Prostate Treatment and Prognosis: Questions and Answers

Q: Are there any new effective benign prostate hyperplasia treatments?
A: Most enlarged prostate treatments are those from the alpha-blocker group, also used to treat hypertension; sometimes 5-alpha reductase inhibitors are used to deal with prostate problems. When the two kinds of drugs mentioned are prescribed together, prostate symptoms are likely to go away very quickly.
However, as more and more studies are done to understand the way our lower urinary tract functions, the scientists keep coming up with new methods of treatment improving enlarged prostate prognosis. Drugs currently used for erectile dysfunction can be used for the treatment of benign prostatic hyperplasia. Botox is another kind of therapy that may be efficient and relieve the symptoms of BPH.

Q: I am using an erectile dysfunction drug and Viagra from time to time. Can these drugs help with BPH symptoms?
A: Several studies have shown that erectile dysfunction and symptoms of prostate enlargement may be treated in a similar way. For a long time these conditions were viewed as completely different, and their simultaneous presence was interpreted as a coincidence. Today it’s quite clear that both erectile dysfunction (ED) and BPH have the same origin and often occur together.
During one study conducted about a year ago, 369 men suffering from ED and BPH were receiving either 50 milligrams of Viagra or placebo for three months. They took a pill one hour before having sex or going to bed. After being treated with Viagra about 73% of the patients with severe benign prostate hyperplasia reported a great improvement of urinary symptoms. Their condition improved significantly and turned into moderate BPH (55%) and mild BPH (16%). In fact, the results could be compared to those achieved after using traditional medication, such as 5-alpha reductase inhibitors and alpha-blockers.
Many people have to stop taking alpha-blockers within one year of prostate treatment because their symptoms do not get better or serious side effects appear. Erectile dysfunction medications can be effectively used to treat lower urinary tract symptoms and to improve erections. Such drugs as Viagra, Levitra and Cialis help deal with both bladder and prostate problems. These medications are not widely used for the treatment of BPH, but your doctor may prescribe them if you didn’t respond to other methods or had to discontinue some medication because of serious side effects.

Q: I’ve heard the ED drugs help men suffering from enlarged prostate. Why does it happen?
A: It’s not known exactly how this happens, but some theories have been suggested. The bladder – a distensible membranous sac containing the urine – has high activity levels of phosphodiesterase 5, and so does the prostate. The effects of the ED drugs may have to do with their influence on the bladder. Such ED medications as Cialis, Levitra and Viagra block the phosphodiesterase 5 enzyme, preventing it from breaking down nitric oxide responsible for dilating the blood vessels. This medication relaxes the penile arteries allowing more blood into the penis, and dilates small blood vessels in the bladder and prostate, which helps the patient urinate with greater ease.
There is yet another theory stating that ED medications affect neurotransmitters – special cells in the spinal cord. They may not always change the urinary flow, but they have a positive influence on the central nervous system, changing the perception of bother and urgency. Another reason may be that older men are more likely to get BPH and ED, and their nerve signals are often erratic. The drugs for erection mute the signals sent to the brain from the central nervous system and relieve the most unpleasant symptoms of enlarged prostate.

Q: Is it possible to use Botox to relieve the symptoms of BPH?
A: Botox is traditionally perceived as a remedy to fill out wrinkles, which is only partly true. Botox (botulinum toxin type A) is also seen by many doctors as a possible effective remedy for people with enlarged prostate, as most patients respond to it very well.
An injection of Botox can be performed under ultrasonic guidance as the substance needs to be delivered through the needle exactly into the prostate. Within a week after such injections, most patients show significant improvement and can even discontinue their regular BPH medications. The drop in the International Prostate Symptoms Scores was 50%. One very big advantage of using Botox for BPH is absence of side effects.
The effects of Botox are based on paralyzing and weakening of certain muscles and blocking certain groups of nerves. The effects of Botox when it’s injected into the prostate are still not clear, but the prostate gland goes through some changes and decreases in size quite quickly. This reduction improves the urine flow and eliminates the symptoms.
Botox is now viewed as a promising product for the treatment of BPH. It’s more simple and effective than most other methods. The only problem is that Botox hasn’t received the approval of the American Food and Drug Administration.

