• Watchful waiting, also called active surveillance. If your symptoms are not too bad, your doctor may tell you to wait before starting any treatment to see if the problem gets worse. Your doctor will tell you how often you need to return for checkups. You can start treatment later if your symptoms worsen.

• Medications. There are medicines that can help shrink the prostate or help relax muscles near your prostate to ease your symptoms. Talk with your doctor about possible side effects.

• Surgery. If nothing else has worked, your doctor may suggest surgery to help urine flow. There are many types of BPH surgery. Talk with your doctor about the risks. Regular checkups are important after surgery.

• Other treatments. Sometimes radio waves, microwaves, or lasers are used to treat urinary problems caused by BPH. These methods use different kinds of heat to reduce extra prostate tissue.

“Acute bacterial prostatitis usually starts suddenly from a bacterial infection. It can cause fever, chills, or pain. It might hurt when you urinate, or you may see blood in your urine. See your doctor right away. He or she can prescribe medicine to make you feel better.

“Chronic bacterial prostatitis is an infection that comes back again and again. This is a rare problem that can be hard to treat. Sometimes taking antibiotics for a long time may work. Talk with your doctor about other things you can do to help you feel better.

“Chronic prostatitis, also called Chronic Pelvic Pain Syndrome (CPPS), is a common prostate problem. It can cause pain in the lower back, in the groin area, or at the tip of the penis. Men with this problem often have painful ejaculation. They may feel the need to urinate frequently, but pass only a small amount of urine. Treating this condition may require a combination of medicines, surgery, and lifestyle changes.

“What is prostate cancer?

“Prostate cancer is common among American men. Your chance of getting prostate cancer may be affected by your:

• Men age 50 and older run a greater risk.

• Prostate cancer is most common among African-American men.

• Family history. If your father or brother has had prostate cancer, you are more likely to have it, too.

• Eating high-fat food with few fruits and vegetables may raise your risk.

“How is prostate cancer diagnosed?

“At the start, prostate cancer does not cause symptoms. As the cancer grows, you may have trouble urinating. Some men need to urinate often, especially at night. Others have pain or burning during urination, blood in the urine or semen, pain in the back, hips, or pelvis, and painful ejaculation.

“To find out if these symptoms are caused by prostate cancer, your doctor will ask about your past medical problems and your family's medical history. He or she will perform a physical exam. During the exam, your doctor will put a gloved finger into your rectum to feel your prostate for hard or lumpy areas.

“Your doctor may also do a blood test to check the prostate-specific antigen (PSA) level. PSA levels can be high in men with an enlarged prostate gland or with prostate cancer. You may also need an ultrasound exam that takes computer pictures of the prostate.

“If tests show that you might have cancer, your doctor will want to confirm this with a biopsy. He or she will take out tiny pieces of the prostate to look for cancer cells. Your doctor may want to do a biopsy again to re-check the results.

“How is prostate cancer treated?

“Treatment for prostate cancer depends on whether cancer is in part or all of the prostate or if it has spread to other parts of the body. It also depends on your age and overall health. Talk with your doctor about the best treatment choice for you. You may want to ask another doctor for a second opinion.

“For cancer that has not spread from the prostate to other parts of the body, your doctor may suggest:

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• Watchful Waiting or Active Surveillance. If the cancer is growing slowly and not causing problems, you may decide not to treat it right away. Instead, your doctor will check regularly for changes in your condition.

• The most common type of surgery removes the whole prostate and some nearby tissue. As with any surgery, there are risks. Talk to your doctor about problems that may result from surgery.

• Radiation Therapy. This treatment uses radiation to kill cancer cells and shrink tumors. The radiation may come from an x-ray machine or from tiny radioactive seeds placed inside or near the tumor. Talk with your doctor about possible side effects.

• Hormone Therapy. Men having other treatments like radiation therapy may also be treated with drugs to stop the body from making testosterone. This is done if it seems likely that the cancer will come back. Hormone therapy can also be used for prostate cancer that has spread beyond the prostate.

“Get more details on treatment choices for prostate cancer by calling the National Cancer Institute's Cancer Information Service at 1-800-422-6237. Or, visit their website at www.cancer.gov/prostate.

“What is PSA testing?

