The prostate gland and a common condition that affects it, benign prostatic hyperplasia (BPH), can change your quality of life. BPH medications help some men find relief from symptoms, which may include difficulty urinating or having to urinate more often than usual. In many cases, other forms of treatment, such as minimally invasive procedures, can be effective in both addressing symptoms and restoring quality of life.
It is estimated that half of men may have BPH by age 60. By age 85, 9 out of 10 men may be living with this condition. Too many men, unfortunately, don’t seek help.
Symptoms of BPH don’t have to define your future. At Charlotte Radiology, our board-certified interventional radiologists will partner with your primary care physician and urologist to take a multidisciplinary approach to BPH management. Together, we work to find the least invasive treatment that can provide you with the most relief.
Defining BPH
A noncancerous condition, BPH occurs when the prostate, driven by hormones, grows so large that it reduces or blocks urine flow from the bladder.
“When you have obstructed urine flow due to BPH, you may develop lower urinary tract symptoms, or LUTS,” says Jeremy Kim, MD, interventional radiologist at Vascular & Interventional Specialists, a division of Charlotte Radiology. “We categorize some LUTS as obstructive, including a weak urine stream, difficulty starting a urine stream and retaining urine. Other LUTS fall into the category of irritative symptoms. These include feeling the need to urinate more urgently or frequently than normal, having to urinate many times at night, and leaking urine.”
Your physician may use a symptom-scoring tool to determine whether LUTS are mild, moderate or severe. This can help doctors identify the most appropriate form of treatment for patients.
If you experience BPH symptoms, don’t ignore them or shrug them off as part of aging. Feeling like you have to plan your life around the nearest bathroom can impact your daily activities. Moreover, if left untreated, BPH symptoms can worsen and lead to bladder stones, urinary tract infections, bladder dysfunction and other complications.
Tell your physician about any BPH-like symptoms you experience. Also, let them know if you’re taking BPH medications and they don’t seem to be helping. Medications aren’t the only possible tools in the treatment toolkit for BPH.
Read More: Enlarged Prostate Treatment: What Are Your Options?
Treating BPH: Medications, Surgery and Minimally Invasive Solutions
The good news is that several treatments are available for BPH. If the initial treatment, such as medication, doesn’t work, your physician has many more options they can recommend. Importantly, with treatment, you can control BPH and enjoy your favorite activities without worrying when a sudden urge to urinate or other symptoms will hit.
If your symptoms are mild, you’ll likely start with BPH medications. If your symptoms are moderate or severe or persist despite taking medications, you and your physician may consider surgery or a minimally invasive procedure. Surgeries for BPH vary in their effectiveness, recovery time and risk of complications. Work with your physician to understand your treatment options in detail so you can choose a solution suited to your unique needs and circumstances.
BPH Medications
Physicians use three main types of medications to manage BPH.
- Alpha-adrenergic inhibitors (also known as alpha-blockers) relax muscles in the prostate to allow urine to flow more easily.
- 5-alpha reductase inhibitors block the body from making the hormone dihydrotestosterone, which can help reduce prostate size and improve urine flow.
- Phosphodiesterase (PDE) inhibitors may improve urine flow by relaxing bladder and prostate muscles.
Like most medications, those for BPH can cause side effects, including, in some cases, erectile dysfunction.
“There’s a complex relationship between BPH and erectile dysfunction to begin with,” Dr. Kim says. “When you add medication therapy and surgical interventions, that relationship becomes even more complex and can affect sexual function.”
Other potential side effects of some BPH medications include a lower sex drive and problems with ejaculation and orgasm.
TURP
If you are considering surgery for an enlarged prostate, one of your options is transurethral resection of the prostate (TURP). This procedure doesn’t involve incisions. You’ll receive anesthesia, and a surgeon will place a small surgical scope into your penis and send it up the urethra. The surgeon will use the scope to remove small pieces of prostate tissue to allow for better urine flow.
“This procedure is quite effective and successful for many men. It does, however, carry a risk of certain complications. These include problems with ejaculation, urinary incontinence, loss of blood and erectile dysfunction.” Dr Kim says.
PAE
At Vascular & Interventional Specialists, we offer a non-surgical, minimally invasive procedure for BPH called prostatic artery embolization (PAE). Physicians have performed this time-tested procedure for decades, first to treat bleeding and then, beginning in 2000, BPH.
Based on study results, PAE demonstrated effectiveness in treating BPH, alleviating urinary symptoms and showing significant improvement lasting at least three years, with a rate of major complications from the procedure of less than 0.5%. In addition, the risk of retrograde ejaculation (dry orgasm) and sexual dysfunction was low.
During PAE, an interventional radiologist will make a small puncture in the groin or wrist. Then, using image guidance, they’ll send a catheter to blood vessels near the prostate. The interventional radiologist will then block blood flow to the prostate. Without a supply of blood, the gland will shrink and symptoms improve.
“Not all prostates are the same,” Dr. Kim says. “There are different sizes and shapes. The one subtype we talk about most often is prostates that have large median lobes, which are glands that protrude into the bladder base. These patients tend to have more symptoms. We looked at patients like this who had PAE and found there was no difference in clinical outcomes, whether someone had severe bulging into the bladder or large median lobes vs. non-severe.”
Beyond BPH Medications
If BPH medications haven’t worked for you or you are unable or unwilling to take them, PAE is an advanced treatment alternative worth considering.
In a 2023 study comparing PAE with medical therapy in patients who weren’t successful with alpha-adrenergic inhibitors, PAE provided more symptom relief than combination therapy (an alpha-adrenergic inhibitor plus a 5-alpha reductase inhibitor). Additionally, a 2024 study compared PAE with BPH medications in patients who hadn’t been treated before. This study found PAE was more effective than combination medication therapy at relieving symptoms and reducing the size of the prostate.
PAE offers patients a variety of advantages, including:
- Convenience. PAE only takes one to two hours, and you’ll return home the same day.
- High success rate. PAE has a clinical success rate of around 80% to 90%, according to clinical studies.
- No general anesthesia. Moderate or local anesthesia will keep you comfortable during the procedure.
- Quick recovery. Post-surgery symptoms typically clear up after a week.
Read More: Unlocking the Power of Interventional Radiology
Collaborative Approach to BPH Management
BPH medications can be quite effective for many men, but they don’t work for everyone. Plus, taking them is a long-term commitment you may not want to make. Understanding all your options can lead you to alternative solutions. That’s where multidisciplinary care comes in.
Start with your primary care physician, who can prescribe BPH medications or refer you to a urologist. They can discuss additional treatment options, such as surgery or minimally invasive procedures. Should your doctor refer you to an interventional radiologist, you can learn more about PAE and whether it’s right for you. The experts at Vascular & Interventional Specialists can explain how this advanced, nonsurgical procedure can help. We’ll collaborate with the other physicians involved in your care to come up with the most appropriate plan for you.
Working with a multidisciplinary team can help you understand just how many potential solutions are available to you — and help you find one that will put you in control of BPH.