Q: I know there are many conventional therapies and enlarged prostate treatments, but I am more interested in ones that offer a good alternative. Are there such therapies and how effective are they?
A: There are a number of emerging therapies for benign prostate hyperplasia, and the good news is: in many cases alternative methods do help. Saw palmetto is one of the most commonly used alternatives. It is a tiny berry from a tree growing in Florida; the berries are harvested, and the medicine is made. Saw palmetto is thought to have effects similar to those of anti-hormone medications; it is beneficial for the muscular elements of the prostate.
However, there is one thing you need to keep in mind when you decide to go for alternative remedies: there should be an accurate diagnosis that you received from your doctor. It’s also quite important to make sure the drugs you are buying have been produced by a reputable company, which may be a bit more expensive, but you are looking for the best quality and guarantee. There are currently many medications being developed to target the problem of enlarged prostate, some of them being more efficient than others.
Another interesting method of prostate treatment is alcohol injection. Alcohol is believed to shrink the prostate and provide for a better urine flow. High frequency ultrasound is a non-invasive procedure that can be helpful in many cases of nonresponse to other methods – it decreases the size of the prostate and has no side effects whatsoever. Botox is also thought to help relax the muscles of the prostate gland, which leads to a great improvement of the symptoms. Currently all the therapies mentioned above are still being tested and different results are achieved, but in many cases they appear to be the best decision for many patients.

Q: If I have an enlarged prostate, does it mean I also have cancer of prostate?
A: Cancer of prostate is one of the most common causes of death in males. The prostate is a walnut-like gland that surrounds the neck of the bladder and urethra and secretes a liquid constituent of the semen.
Cancer of prostate, as it progresses, can cause your prostate gland to enlarge, but it doesn’t work both ways: if you have an enlarged prostate it doesn’t mean cancer. The following symptoms may indicate that you have prostate cancer: inability to pass urine, a weaker flow of the urine, dribbling when urinating, frequent urges to go to the bathroom, the feeling of incomplete emptiness, trouble starting to urinate. At the same time these symptoms can be found in most people suffering from an enlarged prostate, so there is really no way you can determine what it is on your own. If you have any reasons to believe you have prostate cancer, you need to talk to your doctor and go through a number of examinations.
If you experience these symptoms, it’s important not to wait for your yearly examination to take place – you can schedule an arrangement earlier. The faster you deal with any problems or symptoms, the more chances there are. A rectal examination is required to diagnose an enlarged prostate. Another test – PSA (prostate-specific agent) can help your doctor diagnose the illness more accurately and monitor the condition to see whether there are any improvements. However, even if prostate-specific antigens are found, prostate cancer is a possibility, so additional assessment may be required for such patients. 
Men older than 50 are more likely to develop cancer of prostate, especially if they eat an unhealthy diet (high in fats). African-American males are also more susceptible to cancer of prostate that white Caucasian men. Another significant risk factor is genetic predisposition, which means that if your close relatives suffer from this condition, you are at risk. The risk factors add up, so the more of them you have, the higher the probability is.

Q: Which method of BPH is the most effective one and what is its efficiency rate?
A: In general, there are three main categories of treatment for benign prostatic hyperplasia:
o    Medical therapy
o    Minor invasive therapy, such as radiofrequency treatment, microwave treatment, etc.
o    Surgical procedures, which are also minimally invasive
If we speak about their efficiency, most males (60–65%) are likely to respond to medical therapy, so they don’t require any invasive surgeries. The rule is: when the man doesn’t respond to the therapy or the symptoms worsen, the second method is seriously considered. Minor invasive therapies have the same percentage of efficiency – about 50–70%.
Transurethral prostatectomy or laser therapy are the most efficient kinds (80–90%), but they are recommended by the doctor only if the previous methods didn’t work well for you, as these surgeries are the most invasive. However, the initial method of treatment can depend on your symptoms and general health condition – in some cases there is no time to try therapy, and surgery is the only variant. Your doctor will conduct a complete examination and determine the method that will work in your case.

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