“Some doctors think that men younger than 75 should have yearly PSA tests; others do not. Not all prostate cancers are life-threatening, and treatments can cause side effects. Sometimes high PSA levels can be caused by infections, BPH, or small cancers that may not grow or spread. Your doctor may prefer "watchful waiting" until there are signs that treatment is needed. Researchers are studying ways to improve the PSA test so that it detects only cancers that need treatment.

“How can you protect yourself against prostate problems?

“Remember that the following can be signs of a prostate problem:

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• Frequent urge to urinate

• Need to get up many times during the night to urinate

• Blood in urine or semen

• Painful or burning urination

• Not being able to urinate

• Painful ejaculation

• Frequent pain or stiffness in lower back, hips, pelvic or rectal area, or upper thighs

• Dribbling of urine

“If you have any of these symptoms, see your doctor right away.

“Where can I get more information about prostate problems?

“Here are some helpful resources:

“Agency for Healthcare Research and Quality Publications Clearinghouse
P.O. Box 8547
Silver Spring, MD 20907-8547
1-800-358-9295 (toll-free)
1-888-586-6340 (TDD/toll-free)
www.ahrq.gov

“American Cancer Society
1-800-227-2345 (toll-free)
1-866-228-4327 (TTY/toll-free)
www.cancer.org

“American Urological Association Foundation
1000 Corporate Boulevard
Linthicum, MD 21090
1-800-828-7866 (toll-free)
www.urologyhealth.org

“National Cancer Institute Cancer Information Service
1-800-422-6237 (toll-free)
www.cancer.gov/prostate

“National Kidney and Urologic Diseases Information Clearinghouse
3 Information Way
Bethesda, MD 20892-3580
1-800-891-5390 (toll-free)
1-866-569-1162 (TTY/toll-free)
www.kidney.niddk.nih.gov

“For more information on health and aging, contact:

“National Institute on Aging Information Center
P.O. Box 8057
Gaithersburg, MD 20898-8057
1-800-222-2225 (toll-free)
1-800-222-4225 (TTY/toll-free)
www.nia.nih.gov/health
www.nia.nih.gov/espanol

“To sign up for regular email alerts about new publications and other information from the NIA, go to www.nia.nih.gov/health.

“Visit www.nihseniorhealth.gov, a senior-friendly website from the National Institute on Aging and the National Library of Medicine. This website has health and wellness information for older adults. Special features make it simple to use. For example, you can click on a button to make the type larger.

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Third Article From Internet:

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This is the third article from the Internet:

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https://www.webmd.com/men/prostate-enlargement-bph/features/enlarged-prostate-bph-complex-problem#1

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“Enlarged Prostate: A Complex Problem

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“There are many treatments for enlarged prostates (BPH), but all have side effects and possible complications. Learn what to expect -- and how to decide.

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“By Jeanie Lerche Davis

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“All his life, he slept like a stone. But now, there's an annoying trip to the bathroom every night, sometimes once or twice a night.

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“ For most men, these nightly bathroom runs may be the first sign of an enlarged prostate. Other symptoms may include trouble starting a stream of urine, leaking, or dribbling. And, like gray hair, an enlarged prostate is a natural by-product of getting older, doctors say. Trouble is, the nightly bathroom runs become more frequent -- eventually edging their way into the daytime routine.

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“‘They can't sit through a meeting or a plane flight without getting up,’ says Kevin Slawin, MD, a professor of urology at Baylor School of Medicine in Houston. ‘It's very annoying … and when they have to go, they really have to go.’

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“It's a problem that has several names – enlarged prostate, benign prostate hyperplasia, or simply BPH. According to the National Kidney and Urological Disease Information Clearinghouse, the most common prostate problem for men over 50 is prostate enlargement. By age 60, over one-half of men have BPH; by age 85, the number climbs to 90%, according to the American Urological Association (AUA).

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“Enlarged Prostate Symptoms and Causes

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“In men, urine flows from the bladder through the urethra. BPH is a benign (noncancerous) enlargement of the prostate that blocks the flow of urine through the urethra. The prostate cells gradually multiply, creating an enlargement that puts pressure on the urethra -- the ‘chute’ through which urine and semen exit the body.

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“As the urethra narrows, the bladder has to contract more forcefully to push urine through the body.

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“Over time, the bladder muscle may gradually become stronger, thicker, and overly sensitive; it begins to contract even when it contains small amounts of urine, causing a need to urinate frequently. Eventually, the bladder muscle cannot overcome the effect of the narrowed urethra so urine remains in the bladder and it is not completely emptied.

