Prostate Enlargement: Diagnosis, Treatment & Management

What is Prostate Enlargement?

Prostate enlargement is a progressive disease, which can lead to infection, blood in the urine, bladder damage and in some cases, even kidney damage if not properly managed or treated. This is why it is crucial for men experiencing this type of urological condition to manage this through active surveillance by a general practitioner, or active treatment by a specialist or in a hospital setting.

On this information page you can find the following information on prostate enlargement:

Prostate Enlargement Diagnosis


Modern Techniques to Diagnose Prostate Enlargement

In order to diagnose benign prostatic hyperplasia (BPH) and find the right treatment plan, various tests are used by doctors to identify potential signs of prostate enlargement. These include: prostate-specific antigen (PSA) test; digital rectal examination (DRE) and urine flow study (urodynamic study).

Digital Rectal Examination

involves a doctor inserting a gloved finger into the rectum to check the surface of the prostate. Swelling, hardening, lumps and other irregularities on the surface of the prostate may be a sign of cancer.

Prostate-Specific Antigen (PSA) Test

a blood test used to measure the amount of PSA protein produced by the prostate. A small increase in the level of PSA indicates enlargement of the prostate while a significant increase in the PSA level may be a sign of cancer.

Urodynamic Study: A Sophisticated Diagnostic Procedure for BPH

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Urodynamics is a sophisticated diagnostic procedure that enables in-depth analysis of the causes of urinary incontinence, prostatic obstruction and other associated bladder problems. The investigation has two stages. First, the patient voids into a flow meter, allowing measurement of a free flow rate. Then, pressure-sensitive catheters are placed into the bladder and used to monitor bladder function during filling and emptying. Throughout the procedure, the lower urinary tract is visualised using ultrasound.

Urodynamic Study at Katelaris Urology

Urodynamic procedure performed by Dr Phillip Katelaris of Katelaris Urology will happen at the Urology Outpatient Clinic in Hornsby at 51 Palmerston Rd, Hornsby. Patients will be asked to attend with a full bladder.

Interpretation of the computerised urodynamic study is a specialised procedure and the information will therefore not be available on the day of your study. You will require a follow-up appointment to discuss the results and management options. Management of bladder neck obstruction can take the form of certain medications or surgery to relieve the obstruction.

Prostate Enlargement Symptoms

As men get older, many experience what is referred to as “obstructive urinary symptoms” (or “lower urinary tract symptoms”). These include:

  • Decreased urinary flow (poor stream)
  • Having to wait for the flow of urine to start
  • An interrupted flow
  • A feeling of incomplete emptying
  • Waking at night to pass urine
  • Passing urine more frequently during the day
  • Feeling like you urgently need to pass urine
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These symptoms are most often caused by obstruction of the urethra by an enlarging prostate gland. This is a normal part of the ageing process: most men will experience some enlargement of the prostate gland from age 50 onward.

Benign prostatic hyperplasia: an enlarged prostate disrupts normal bladder function.

The condition is called benign prostatic hyperplasia or BPH, and simply means a non-cancerous enlargement of the prostate gland.

Many men present concerned that their symptoms of benign prostatic bladder neck obstruction may be indicative of early prostate cancer: early prostate cancer does not cause symptoms of bladder dysfunction. The decision to investigate and treat should be made on the basis of how severe your symptoms are rather than a fear of cancer.

 There are two surgeries performed to provided definitive relief of the symptoms of BPH.

Prostate Enlargement Treatment

Bladder neck incision

Bladder neck incision is an endoscopic procedure performed under general anaesthetic. The trigone, bladder neck and prostate gland are cut to relieve the obstructive effect of the prostate on outflow of urine.

This is a minimally invasive procedure with good long-term relief of symptoms for well-selected patients.

Retrograde ejaculation occurs in 25% of men following bladder neck incision surgery, resulting in sub-fertility.

