urinate), finasteride
may decrease the severity of symptoms. Finasteride may also reduce the
chance that surgery on the prostate will be needed.
Finasteride blocks an enzyme called 5-alpha-reductase, which is
necessary to change testosterone to another hormone that causes the
prostate to grow. As a result, the size of the prostate is decreased.
The effect of finasteride on the prostate lasts only as long as the
medicine is taken. If it is stopped, the prostate begins to grow
again.
Finasteride also is used by some balding men to stimulate hair growth.
If hair growth is going to occur with the use of finasteride, it
usually occurs after the medicine has been used for about 3 months and
lasts only as long as the medicine continues to be used. The new hair
will be lost within 1 year after finasteride treatment is stopped.?
http://kidney.niddk.nih.gov/kudiseases/pubs/prostateenlargement/
?Alfuzosin belongs to a class of drugs called alpha-blockers. It is
used for increasing the flow of urine that is reduced by benign
prostatic hypertrophy (BPH). Alpha blockers relax the muscles in the
prostate gland and the neck of the bladder. This allows the urethra
(the tube that conducts urine out of the bladder) to open wider so
that urine flows more easily.?
http://www.medicinenet.com/alfuzosin/article.htm
?Alfuzosin controls BPH but does not cure it. Continue to take
alfuzosin even if you feel well. Do not stop taking alfuzosin without
talking to your doctor.?
http://www.nlm.nih.gov/medlineplus/druginfo/medmaster/a604002.html
Non-surgical therapies for BPH:
===============================
· Drugs - Medication or prescription drugs are a common treatment
option for BPH. Drugs address the symptoms of BPH but do not cure the
disease. Symptom relief can cease when you stop taking the drugs.
Medication can be costly, and some BPH drugs may interfere with other
medications you are taking. Potential side effects may include
impotence, dizziness, headaches and fatigue.
· Microwave therapy - This in office procedure relies on energy
sources to heat and treat prostate tissue?
Less Invasive Surgery ?Holmium Laser Treatment - Holmium laser
treatments use laser energy to remove obstructing prostate tissue.
Holmium laser treatment provides immediate symptom relief and improves
quality of life with little risk of complications. Holmium laser
vaporization is generally performed with the patient under spinal,
epidural or general anesthesia. After receiving anesthesia, your
urologist will pass a cystoscope into your urethra, enabling him or
her to view the bladder and prostate. A thin flexible fiber is
inserted into the cystoscope and used to transmit the laser energy to
the prostate with a very high degree of precision. Your doctor
controls the direction and delivery of laser energy by moving the
fiber back and forth in a sweeping, or ?painting?, motion. The laser
energy instantly vaporizes the obstructing tissue. The laser also
seals the area, resulting in little if any bleeding during and after
the procedure. Since holmium energy penetrates superficially, thermal
injury to surrounding tissue that could delay your symptom relief is
avoided. And if you should also have a bladder stone, the holmium
laser can be used to fragment and remove your stone during the
prostate treatment. The procedure may be completed in an hour or less,
depending upon the size of your prostate, amount of prostate removed,
surgical technique, and power of laser used by your doctor. After the
procedure, bladder irrigation is rarely needed. There are fewer risks
for postoperative complications than TURP, and recovery time is
shorter.?
http://www.bostonscientific.com/patient_ed/PEprocedureOverview.jsp?task=tskPEprocedureOverview.jsp§ionId=3&relId=1008,1353
This Urology Channel site explains the non-surgical and minimally
invasive techniques for BPH. (Due to copyright restrictions, I have
posted only snippets of information here. Please read the link below
for complete information)
Interstitial Laser Coagulation
------------------------------
Interstitial laser coagulation is often performed under local
anesthesia on an outpatient basis. The Indigo LaserOptic Treatment?
System uses a cystoscope through which a fiberoptic probe is directly
introduced into the prostate. Heat energy is conducted through the
probe for 3 minutes and quickly coagulates the obstructing prostate
tissue. The process can be repeated to treat another area in the
prostate, as determined by the physician.
PVP
----
Photoselective vaporization of the prostate (PVP) is a minimally
invasive procedure that uses a special high-energy laser (e.g.,
GreenLight PVP? Laser) to vaporize excess prostate tissue and seal the
treated area. The procedure is performed on an outpatient basis in a
hospital or surgical center and may be performed under local, spinal,
or general anesthesia. PVP takes between 10 and 30 minutes to perform,
depending on the size of the prostate and patients are usually
discharged within a few hours.
HoLAP
-----
HoLAP (holmium laser ablation of the prostate) involves using a laser
to vaporize obstructive prostatic tissue. The decision whether to use
HoLAP or HoLEP (holmium enucleation of the prostate) is based
primarily on the size of the prostate. Ablation usually is performed
when the prostate is smaller than 60 cc (cubic centimeters).
Cooled ThermoTherapy?/TUMT?
---------------------------
Cooled ThermoTherapy?/TUMT? reduces BPH symptoms, preserves sexual
function, and provides durable results using the Targis? system or the
Prostatron® system. Treatment can be completed within 30 minutes,
usually does not require anesthesia, and is performed in a physician?s
office or an outpatient setting.
CoreTherm®
----------
An outpatient, microwave-generated heat treatment that destroys excess
prostate tissue. CoreTherm uses a transurethral catheter containing a
microwave antenna and an intraprostatic probe with three temperature
sensors. This system takes into account the fact that different
patients have differently sized prostates and different intraprostatic
blood flows.
