Prostate Enlargement-Benign Prostatic Hyperplasia :What Are Your Treatment Options?

Gentlemen, if trips to the restroom require sudden dashes or are marked by difficulty urinating, your prostate may be enlarged. You’re not alone—an estimated 50 percent of men in their 50s have an enlarged prostate.  The prostate, the gland that produces the fluid that carries sperm, grows larger with age. An enlarged prostate, or benign prostatic hyperplasia (BPH), can block the urethra from transporting urine from the bladder and out of the penis.

Don’t resign yourself to living with BPH. Addressing your symptoms now can help avoid problems later. Untreated BPH may lead to urinary tract infections, acute urinary retention (you can’t go at all), kidney and bladder stones and, in severe cases, kidney damage. Treatment options include medications and surgery. When you evaluate these choices, you and your doctor will consider how much your symptoms interfere with your life, the size of your prostate, your age, overall health, and other medical conditions you have.

Symptoms

An enlarged prostate can make it more difficult to urinate. Not all men who have an enlarged prostate experience symptoms. However, about one-fourth of all men in the United States report some trouble urinating.

At first, symptoms may be mild because the bladder muscle is able to compensate for the pressure from the enlarged prostate on the urethra.

The pressure of the prostate on the urethra causes an interrupted or weak stream of urine. Other symptoms include:

·         Difficulty starting to urinate

·         Continuing to dribble after urination

·         A feeling that you have not completely emptied your bladder

The severity of these problems depends on how much pressure the prostate is putting on the urethra.

Another set of symptoms happens when the urine that collects in the bladder causes irritation. These symptoms include:

·         Painful urination

·         A frequent need to empty the bladder, especially at night

·         A feeling of urgency that accompanies the sensation to urinate

·         Loss of bladder control (incontinence)

Potentially serious complications can occur if the bladder does not empty completely. Urine that does not exit the bladder can lead to the growth of bacteria, which can cause frequent urinary tract infections. Also, urinary stones can form in the bladder lining due to an accumulation of debris and chemicals. Broken blood vessels can cause blood in the urine, often because of torn or enlarged veins on the inner surface of the prostate. Blood in the urine also can be caused by the sudden stretching of the bladder wall. If left untreated, urine retained in the bladder can back up into the kidneys, which can cause kidney failure over time.

Diagnosis

Your doctor will ask questions to rate the severity of your urinary symptoms. The doctor will do a digital rectal exam to feel the size, shape and consistency of the prostate gland. Usually, a sample of your urine will be examined for blood or evidence of infection.

Occasionally, your doctor may order tests, such as an ultrasound, to measure the amount of urine in your bladder, or a cytoscopy, in which a lighted tube is inserted through the penis into the bladder. Special tests also can be done to evaluate the muscles and nerves in the bladder, especially if you are having trouble with leakage of urine.

Invasive surgery for BPH includes transurethral surgery, which does not require an external incision, or open surgery, which does. In 90 percent of all surgeries for BPH, the surgeon performs transurethral resection of the prostate, or TURP. Using a resectoscope inserted through the penis, the surgeon removes prostate tissue obstructing the urethra. With TUIP, transurethral incision of the prostate, the surgeon makes incisions in the neck of the bladder and in the prostate. This serves to widen the urethra and increase urine flow.

Laser Surgery

Laser surgery for BPH involves inserting a scope through the penis tip into the urethra. A laser passed through the scope removes prostate tissue by ablation (melting) or enucleation (cutting). In photoselective vaporization of the prostate (PVP), the laser melts excess prostate tissue.

Holmium laser ablation of the prostate (HoLAP) is similar, but a different type of laser is used. The surgeon uses two instruments for Holmium laser enucleation of the prostate (HoLEP): a laser to cut and remove excess tissue and a morcellator to slice extra tissue into small segments that are removed.

Open Simple Prostatectomy

In complicated cases of a very enlarged prostate, bladder damage, or other problems, open surgery may be required. In open simple prostatectomy, the surgeon makes an incision below the navel or, in laparoscopic surgery, several small incisions in the abdomen. Unlike prostatectomy for prostate cancer when the entire prostate gland is removed, in open simple prostatectomy the surgeon removes only the portion of the prostate blocking urine flow.

