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Category: BPH

Choosing Between In-Office and Surgical BPH Treatment

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Benign prostatic hyperplasia, or BPH, is a common concern as men age and represents a significant cause of lower urinary tract symptoms ranging from mild to severe. Due to the prevalence of this condition, there are plenty of treatment options, from medication to office therapies and surgery. With all the available options, it can be confusing for patients to make the best choice for their circumstances. This article will discuss office versus surgical treatment options and when they make the most sense for your circumstances.

When patients first begin to experience lower urinary tract symptoms, many believe that they may have prostate cancer. However, prostate cancer rarely presents with urinary symptoms in its earlier stages. Most patients are relieved to find out that their symptoms are caused by benign prostatic enlargement, and they often, at this point, may or may not pursue therapy. Unfortunately, BPH is a progressive condition and tends to get worse. The gradual worsening, however, is often managed through lifestyle changes, including not going out to events or dinner or limiting fluid intake. These slowly creep up on a man, and their life can be severely limited before they know it. Many patients do not understand the breadth of minimally invasive options, including in-office ones, and consequently wait too long for treatment.

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Should You Drink Less if You Have BPH?

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Man drinking from plastic water bottle while working out

While benign is in the name, it sure doesn’t feel like it to patients suffering from Benign Prostatic Hyperplasia (BPH). At first, many patients think they may have prostate cancer. They are relieved to learn that most cases of symptomatic lower urinary tract symptoms are not caused by a malignancy but rather this ubiquitous normal part of the aging process. However, BPH only tends to get worse as the cells in the prostate continue to grow. The result is often nocturia, in which the patient wakes for a visit to the bathroom multiple times each night, often causing disrupted sleep and constant daytime fatigue. As such, many patients think that reducing their water intake will solve the issue.

Ultimately, drinking fewer fluids to try to avoid the symptoms of BPH doesn’t work and may be counterproductive. For one, it is critically important that you stay hydrated for continued health. This is not just the health of your urinary system, but every bodily function depends on proper hydration. Even mild dehydration has significant physical and psychological consequences. Further, dehydration can make your lower urinary tract symptoms worse. Lack of fluid intake can cause bladder irritation as the urine is more concentrated. The result? You guessed it! An urge to urinate more frequently. It can also cause significant kidney issues that, once again, can create problematic urinary symptoms.

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Could How You Grow Your Hair Be Causing ED?

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Man looking in mirror touching hair

One of the most concerning issues that male patients discuss with their friends or physicians is hair loss. For many, hair is a sign of virility, and despite the inevitability of male pattern, baldness, which ultimately comes down to genetics, we still fight for that hair tooth and nail. It’s no wonder that hair restoration has grown to be such a huge industry and is rife with therapies that work and others that many claim to be effective but don’t have much data to support the assertion. From micro-needling rollers to caffeine ointment, red light therapy, various essential oils, and medication, there’s an overwhelming amount of information to process and seemingly impossible decisions to make.

Enter Finasteride

Finasteride is a drug known as a five alpha reductase inhibitor. Its main claim to fame is the very effective blockage of dihydrotestosterone (DHT (finasteride blocks upwards of 90% of DHT in the prostate and 70% in the blood)). DHT is essential to the normal workings of our bodies and is instrumental in developing male characteristics. However, excess DHT on our scalp later in life can cause hair follicles to shrink and ultimately die. By controlling the DHT systemically via the oral intake of finasteride or locally through topical applications, we see some of the very best hair regrowth results of any therapy.

It’s worth understanding that finasteride was not developed as a treatment for hair loss but rather to slow the growth of the prostate to fight a natural process known as benign prostatic hyperplasia (BPH) that affects most men later in their lives. However, it soon became clear that men taking this drug grew more hair on their scalps, and you have the ubiquitous drug we are used to hearing about today.

The Side Effects of Finasteride

For all its benefits, Finasteride has some potentially significant side effects. They mostly revolve around the effects of very low DHT, including low libido, reduced general function, depression in some, and even erectile dysfunction. These effects seem more pronounced when finasteride is taken orally, but the topical version can also be problematic. Younger men seem to have greater side effects than their older counterparts. As such, if you are currently using finasteride therapy for hair loss and having difficulty maintaining an erection, you may wish to speak to Dr. Kapadia to understand more about the systemic effects that both the oral drug and, to a lesser extent, topical application can cause.

