a roundup of prostate treatments

Source: FDA Office of Public Affairs

For men who are having prostate problems, the good news is that many new and effective prostate treatments are available.

Treatment for Prostatitis

For prostatitis, getting the right diagnosis of the exact type is key to getting the best treatment. George Benson, M.D., a medical reviewer in the FDA's CDER, says that prostatitis caused by an infection is treated with antibiotics, "but there are no drugs approved to treat chronic pelvic pain syndrome. This condition is often treated with anti-inflammatory drugs and analgesics," he says.

Medications for BPH (Benign Prostatic Hyperplasia)

Although BPH cannot be cured, FDA-approved drugs can often relieve its symptoms. Such drugs to treat BPH currently include two major classes. The 5 alpha-reductase inhibitors shrink the prostate gland and include Proscar (finasteride) and Avodart (dutasteride). These drugs work by blocking an enzyme that acts on the male hormone, testosterone, to boost organ growth. When the enzyme is blocked, growth slows down and the gland may shrink. This treatment may not produce a positive effect until after six to 12 months of treatment. It also works best for the larger prostate.

Alpha-adrenergic receptor blockers, which work by blocking adrenergic nerve receptors in the lower urinary tract, basically help relax the smooth muscle of the prostate and bladder neck to relieve pressure and to improve urine flow. These drugs, which do not shrink the size of the prostate, include: Cardura (doxazosin), Flomax (tamsulosin), Hytrin (terazosin), and Uroxatral (alfuzosin). For many men, these alpha-blockers can improve urine flow and can reduce symptoms within days. Possible side effects include dizziness, headache, fatigue, and a lowering of blood pressure.

Non-Surgical Treatments for BPH

Because drug treatment is not effective in all cases, and different surgeries are often associated with serious complications, researchers have developed a number of procedures, including transurethral (accessing the affected area through the urethra) using FDA-approved or cleared medical devices to relieve BPH symptoms. These procedures are considered minimally invasive, non-surgical treatments:

Transurethral microwave thermotherapy (TUMT)

Uses microwaves sent through a catheter to heat and destroy excess prostate tissue. For most TUMT devices, a cooling system protects the portion of the urethra that goes through the prostate during the procedure. The TUMT procedure takes about one hour and can be an option for men who should not have major surgery because they have other medical problems. Microwave therapy does not cure BPH, but it reduces urinary frequency, urgency, straining, and intermittent flow. It does not completely correct the problem of incomplete emptying of the bladder. TUMT has limited long-term effects. Up to 40 percent of men treated may need re-treatment a few years later. Though rare, there have been cases reported of incontinence and impotence with this procedure. Although microwave thermotherapy has been demonstrated to be safe and effective, the FDA has been concerned in the past about unexpected procedure-related complications that occurred since these devices were marketed.

Water-induced thermotherapy (WIT)

Uses a device to treat urinary symptoms of BPH. The device uses hot water circulated through an inflated balloon catheter to heat the inside of the prostate, causing adjacent tissue to die. Over time, some tissue is either expelled through urine or absorbed internally.

Surgical Treatments for BPH

A number of devices with different modes of action have been cleared by the FDA to perform transurethral surgery that usually relieves any obstruction and incomplete emptying of the bladder. Less tissue is removed in these procedures, which is either ablated or vaporized, rather than cut. They are considered minimally invasive surgeries:

Transurethral needle ablation (TUNA)

Delivers low-level radio frequency energy through twin needles to burn away a well-defined area of the enlarged prostate.

Transurethral vaporization of the prostate (TUVP)

 Uses electrical current to vaporize prostate tissue.

Laser surgery

Uses side-firing laser fibers to vaporize obstructing prostate tissue. The doctor passes the laser fiber through the urethra into the prostate and then delivers several bursts of energy lasting 30 seconds to 60 seconds. The laser energy destroys prostate tissue and causes shrinkage. Laser surgery requires anesthesia and a hospital stay. One advantage of this laser evaporating surgery may be that it causes little blood loss. It also allows for a quicker recovery time. This procedure may not be effective on large prostates. Its long-term effectiveness is unknown.

Transurethral resection of the prostate (TURP)

Considered the gold standard for treating BPH, and accounts for 90 percent of all BPH surgeries. The doctor passes an instrument through the urethra and trims away extra prostate tissue. The tissue is sent to the lab to check for prostate cancer. This surgery requires anesthesia and a hospital stay. Recovery from TURP is much shorter than with open surgery, but TURP and other procedures for BPH remove only enough tissue to relieve urine blockage.

Transurethral incision of the prostate (TUIP)

Similar to TURP but, instead of removing tissue, widens the urethra by making a few small cuts in the bladder neck, where the urethra joins the bladder, and in the prostate gland itself, which relieves pressure without trimming away tissue. This procedure is often done on smaller prostates. The NIDDK says that although people believe that TUIP gives the same relief as TURP with less risk of side effects, its advantages and long-term side effects have not been clearly established.

Open prostatectomy

Removes the prostate through a cut in the lower abdomen or between the anus and scrotum. This procedure is done only in rare cases when the prostate is very large with severe obstruction, or when other procedures can't be done. General or spinal anesthesia is used, and a catheter remains for up to seven days after the surgery. This surgery carries a higher risk of complications, such as incontinence and impotence, than medical treatment or less invasive surgeries. Removed tissue is sent to the lab to check for prostate cancer, and periodic follow-up is recommended.

All of these procedures, whether less invasive or not, often require patients to wear a catheter for three to four days after surgery, and carry some risk of urinary incontinence and impotence. The CDRH says that the more invasive the procedure, the more risks are involved. Because all of these procedures involve the removal of some, but not all, of the prostate, regular follow-ups are necessary to watch for cancer.

An alternative treatment that has become popular is an herbal pill--saw palmetto--used by millions of men in the United States to treat BPH. Saw palmetto, however, was recently found to have no effect in reducing the frequent urge to urinate or other annoying symptoms of an enlarged prostate. Published in the Feb. 9, 2006, New England Journal of Medicine, the yearlong study found that the plant extract was no more effective than inactive pills (placebos) in easing symptoms of BPH.

Experts agree that the best protection against prostate problems is to have regular medical checkups that include a prostate exam.

Posted June 2006
Updated November 2009