Men of African ancestry have a higher risk of developing prostate cancer !!!

There are a few types of prostate cancer and the condition is often present in different parts of the prostate. The precursor to prostate cancer is known as prostatic intraepithelial neoplasia, and is also found in different locations within the prostate.

Benignprostatic hyperplasia (BPH): This is a benign (non-cancerous) type of tumor of the prostate.  The prostate grows larger and squeezes the urethra.  This prevents the normal flow of urine.  BPH is a very common problem.  For some men the symptoms may be severe enough to need treatment or surgery.

Prostatic adenocarcinoma: This type of tumor is the most frequent form of prostate cancer and accounts for 90 to 95% of prostate cancer.  Prostatic adenocarcinoma is occurring in the cells lining the glandular organ of the prostate, the area responsible for the secretion of the chemicals that make up a large portion of seminal fluid.  The most common site of origin of prostate cancer is the peripheral zone where two thirds of the prostate glandular tissue is located.  Typically, prostatic adenocarcinoma is a slow growing form of cancer, and when found early there is a good chance of achieving cures.

Small cell carcinoma:  This type of cancer is made of small round cells. It is a very aggressive form of prostate cancer that does not lead to a change in prostate specific antigen (PSA).  It thus can be more difficult to detect than adenocarcinoma.  The small cell carcinoma has usually reached an advanced form upon detection.

Squamous cell carcinoma: This type of prostate cancer is non glandular and like small cell carcinoma does not lead to an increase in prostate specific antigens (PSA).  Squamous cell carcinoma is a very aggressive form of cancer.

Prostaticsarcomas: This type of cancer is extremely rare and account for less than 0.1% of primary prostate cancer.  Prostatic sarcoma occurs in relatively younger men between the ages of 35 and 60.  The tumor is made up of prostate cancer cell types that are capable of developing into connective tissues, lymphatic vessels, and blood vessels originating from smooth muscles of the prostate.

Twenty-five percent of cases present with metastatic disease at the time of diagnosis. Prostatic sarcoma remains localized for a viable period of time before it spreads locally to the bladder, rectum or perineum. Over more time the tumor will spread to distant locations like the lungs, brain, bones or liver. The most common sites of distant metastasis are the lungs.

Transitional cell carcinomas: This type of cancer rarely develops in the prostate but derives from primary tumors present in the bladder or urethra.

Prostate Cancer – Causes and Risk Factors

There is not a known single cause of prostate cancer.  In general, most cancers are the result of many risk factors.  However, some men with prostate cancer do not have any identifiable risk factors.

Independent factors include:

• Men over 65: prostate cancer is not very common in men under 50.

• African ancestry:  Men of African ancestry have a higher risk of developing prostate cancer.   They have about a 60% higher rate of prostate cancer than Caucasian men.  Men of African ancestry are more likely to be diagnosed at a younger age and with more aggressive and advanced tumor.

• Family history: the risk of developing prostate cancer is higher if a first-degree relative (father or brother) has been diagnosed with the disease.  Men are at the most risk if more than one relative has been diagnosed and if the relatives were diagnosed at a younger age.  The risk doubles if a man’s father had the disease, and if a brother had it, the risk triples; hereditary prostate cancer typically begins among a cluster of relatives before age 55.

Dependent risk factors include: 
• High-fat diet: a diet high in fat, especially animal fat, may increase the risk of prostate cancer.  
• Exposure to cadmium:  Cadmium is a metallic element known to cause cancer and is a possible risk factor for prostate cancer.

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Risk Factors and Prevention for prostate cancer - Low Cost Prostate Cancer Surgery in India

A risk factor is anything that increases a person’s chance of developing a disease, including cancer. There are risk factors that can be controlled, such as smoking, and risk factors that cannot be controlled, such as age and family history. Although risk factors can influence disease, for many risk factors it is not known whether they actually cause the disease directly. Some people with several risk factors never develop the disease, while others with no known risk factors do. However, knowing your risk factors and communicating them to your doctor may help you make more informed lifestyle and health-care choices.

Since the exact cause of prostatecancer is still unknown, it is also unknown how to prevent prostate cancer. The following factors can raise a person’s risk of developing prostate cancer:

Age. The risk of prostate cancer increases with age, rising rapidly after age 50. More than 80% of prostate cancers are diagnosed in men who are 65 years old or older.