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“Symptoms of enlarged prostate can include:

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• A weak or slow urinary stream

• A feeling of incomplete bladder emptying

• Difficulty starting urination

• Frequent urination

• Urgency to urinate

• Getting up frequently at night to urinate

• A urinary stream that starts and stops

• Straining to urinate

• Continued dribbling of urine

• Returning to urinate again minutes after finishing

“When the bladder does not empty completely, you become at risk for developing urinary tract infections. Other serious problems can also develop over time, including bladder stones, blood in the urine, incontinence, and acute urinary retention (an inability to urinate). A sudden and complete inability to urinate is a medical emergency; you should see your doctor immediately. In rare cases, bladder and/or kidney damage can develop from BPH.

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“Time to Do Something About Your Enlarged Prostate?

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“Most men put up with an enlarged prostate for months, even years, before seeing a doctor, says Slawin. ‘When they're getting up several times a night, and have trouble falling asleep again, that's when they come in,’ he tells WebMD.

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“It's not always obvious what's going on, Slawin adds. ‘When men start having urinary problems, it's hard to know the reason. They should see a doctor when anything changes, because there can be bladder cancer, stones, prostate cancer. BPH is often a diagnosis of exclusion … after we make sure nothing more serious is going on.’

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“Urologists use the BPH Impact Index, a symptom questionnaire developed by the American Urological Association to determine if a man's symptoms from BPH require treatment. ‘It helps us understand how severe the problem is,’ says Slawin. Higher scores indicate more severe symptoms.

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“Prostate growth -- and the trouble it causes -- varies greatly from person to person, says O. Lenaine Westney, MD, division director of urology at The University of Texas Medical School at Houston. ‘Some people have more growth than others. Some people with very large prostates don't have trouble with voiding. It's a very individual thing.’

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“Watchful Waiting With an Enlarged Prostate

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“When the symptoms of an enlarged prostate gland are mild, with low scores on the BPH Impact Index (less than 8), it may be best to wait before starting any treatment -- what's known as ‘watchful waiting.’

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“With regular checkups once a year or more often, doctors can watch for early problems and signs that the condition is posing a health risk or a major inconvenience. That's where the BPH Index is especially helpful, Westney tells WebMD. ‘It lets us know how high the symptom score is … when to start treatment.’

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“The ‘driving force in treatment,’ she explains, is whether the symptoms are affecting your quality of life -- and whether a blockage is causing serious complications, such as inability to urinate, blood in the urine, bladder stones, kidney failure, or other bladder problems.

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“A few questions to ask yourself:

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• How severe are your symptoms?

• Do symptoms prevent you from doing things you enjoy?

• Do they seriously affect your quality of life?

• Are they getting worse?

• Are you ready to accept some small risks to get rid of your symptoms?

• Do you know the risks associated with each treatment?

• Is it time to do something?

“Deciding on Treatment for an Enlarged Prostate

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“A range of treatments can relieve enlarged prostate symptoms – medications, minimally-invasive office procedures, and surgery. The best one for you depends on your symptoms, how severe they are, and whether you have other medical conditions.

“The size of your prostate gland, your age, and your overall health will also factor into treatment decisions. What's best for a man in his 50s might not be optimal for an 80-year-old. An older man may want immediate symptom relief through drugs or surgery, whereas a younger man may lean toward a minimally invasive treatment. According to the American Urological Association, surgery often does the best job of relieving symptoms, but it also has more risks than other treatments.

“Consider the options carefully with your doctor, says Westney. ‘We can start with medications, and if there's no improvement, we look at minimally invasive therapy to reduce a portion of the prostate,’ she tells WebMD. ‘These procedures are very effective, and side effects are very rare.’

“If symptoms are really bothersome -- or if you have complications like urine retention -- it may be best to bypass medication. The minimally invasive treatments have benefits over surgery, like quick recovery time; however, you may need a second procedure later on. There is also less risk of serious side effects like long-term incontinence or erection problems -- which can occur rarely with surgery.

“Medications for an Enlarged Prostate

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“Several drugs are FDA-approved to relieve common symptoms of an enlarged prostate. Each works differently, says Westney. They either shrink the enlarged prostate or stop the prostate cell growth, she explains. ‘For many men, medications are very effective,’ Westney tells WebMD. ‘They have a significant change in symptoms, and side effects are very uncommon … so medications are an attractive treatment.’

