Enlarged Prostate
with Stephen Busky, MD
What are the potential diagnostic tests if you have voiding difficulties?
An enlarged prostate is not necessarily an indication of prostate cancer. In a condition called benign prostatic hypertrophy (BPH), the prostate increases significantly in size and can cause difficulty with urination (or voiding). As the prostate enlarges, it compresses the urethra and interferes with urination. Simultaneously, the wall of the bladder becomes thicker and irritated, which causes more frequent voiding. As the bladder continues to weaken, it’s unlikely to empty completely.
Urologist Dr. Stephen Busky, MD at GBMC sits down with his patients to determine what potential symptoms of an enlarged prostate could mean. “I ask a patient about his voiding pattern. How often is he going? How much of a disturbance is this to his quality of life?” says Dr. Busky.
According to Dr. Busky, there can be many reasons for voiding difficulties including everything from stress, excessive intake of caffeinated drinks such as coffee, soda or alcohol, and consumption of spicy foods to diabetes, lower bowel disease, and prostate cancer.
“After an extensive conversation with the patient, we next go to a physical exam,” says Dr. Busky. The first step could be a digital rectal exam (DRE). In this exam, Dr. Busky feels the prostate for size and hardness. This information is correlated in a blood test for a prostate-specific antigen (PSA). BPH can raise PSA levels up to three times higher than the normal level. While a heightened PSA level does not indicate cancer, it may indicate a higher chance of having cancer.
There are numerous medications and herbal substances a patient can choose to reduce his voiding symptoms. Some of the same medications used to lower blood pressure can be used to relax the muscle tissue and decrease the stiffness of the prostate. Another class of medicines decreases the number of glandular cells, thereby decreasing the size of the prostate. However, some of these medicines must be taken for six to nine months before the patient knows if they are working.
If necessary, there are procedures to remove part of the tissue of the prostate. In a transurethral needle ablation (TUNA), the prostate is shrunk by inserting small needles to heat the prostate with radiofrequency energy. The body then reabsorbs the parts of the prostate that have been heated. According to Dr. Busky, “This is a minimally invasive procedure and can be done on an outpatient basis.”
Another procedure involves using a catheter as a microwave generator to shrink the prostate with heat. This procedure is good for older patients who aren’t candidates for anesthetics. However, it may not be as effective as TUNA.
Then there is transurethral resection of the prostate (TURP), which has been around since the 1930s. This classic procedure utilizes an electric current to carve out the prostate, systematically getting rid of tissue. However, TURP does require an anesthetic and hospitalization is necessary. Dr. Busky says bleeding can be minimized by “using a laser apparatus to vaporize the prostate. The only problem is that the tissue can’t be analyzed because it’s no longer there.”
Dr. Busky stresses, “Early diagnosis is a must. Patients can pick an option and get on with life. Some look at their problem as a brick wall, but treatment is a door to get through that wall—and then leave it behind.”