Race/ethnicity. Black men are at higher risk for prostate cancer than white men. They are more likely to develop prostate cancer at an earlier age and to have aggressive, fast-growing tumors. Prostate cancer occurs most often in North America and northern Europe and is less common in Asia, Africa, and Latin America. Of importance, it appears that its frequency is increasing in Asian populations living in urbanized environments, such as Hong Kong, Singapore, and North American/European cities.

Family history. A man who has a father or brother with prostate cancer has a higher risk of developing the disease than a man who does not. Researchers have discovered specific genes that may possibly be associated with prostate cancer, although these have not yet been shown to cause prostate cancer or to be specific to this disease.

Diet. No study has shown conclusively that diet can directly influence the development of prostate cancer, but many studies have indicated there may be a link. There is not enough information yet to make clear recommendations about the role diet plays in prostate cancer, but the following may be helpful:

• A diet high in fat, especially animal fat, may increase prostate cancer risk. In fact, many doctors believe that a low-fat diet may help to reduce the risk of prostate cancer.
• A diet high in vegetables, fruits, and legumes (beans and peas) may decrease risk of prostate cancer. It is unclear which nutrients are directly responsible, but lycopene, found in tomatoes and other vegetables, may slow or prevent cancer growth. A low-fat diet that is high in vegetables and fruits can lower blood pressure and the risk of heart disease, with no evidence that such a diet causes harm.
• Selenium, an element humans get in trace amounts from food and water, may play a role in lowering the risk of prostate and other cancers. Selenium is currently being tested in clinical trials and has not yet been proven to alter risk.
• It has been suggested that vitamin E may help to reduce the risk of prostate cancer; this is currently being tested in clinical trials and has not yet been proven to alter risk. In some studies of vitamin E in other settings, it has been suggested that there may be inherent cardiovascular risks (for example, an increased chance of having cardiac or blood vessel problems) with the use of high doses of vitamin E, and final judgment on the use of this supplement will require the completion of ongoing clinical trials.

Hormones. High levels of testosterone (a male sex hormone) may speed up or cause the development of prostate cancer. Prostate cancer does not develop in men who, for other reasons, were castrated (the removal of the testes) before puberty and whose bodies no longer make testosterone. Stopping the body’s production of testosterone, called androgen deprivation therapy, or castration, often treats advanced prostate cancer.

Symptoms

Often, prostate cancer is discovered through a prostate-specific antigen (PSA) test or digital rectal examination (DRE) in otherwise healthy men who have not had any symptoms. (Both tests are described in Diagnosis.) When prostate cancer does cause symptoms, the following symptoms may occur. Sometimes, people with prostate cancer do not show any of these symptoms. Or, these symptoms may be caused a medical condition that is not cancer. If you are concerned about a symptom on this list, please talk with your doctor.

• Frequent urination
• Pain or burning during urination
• Weak or interrupted urine flow
• Blood in the urine
• The urge to urinate frequently at night

None of these symptoms is specific to prostate cancer. The same symptoms occur in men who have a noncancerous condition known as benign prostatic hyperplasia (BPH), or enlarged prostate. Urinary symptoms also can indicate an infection or other conditions.

If cancer has spread beyond the prostate gland, a man may experience:

• Pain in the back, hips, thighs, shoulders, or other bones
• Unexplained weight loss
• Fatigue
• Other symptoms that arise at the site of cancer growth

• Age and medical condition
• The type of cancer
• Severity of symptoms
• Previous test results

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Cost Estimate for Prostate Cancer Surgery at World Best Hospital in India

Cost Estimate for Robotic Prostate Cancer Surgery at World Class Hospital in India is $ 9000 US Dollars
Cost Estimate for Laproscopic Radical Prostatectomy Surgery at World Class Hospital in India is $ 7000 US Dollars

Note: Cost Estimate for above include stay in a Private Room where a Companion can stay with the patient surgeon fee, medicines and consumables, nursing care, food and Airport Pick & Drop. More accurate treatment cost estimates can be provided if medical reports are emailed to us or after the patient is examined by doctors after arrival at hospital in India and medical tests are done after admission.