Transurethral Prostatectomy (TURP)

TURP is the gold standard treatment for prostatic bladder neck obstruction. The contemporary procedure is performed with modern equipment enabling a short hospital stay, for most patients this is 24 hours.

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Transurethral prostatectomy is a procedure to resect the prostate to relieve urethral obstruction.

This technology is effective in removing large amounts of prostate tissue in a shorter period of time than laser ablation, meaning shorter anaesthetic times and faster recovery.

TURP removes the periurethral adenoma, now called the transition zone of the prostate.

Following TURP, retrograde ejaculation is inevitable and you will be counselled with regards to post-operative fertility prior to surgery.

Greenlight Laser

Greenlight laser treatment for prostate enlargement is suitable for certain selected patients. Its disadvantages include prolonged anaesthetic time for large prostate glands and an inability to remove prostatic stones which often predispose to a prostatic infection.

Additionally, green light laser surgery vaporises tissue and therefore does not provide information about whether or not prostate cancer is present in the transition zone of the prostate gland.

Green light laser prostatectomy causes retrograde ejaculation similar to transurethral prostatectomy surgery generally.

Prostate Enlargement Medical Management

Types of Medications to Treat Obstructive Urinary Symptoms

There are several options available to treat symptoms of benign prostate hyperplasia, including medications such as:

Alpha-blockers

These are medications that relax the smooth muscles of the bladder neck and the prostate to improve urine flow and lessen bladder outlet obstruction. Examples of alpha-blockers are: terazosin, alfuzosin, tamsulosin and doxazosin. Although these medications help relieve the symptoms of BPH, they do not have the capacity to reduce the size of the prostate.

5-Alpha-Reductase Inhibitors

These oral medications work by inhibiting the production of male hormones thought to be responsible for prostatic enlargement. 5-alpha-reductase inhibitors, such as finasteride and dutasteride help relieve the symptoms of BPH, increase the rate of urinary flow and reduce the size of the prostate. However, these drugs are only best suited for men with large prostates.

Combination Therapies

Make use of both alpha-blockers and 5-alpha-reductase inhibitors for better amelioration of BPH symptoms.

Choosing the Best Treatment for BPH

There are a plethora of treatments to manage prostate enlargement, including medications, surgery and minimally invasive therapies. In order to find the right treatment for prostate enlargement, make sure to consult a doctor who can assess your condition based on factors, such as: the size of your prostate; the symptoms you are experiencing; other health conditions you might have and your preferences.

Speak with a trusted urologist from Katelaris Urology. Dr Phillip Katelaris is an award-winning urological surgeon who specialises in prostate enlargement treatment. He can provide you with sound medical advice and effective treatment for urological problems, such as prostate enlargement or cancer, kidney stonebladder cancererectile dysfunction and incontinence.

Schedule an appointment with Dr Katelaris, call us today at (02) 9477 7904.

Frequently Asked Questions: Prostate Enlargement

Some causes of prostate enlargement can be due to the following:

  • Urinary tract infection (UTI)
  • Inflammation of the prostate (prostatitis)
  • Narrowing of the urethra (urethral stricture)
  • Scarring in the bladder neck as a result of previous surgery
  • Bladder or kidney stones
  • Prostate or bladder cancer

The below are common ways to tell if your prostate is enlarged:

  • Difficulty in passing urine, for example, difficulty getting started or dribbling
  • Frequent urination
  • Waking at night to urinate
  • Pain or burning when passing urine
  • Pain when ejaculating
  • Cloudy urine
  • Blood in the urine
  • Pain in your scrotum, penis, testicles or rectum

Research shows us that 20% of men at the age of 40 years had an enlarged prostate, 70% at age 60, and 90% by the age of 80 years old. With an incidence so great, it has been suggested that prostate enlargement is a normal process of ageing and does not reflect a disease process.

However, approximately 25% of men will require surgery to treat the symptoms of an enlarged prostate.

Source: https://healthengine.com.au/info/enlarged-prostate-benign-prostatic-hyperplasia