TherMatrx®
----------
TherMatrx® is a minimally invasive procedure performed in a
urologist's office that uses heat delivered through a microwave
antenna. This outpatient procedure requires local anesthesia. A mild
sedative or pain reliever may be given to help the patient relax and
make him as comfortable as possible during the procedure.
Prolieve?
---------
Prolieve? Thermodilatation System is a transurethral microwave
thermotherapy (TUMT) device that also uses a special balloon catheter
to open up (dilate) the urethra, as well as microwave energy to heat
and destroy enlarged prostatic tissue. In this procedure, the balloon
catheter is filled with warm water.
AquaTherm?
----------
The AquaTherm? System uses water-induced thermotherapy (WIT) to
destroy obstructive prostatic tissue and reopen the urethra. WIT can
be performed in ambulatory surgery, outpatient surgery, or a
physician's office. It takes only 45 minutes and does not require
general anesthesia.
Transurethral Needle Ablation (TUNA)
------------------------------------
Transurethral needle ablation of the prostate (TUNA), procedure
delivers low level radio frequency (RF) energy to the prostate,
relieving obstruction without causing damage to the urethra.
TUVP, and High Intensity Focused Ultrasound (HIFU) are also explained
on this site.
http://www.urologychannel.com/prostate/bph/treatment_therm.shtml
?The Prostatron reduces excess prostate tissue by directing controlled
microwave heat in combination with cooling water through a small
treatment catheter, a process known as thermotherapy. "Previously, BPH
patients could choose only between long-term drug regimens and
invasive surgery," Krane notes. "Now patients have a nonsurgical,
one-time treatment option that takes about an hour."
Developed by Burlington-based EDAP Technomed, Inc., the Prostatron was
approved for use by the Food and Drug Administration in May 1996. It
has been used widely outside the United States since 1990, treating
some 40,000 men.?
http://www.bu.edu/phpbin/researchbriefs/display.php?id=27
?The US Food and Drug Administration (FDA) has cleared France-based
EDAP TMS SA's new treatment protocol, the 30-Minute TransUrethral
Microwave Thermotherapy (TUMT), for use in the firm's Prostatron
device.
The new protocol cuts from 1 hour to 30 minutes the Prostatron's
operating time in treating benign prostatic hyperplasia (BPH). The new
method employs a high-energy bladder neck process, giving physicians
the capability to treat the condition via an 80-watt, minimally
invasive procedure on an outpatient basis.
EDAP developed its newly approved microwave technology in response to
requests from approximately 1,200 TUMT-trained US urologists for a new
method that could trim treatment time without sacrificing Prostatron
effectiveness, noted EDAP CEO Eric Simon.P's 30-minute protocol has
only one rival in the field, Urologic's Targis, approved 1 year after
the FDA's May 1996 approval of Prostatron. Since its debut, the
Prostatron device has been used in approximately 17,000 treatments and
is now used in an average of 7,500 treatments per year, according to
Krachon.?
http://www.oncolink.com/resources/article.cfm?c=3&s=8&ss=23&Year=2000&Month=4&id=63
Hormonal Therapy
-----------------
?Androgens (95% from the testis, 5% from the adrenal), Prolactin,
Oestrogen and the growth regulating factors (peptides) all affect the
growth and function of the prostate. Therefore interfering at any
level with any of the above mentioned will inevitably lead to
alterations in the metabolism and functions of the prostate.
Testosterone is the principle androgen in other tissues (brain,
skeletal muscle and the seminiferous epithelium) and acts directly to
stimulate androgen-dependent processes. In the prostate however,
Dihidrotestosterone (DHT) is the principal androgen and the enzyme 5
alpha-reductase (5a R) converts testosterone (T) to
dihidrotestosterone (DHT). Ninety five percent of the prostatic
androgens are in the form of DHT. Despite the decrease in serum
testosterone, which occurs with ageing DHT levels in the prostate,
remains at normal level or in some instances of BPH, DHT levels might
even be raised.?
Diverse medical modalities:
----------------------------
1. Phytotherapeutic Agents
A variety of agents such as pumpkin seeds, sago palm, rye and others
have been popularised as having a beneficial effect on patients with
symptomatic BPH. Some of these products are still being used in Europe
and Japan.
2. Amino acid complexes
Glycine-alanine-glutamic acid has been reported to reduce the size of
an enlarged prostate and to relieve symptoms. No objective proof has
been produced as yet to prove that these agents are effective.
3. Organ extracts
Although some improvements have been reported, the intra-muscular
injection of prostatic extracts remains a theoretical possibility and
no controlled objective results have thus far been published.
Also on this page are explanations of Urethral Stents, Cryotherapy,
Laser and Heat treatment.
http://www.medpharm.co.za/safp/2000/apr/benign.html
In case you end up needing a prostatectomy, here are some useful sites:
http://www.healthsquare.com/mc/fgmc0820.htm
http://www.webmd.com/hw/prostate_cancer/hw77111.asp
http://www.yoursurgery.com/ProcedureDetails.cfm?BR=7&Proc=41
http://www.med.umich.edu/1libr/aha/aha_turp_crs.htm
I hope this has fully answered your question. If not, please request
an Answer Clarification. I will be happy to assist you further, before
you rate this answer. Remember, your doctor and you will decide on the
best treatment for your individual case, as your doctor is familiar
with your medical history. Good luck!
Sincerely, Crabcakes
Search Terms
=============
BPH + non-surgical procedures
non-surgical + treatment + BPH
Minimally invasive + BPH
enlarged prostate + non-surgical procedures
urinary frequency + prostate
prostatectomy |