Laser Enlarged Prostate Surgery in India

What is Prostate Enlargement or Benign Prostate Hyperplasia (BPH)

It’s common for the prostate gland to enlarge as men get older. The condition is known as benign prostatic hyperplasia (BPH). This is benign and there is no evidence that it leads to cancer. In some cases, it becomes large enough to put pressure on the urethra (the tube that carries urine out of the penis). This can cause problems with urination, such as frequent trips to the toilet, including having to get up several times in the night, and dribbling of urine.

What treatments are available for BPH

• Watchful waiting
• Medication
• Microwave and heat therapies
• Conventional surgery - TURP or Transurethral Resection of the Prostate
• Laser surgery - e.g. Holmium laser  enucleation (HoLEP) or Green Light laser

Minimally invasive and surgical procedures are available to treat moderate-to-severe enlarged prostate symptoms that are bothersome. These procedures are also used if tests show that urinary function is seriously affected. Each treatment has benefits and risks, and some treatments can help certain patients more than others.

MinimallyInvasive Procedures for an Enlarged Prostate

Minimally invasive procedures for an enlarged prostate are often performed in a doctor's office. Overall these procedures are better than drugs at relieving symptoms, but they are less effective than surgery. 

•  Transurethral microwave therapy (TUMT). This procedure uses a microwave antenna attached to a flexible tube that is inserted into the bladder. The microwave heat destroys excess prostate tissue.
•  Transurethral needle ablation (TUNA). This procedure uses a heated needle inserted into the prostate through the urethra to destroy excess prostate tissue.

Surgeryfor an Enlarged Prostate

Most men have tried medications for their enlarged prostate before discussing surgery. However, some men may wish to move directly to surgery if their symptoms are particularly bothersome. As with any treatment decision, it's important to fully discuss the risks and benefits with your doctor.

Surgery is often considered the best long-term solution for relief of BPH symptoms. Most surgical procedures involve removing the enlarged part of the prostate.  

Surgery is usually recommended in treating BPH-related complications, such as:

• Urinary retention (inability to urinate)
• Failure to respond to medical or minimally invasive treatments
• Blood in the urine that is not getting better
• Bladder stones
• Frequent urinary tract infections
• Kidney damage

The surgical procedures include:

TURP

A transurethral resection of the prostate, or TURP for short, involves a thin, tube-like telescope called a resectoscope, which is put into the opening of your penis and passed up the urethra towards the prostate. An attachment at the end of the resectoscope is used to cut away part of the prostate using electrical energy. There are no stitches or dressings after this operation. The operation lasts for about an hour. Afterwards, a catheter is inserted to allow urine to flow freely. This is a thin, sterile tube that is inserted through the urethra and into your bladder. TURP usually involves a hospital stay of up to five days. Your surgeon will explain the benefits and risks of having TURP and will also discuss the alternatives to the procedure. 
TURP is a commonly performed and generally safe operation. However, all surgery carries risks as well as benefits. Most men find that a lasting side-effect of a TURP is dry orgasm (retrograde ejaculation), which happens because semen can travel back up into the bladder rather than out through the penis. This should not interfere with sex and after recovery from the operation, most men return to the same level of sexual activity as before the treatment.

What is laser prostate surgery?
Laser prostate surgery is a treatment using high powered laser energy (eg: HoLEP Holmium laser or GreenLight laser) to remove or enucleate obstructive prostatic tissue or vaporise tissue with the aim of leaving a wide channel and restoring normal urinary function. Under anaesthesia a small flexible fibre-optic is inserted into the urethra. Light pulses are then sent through this fibre, to cut away the obstructing prostatic tissue which is removed from the bladder with a morcellator.  There is minimal bleeding or pain after the procedure.
The procedure takes around 60-90 minutes and is performed under general or spinal anaesthesia. You may be allowed to return home on the same day, but sometimes an overnight stay will be required. You can generally be discharged once you are emptying your bladder satisfactorily.Strenuous activity should be avoided for two weeks and patients generally return to work about five days after surgery.

Benefits of laser prostate surgery?
The two most widely reported benefits of laser surgery are reduced risk of bleeding (compared to TURP) and shorter hospital stay. Most patients can expect a rapid improvement in their urinary flow rate, and a quick return to normal activities following the procedure. Laser surgery is also associated with lower risks of sexual and other side-effects common with TURP.

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