What Is the Answer?

If you look up the recommended dosages of oral finasteride, you may be shocked to see how varied they are. Dosages from .5 mg up to 5 mg are routinely prescribed. Why so much variance? We all react differently to finasteride; no single dosage makes sense for every patient. However, as with most drugs, we strongly encourage working with your primary care physician, urologist, and hair loss specialist, to take the minimum effective dose. This helps ensure the drug can take effect while minimizing its potential, side effects, and considerations. This dosage can, of course, be modified to find a sweet spot. And patients should be aware of how their body reacts in the days and weeks after changing their dosage.

It’s also important to remember that finasteride may not cause erectile dysfunction and that aging is making it more difficult for you to achieve and maintain an erection during intercourse. In this situation, we can work with you to develop an erectile dysfunction treatment plan, including medication like sildenafil (generic Viagra) or tadalafil (generic Cialis), or for more severe erectile function, problems, course of injections, or even a penile implant.

Most importantly, speak to us about this and any other erectile function issues he may have. While it may feel awkward to have that conversation, we’ve helped thousands of men with the same problem, and want you to rest, assured that it is nothing to be ashamed of. Ultimately, erectile function can be achieved, no matter how bad your condition.

Is It BPH or Prostate Cancer?

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Skeletal diagram showing a highlighted prostate

Patients often worry about the possibility of prostate cancer when they experience lower urinary tract symptoms, like urinary frequency, urge to urinate, or an inability to fully empty the bladder. These concerns are legitimate, but many patients’ minds go directly to the worst-case scenario they can think of – cancer. However, it is essential to understand the differences between benign prostate issues, like BPH, and something insidious, like prostate cancer.

First, the patient should understand that prostate cancer rarely presents with symptoms, especially in the earliest stages. Therefore, if you are experiencing some or all the symptoms above, chances are it is related to an enlarged prostate and not cancer. This is not to say that a trip to a urologist is not warranted—quite the opposite. Visiting your urologist at this point is essential as we can help eliminate the symptoms associated with BPH and improve your quality of life and lifestyle. Remember that BPH is a progressive disorder and purported remedies such as saw palmetto have no proven benefit. On the flip side, minimally invasive BPH therapies like Rezum, which uses water vapor to ablate or destroy excess prostatic tissue, are convenient and very effective for upwards of five years from the procedure day.

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The PSA and How We Use It

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PSA test held by person in glove

Prostate-specific antigen, or PSA, was discovered in 1970, and a purified form that could be used for diagnostics was developed in the 1980s. PSA measurement started as a way to track the effectiveness of prostate cancer treatment but, in the early 1990s, quickly became the definitive first-line diagnostic measure for prostate cancer. PSA is unique in that it is only produced in the prostate, and levels can fluctuate based on the health of the prostate. In fact, much of the reduction in prostate cancer mortality since the 1980s has been attributed to PSA screenings.

However, early on, patients with elevated PSA were often biopsied as a matter of course. Then, when prostate cancer was found, they were referred, amongst other treatments, to surgery in the form of a prostatectomy. This started an era of overtreatment of prostate cancer. We now know that many cases of prostate cancer are not aggressive, and some men may even be able to live normal lives with prostate cancer and routine watchful checkups, never needing to treat it in their lifetimes. We also know that using a single PSA reading makes this testing method unreliable in predicting clinically significant prostate cancer.

The result was that many men were unfortunately rendered impotent and incontinent due to prostate cancer surgeries that were the standard of care at the time, but we now know to have been unnecessary. We still see some patients that implant inflatable penile prostheses years or decades after becoming impotent due to prostatectomy.

Upon analysis by a U.S. Preventative Task Force in the 2010s on the effectiveness of screening (including PSA), there were some damning results in a report that was subsequently used to campaign against this test. Of course, there were some significant limitations, including no urologic specialist being on the task force and the use of older data from the times of overtreatment. For a while, it seemed that PSA, as a front-line diagnostic tool, would be relegated to the history books. Fortunately, this was not to be the case.

Modern PSA Testing

In what can only be described as a stunning turnaround for PSA testing, we now consider PSA to be one of the most accurate diagnostic tests in urology, and maybe all of medicine, not because of a single reading but because of how they trend. Today, we use a series of two or three PSA readings to understand whether the prostate should be biopsied and, ultimately, if prostate cancer should be treated. With this newfound knowledge and a deeper understanding of the art of PSA trend testing, we are better able than at any time in the past to differentiate clinically insignificant prostate cancer from that which needs biopsy and treatment.

