Young men are usually unaware of the prostate gland; its contributions to one’s sexual satisfaction and fertility are typically taken for granted. Men aren’t taught about prostate health in school. Most have never heard of BPH, though it is the most common benign tumor in men. In fact, many men suffer with urinary difficulties needlessly, related to fear, embarrassment, ignorance, and their general resistance to seek medical care. But if dealt with early, most prostate conditions are manageable. Recent technological advances have made treatment easier and more affordable.
The prostate is the “semen factory” and is positioned in the male pelvis just beneath the bladder. Because the prostate encircles the urethra, it can create urinary difficulties. Growing steadily from adolescence on, the average 50-year-old prostate is about the size of a golf ball (and some get larger than baseballs!). Although we often talk about the “enlarged prostate”, its really not the size that counts: the amount of squeeze applied to the urethra is what causes urinary symptoms. So even a small prostate can cause problems.
What do prostate problems feel like? Occasionally, in cases of prostate infection or acute bacterial prostatitis, the symptoms are impossible to ignore: fever, chills, severe pain in the abdomen or perineum (the area you sit on), and inability to urinate, usually bring a man to the emergency room for antibiotics. More commonly, in cases of benign prostatatic hypertrophy (BPH), the gradual onset of increased urinary frequency, slowing of the urinary stream, and getting up at night to urinate can be subtle. If unrecognized, complications of infection, bladder stone formation, kidney damage, and total inability to void can follow. Seeking medical attention early can prevent these tribulations.
After an examination (called the digital rectal exam or DRE), a physician will often order a PSA for a man with these complaints. Alpha-blocker medications (Flomax, Cardura, Hytrin) are effective at quickly releasing the squeeze on the urethra by relaxing muscle in the prostate. Proscar is occasionally added to reduce prostate size. These medications work well in early BPH, but prescription costs can run over $100 per month. In patients in whom medications fail, the traditional gold standard surgical procedure has been the transurethral resection of the prostate (TURP). An anesthetic and hospitalization are required, but the outcome may well be worth the hassle. Total costs may exceed $10,000. Unlike drugs, Medicare and all secondary insurers cover this procedure.
Most of us prefer to look at surgery as a last resort. Fortunately, the development of cooled thermotherapy for the prostate has provided an effective non-surgical alternative to those for whom medications fail or are too costly. Also known as transurethral microwave thermotherapy (TUMT), this procedure has been used in the U.S. for the past seven years. The treatment involves heating prostate tissue to a temperature at which cells in the prostate are destroyed, while keeping the urethra intact. Patient satisfaction exceeds 80%, and the office procedure appears to work as well as the hospital-based TURP. As with TURP, Medicare and secondary insurers cover this procedure, which costs less than $3000.
Not everyone is a candidate for TUMT. For a patient interested in this treatment, his urologist will assess the size and shape of the prostate with ultrasound or by looking into the urethra with a flexible scope—certain prostates are better treated with surgery. Care must be taken with treating patients who have pacemakers. This treatment does not cure prostate cancer, although it may help prostate cancer patients who have difficulty urinating.
Once cleared for TUMT, a patient should expect to receive oral medications and local anesthetics to make this procedure tolerable. A rectal temperature sensor is inserted along with the treatment catheter. As the microwave energy is applied though the catheter the urethra is simultaneously cooled and protected. During the 30-45 minute treatment patients usually experience some urgency to urinate and pressure in the bladder area. After treatment a smaller catheter may be left in place for a few days. Return to work or full activity should quickly, and with few restrictions. Maximal improvement of urinary symptoms takes about a month.
Not all urologists perform TUMT in their offices, but the convenience and comfort that setting provides enhances the treatment experience. If you are suffering with symptoms of BPH (of the cost of the pills used to treat it!) ask your urologist about TUMT.
Finally, a word about prostate cancer: although it kills an American man every fifteen minutes, it causes no pain or urinary problems in its earliest, curable stage. This underscores the importance of annual screening with a PSA blood test and prostate exam. The American Urological Association and American Cancer Society advise most men begin screening at age 50, and at age 40 if African-American or a family history of prostate cancer exists.