Senior Urologist & Uro-Oncologist, Apollo Hospital Gurugram
Part 7 of 10 in Diagnosis and Management of Prostate Cancer
Managing BPH: From Lifestyle to Alpha-Blockers to Surgery
July 7, 2024
Benign prostatic hyperplasia (BPH) management follows a clear, stepped approach rather than one single method for every patient.
Matching treatment to severity
The first priority is always confirming BPH isn't damaging the kidneys. Mild symptoms are managed with lifestyle measures alone. Bothersome symptoms are managed with a single alpha-blocker medication. Only when BPH is causing kidney damage does the answer become surgery, there is no single universal method, the right approach depends entirely on severity.
What actually decides the age question
Asked what age range makes surgery preferable to ongoing catheterisation for BPH, Dr. Shrivastava's answer reframed the question entirely: it is fitness for the procedure, not age, that matters. He has personally operated on a 100-year-old patient, while some 60-year-olds carry too many comorbidities to safely undergo surgery and are better served staying on a catheter. Long-term catheter use is uncomfortable for anyone, so when a patient has a large prostate requiring a long surgery and carries high risk from other conditions, the decision to proceed with surgery anyway, understanding the risk, ultimately becomes the patient's own informed choice.
This article is based on a Jivo Masterclass session conducted by Dr. Nitin Shrivastava, Consultant, Urology and Uro-Oncology, Artemis Hospital, Gurgaon (his affiliation at the time of this session). 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.Nitin Shrivastava taught doctors across Africa on July 7, 2024.
FROM THE LIVE Q&A
Moderator
What are the factors contributing to prostate cancer, and what are the staging parameters?
Dr.Nitin Shrivastava
The most important contributing factor is genetics and family history. Researchers point to some role of obesity and possibly a non-vegetarian diet, but these risk factors are not firmly established.
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Frequently Asked Questions
What is a neobladder? What is an ileal conduit? How will treatment affect my quality of life?▼
Neobladder and ileal conduit are treatments for bladder cancer, not prostate cancer. A neobladder is an artificial bladder made from the patient's intestine, stitched together so the patient continues to pass urine through their natural passage. An ileal conduit instead diverts urine to exit through a different passage into a bag. On quality of life: what matters most in the long run is that the cancer comes out of the body completely; patients adjust well to either option over time.
Is there a limitation on the number of times TURP can be done on the same patient?▼
About 10 out of 100 patients will require another TURP within the following 10 years. There is no fixed limit, sometimes the prostate regrows fast and requires re-intervention, and sometimes it's done in stages. The more times TURP is repeated, the higher the chance of complications. Personally, the doctor has done it twice at most on the same patient.
CT scan is more accessible in our setup than MRI. Is there any place for CT to confirm prostate cancer?▼
CT scan cannot be used to confirm prostate cancer diagnosis, only MRI can do that. But if MRI isn't available, CT scan is very useful for staging: once a cancer diagnosis is confirmed by biopsy, CT can tell you if it has spread outside the prostate.
What is the value of PSA to consider dangerous: free PSA, total PSA, PSA ratio?▼
PSA density above 0.15 is suspicious for cancer. A PSA rise of more than 0.75 per year is also suspicious. These are used alongside the age-adjusted PSA cutoffs (2.5 / 3.5 / 4.5 / 6.5 for the 40s / 50s / 60s / 70s age bands) when a single reading is borderline.
In case of BPH, what age range is surgery recommended instead of just urine diversion or catheterization?▼
It is not age but fitness for the procedure that matters. The doctor has operated on a 100-year-old patient, while some patients who are only 60 have too many other diseases and are too high-risk for surgery, and stay on a catheter instead. If a patient has a large prostate requiring long surgery and is high-risk, the choice to proceed with surgery understanding the risk ultimately becomes the patient's own.
What is the standard approach to managing BPH?▼
First confirm it isn't damaging the kidneys. Mild symptoms get lifestyle management, bothersome symptoms get a single alpha-blocker, and kidney damage is the indication for surgery.
What determines whether a BPH patient should have surgery versus staying on a catheter?▼
Fitness for the procedure, not age. A 100-year-old patient has been operated on successfully, while some 60-year-olds with significant comorbidities are too high-risk for surgery.
In This Series: Diagnosis and Management of Prostate Cancer
- 1.Diagnosis and Management of Prostate Cancer
- 2.Why Physical Examination Still Matters in Prostate Cancer
- 3.PSA Testing: Age-Adjusted Thresholds, Density and Velocity
- 4.Who Needs Earlier Prostate Cancer Screening
- 5.When to Biopsy: Balancing Missed Cancer Against Overtreatment
- 6.Biopsy Technique and Imaging: Transrectal vs Transperineal, CT vs MRI
- 7.Managing BPH: From Lifestyle to Alpha-Blockers to Surgery
- 8.TURP: How Often It Can Be Repeated, and the Real Tradeoff
- 9.After Prostate Surgery: Incontinence, Neobladder and Quality of Life
- 10.Nutrition and Multidisciplinary Care in Prostate Cancer