Of course, prostate cancer still exists, and tens of thousands of men die each year due to aggressive forms of this cancer. Along with better diagnostic tools, we need men to prioritize prostate cancer screening, which is not only simple but less invasive than many other cancer screenings.

Next Steps

Prostate cancer is insidious because it often does not show symptoms until it has reached a more advanced stage. The first step toward improving prostate health and early cancer detection is speaking to your primary care physician or a men’s health urologist like Dr. Kapadia to understand your risk for prostate cancer and develop an appropriate screening plan. It is worth noting that lower urinary tract symptoms like urgency, frequency, the inability to empty the bladder fully, and more are typically due to a benign condition known as benign prostatic hyperplasia or enlarged prostate and are rarely caused by prostate cancer.

As such, we encourage you to visit Dr. Kapadia for a consultation on your prostate health and to learn more about how to screen for prostate cancer and manage those findings.

Do Supplements Work to Treat BPH?

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Man holds a supplement hoping it will help with his BPH symptoms

When discussing Benign Prostatic Hyperplasia or BPH with patients concerned about their lower urinary tract symptoms, they often ask us about supplements and, most often, Saw Palmetto. If you have paid attention to media ads over the years, you’ve almost surely seen one or more for this supplement. Indeed, this supplement is touted as a natural and effective option for enlarged prostate.

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Warning Signs That You May Be Suffering From BPH

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Row of urinals represents frustrating symptoms of BPH like urinary hesitancy and inability to fully empty the bladder

As a man ages, the risk of developing Benign Prostatic Hyperplasia (BPH) increases dramatically. By our advanced years, most men will experience BPH. For some, this can be a minor nuisance, while for others, BPH may represent an impediment to living a normal lifestyle. Treating BPH at its earlier stages allows for better outcomes and reduces the amount of time a patient lives with potentially severe symptoms.

Unfortunately, many men decide that they would sooner modify their lifestyle to minimize the disruption than visit a qualified urologist. They don’t realize that there are incredible advances in urology and BPH treatments that allow for in-office therapies that require only about 10 to 15 minutes of procedural time and may last for five or more years.

In this article, we look forward to giving our patients the top warning signs to look out for and offering some guidance on when to see their urologist for BPH treatment.

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Do BPH Supplements Work for Treating Enlarged Prostate?

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Man takes a supplement in hopes it will help with his Benign prostatic hyperplasia, or BPH, but men's health specialists Dr. Akash Kapadia cautions that supplements are not FDA approved or regulated

Benign prostatic hyperplasia or BPH is a prevalent condition that affects about 50% of men over 50 and 80% of men over 80. As we get older, there is a tendency for the prostate to grow. This, in turn, puts pressure on the urethra and can cause Lower Urinary Tract Symptoms or LUTS. Many men spend years living with the consequences of BPH, which can include frequent trips to the bathroom, urgency, and even embarrassing leaks. However, this does not have to be the norm. Today, we have more BPH treatments than ever before, including minimally invasive in-office BPH procedures and effective BPH surgeries.

While we look to treat BPH in a stepwise manner, patients will often have tried several potential therapies before visiting their urologist. One such therapy is supplementation; you may have seen Saw Palmetto, for example, marketed as an effective BPH treatment option.

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Rezum BPH Treatment After a TURP

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Medical illustration of Benign Prostatic Hyperplasia (BPH) which has many treatments to help you reduce symptoms including TURP and Rezum with Dr. Akash Kapadia

Minimally invasive benign prostatic hyperplasia or BPH therapy has made tremendous leaps in technology and effectiveness over the past several decades. Today, prostatic enlargement can be managed in several ways, none of which is more exciting than in-office therapies, which combine similar effectiveness of more invasive treatments with greater safety and generally fewer side effects.

Dr. Kapadia often uses Rezum BPH therapy, which employs steam to ablate or destroy excess prostatic tissue. However, many men have undergone a Transurethral Resection of the Prostate or TURP and now are experiencing renewed urinary symptoms. These men can take comfort in knowing that minimally invasive in-office Rezum therapy may still be available to them.

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