Additional Director, Urology, Fortis Hospital, Shalimar Bagh, New Delhi
Part 7 of 8 in Prostate Cancer: Diagnosis and Latest Treatment Guidelines
Managing BPH: Medications and When Size Doesn't Matter
May 5, 2024
Benign prostatic hyperplasia (BPH) is a separate, much more common condition from prostate cancer, and is managed on its own track.
Medical management of BPH
Alfuzosin is commonly used to relieve BPH urinary symptoms by relaxing the prostate, generally preferred in younger, sexually active men; silodosin is a newer, more potent alternative generally preferred in older patients because of its more favourable sexual side-effect profile. Combining tamsulosin (which relaxes the prostate to improve flow) with finasteride (which can shrink the prostate over time) provides symptomatic relief, but neither eradicates the underlying benign enlargement.
Prostate size doesn't dictate treatment - symptoms do
Prostate enlargement occurs with age and has a genetic component, but the size of the prostate itself does not determine whether treatment is needed. A 100-gram prostate causing no obstruction may need no treatment, while a much smaller prostate causing symptoms and blocked urine flow does need treatment.
This article is based on a Jivo Masterclass session conducted by Dr. Anurag Puri, Additional Director, Urology, Fortis Hospital, Shalimar Bagh, New Delhi. The article has been summarised with the assistance of an AI tool from the original masterclass recording. Watch the full Masterclass recording
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This guide is based on a live Jivo Masterclass: Dr. Anurag Puri taught doctors across Africa on May 5, 2024.
FROM THE LIVE Q&A
Moderator
Is there really no treatment available for prostate cancer above the age of 80?
Dr. Anurag Puri
That is not the case. Between the ages of 80 and 90, up to 80% of men are found to harbour some focus of prostate cancer, but most die of other causes rather than the cancer itself. Because it is often a low-risk, indolent disease in this age group, treatment is sometimes deliberately avoided if the patient is asymptomatic.
Frequently Asked Questions
Does declining male sexual performance with age relate to atherosclerotic changes in penile vessels? Is there a better urological explanation?▼
Yes - this is generally due to atherosclerosis: as blood vessels narrow with age, blood supply to the penis decreases, and this reduced blood flow is the main driver of declining sexual performance.
What are the principles of prostate cancer management, the survival rates by stage, and can advanced disease be managed locally?▼
Management is decided by the disease's staging and parameters: PSA level, Gleason score, and clinical stage on digital rectal examination. Survival rates vary sharply by stage - low-risk, early disease has close to a 100% cure rate, and even metastatic (stage four) patients now have meaningfully better life expectancy with appropriate treatment than with many other stage-four cancers.
What does a kidney transplant require if the donor's genetic makeup is different, and what can be done to restore a failing transplanted kidney?▼
Kidney transplant is the treatment of choice for renal failure, and results are best with a related, genetically matched donor. Even without a genetic match or matching blood group, plasmapheresis, an advanced technique that lowers the antigenicity of the donor organ, can still allow a transplant to proceed.
Is it true that many patients who undergo prostate surgery end up dying, as some patients believe?▼
This is a misconception. The great majority of prostate operations are for benign BPH and are done endoscopically with little morbidity; patients are very satisfied. Even for cancer, with modern robotic surgery, hospital stay is just about three days, and patients are often fit to fly home within two to three weeks without a catheter.
Can a combination of tamsulosin and finasteride eradicate BPH?▼
No - this combination provides symptomatic relief rather than eradication. Tamsulosin relaxes the prostate to improve urinary flow, while finasteride can shrink the size of the prostate over time, but neither eliminates the underlying benign enlargement.
What medications treat BPH symptoms?▼
Alfuzosin (preferred in younger men) or the newer silodosin (preferred in older men); tamsulosin plus finasteride gives symptomatic relief but does not eradicate the enlargement.
Does prostate size determine whether BPH needs treatment?▼
No - symptoms determine treatment. A large prostate causing no obstruction may need none, while a smaller one causing blocked flow does.
In This Series: Prostate Cancer: Diagnosis and Latest Treatment Guidelines
- 1.Prostate Cancer
- 2.Prostate Cancer Risk Factors and How It Presents
- 3.Diagnosing Prostate Cancer: PSA, Biopsy and Staging
- 4.Gleason Score and Risk Stratification in Prostate Cancer
- 5.Prostate Cancer Treatment: From Active Surveillance to Robotic Surgery
- 6.Advanced and Hormone-Resistant Prostate Cancer Management
- 7.Managing BPH: Medications and When Size Doesn't Matter
- 8.When to Refer a Prostate Cancer Patient for Treatment Abroad