“Doctors use the BPH Index to gauge how the patient responds to medication, Westney adds. ‘We see how symptoms are progressing … if they've stabilized or not.’

“Alpha blockers: These drugs don't reduce the size of the prostate, but they are very effective at relieving symptoms. They work by relaxing the muscles around the prostate and bladder neck, so urine can flow more easily. These drugs work quickly, so symptoms improve within a day or two. They are most effective for men with normal to moderately enlarged prostate glands.

“The drugs: Flomax (tamsulosin), Uroxatral (alfuzosin), Hytrin (terazosin),   Cardura (doxazosin), and Rapaflo (silodosin).

“Alpha blockers were originally created to treat high blood pressure; dizziness is the most common side effect; other side effects are generally mild and controllable. Possible side effects include headache, stomach irritation, and stuffy nose. These drugs are not for men with significant urine retention and frequent urinary tract infections.

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“5-Alpha reductase inhibitors: These drugs can partially shrink the prostate by reducing levels of a male hormone -- dihydrotestosterone (DHT) -- which is involved in prostate growth. These drugs take longer to work than alpha blockers, but there is urine flow improvement after three months. These drugs can reduce

risk of acute retention (inability to urinate) -- and also reduce the need for prostate surgery. You may need to take them for 6 to 12 months to see if they work.

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“The drugs: Proscar (finasteride) and Avodart (dutasteride).

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“Possible side effects include erection problems, decreased sexual desire, and reduced amount of semen. These side effects are generally mild and may go away when you stop taking the drugs -- or after the first year of taking the drugs.

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“Minimally Invasive Treatments for an Enlarged Prostate

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“When medications don't help your enlarged prostate, several procedures can relieve symptoms -- without surgery. They are performed in a doctor's office. "These procedures use various types of heat energy to shrink a portion of the prostate," explains Westney. "They are very effective."

“TUMT (transurethral microwave thermotherapy): This therapy for mild to moderate blockage reduces urinary frequency, urgency, straining, and intermittent flow -- but does not correct any bladder-emptying problems. In this procedure, computer-regulated microwaves are used to heat portions within the prostate to destroy select tissue. A cooling system protects the wall of the urethra during the procedure. TUMT is performed in a doctor's office and requires only topical anesthesia and pain medications.

​

“Possible side effects include painful urination for several weeks. Temporary urgency and frequency of urination is also possible. There may be less semen ejaculated. Many men must have this procedure repeated, either because symptoms return or do not improve.

​

“TUNA (transurethral radio frequency needle ablation): This procedure also destroys prostate tissue to improve urine flow and relieve symptoms. It involves heating the tissue with high-frequency radiowaves transmitted by needles inserted directly into the prostate (some anesthesia is used). The procedure does not require a hospital stay. Possible side effects include painful, urgent, or frequent urination for a few weeks.

​

“Prostatic stents: In some cases, a tiny metal coil called a stent can be inserted in the urethra to widen it and keep it open. Stenting is done on an outpatient basis under local or spinal anesthesia. Usually, stents are only for men who are unwilling or unable to take medications -- or who are reluctant or unable to have surgery. The majority of doctors don't consider stents a good option for most men.

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“There could be serious side effects, and some men find that stents don't improve their symptoms. Sometimes a stent shifts position, which can worsen the symptoms. In some cases, men experience painful urination or have frequent urinary tract infections. Stents are expensive, and there can be difficulty in removing them.

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“Surgery for an Enlarged Prostate

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“For most men with very enlarged prostates, surgery can relieve symptoms -- but there are both risks and benefits with each type of operation. Discuss them with your doctor. After a careful evaluation of your situation and your general medical condition, your doctor will recommend which is best for you.

​

“TURP (transurethral resection of the prostate): This is the most common surgery for an enlarged prostate, and considered to bring the greatest reduction in symptoms. Only the tissue growth that is pressing against the urethra is removed to allow urine to flow easily. The procedure involves an electrical loop that cuts tissue and seals blood vessels. Most doctors suggest using TURP whenever surgery is required, as it is less traumatic than open surgery and requires shorter recovery time.

“With the TURP procedure, patients can expect to have retrograde ejaculation afterwards, says Westney. This is a condition in which a man ejaculates backward into the bladder instead of through the urethra.

"Retrograde ejaculation generally isn't painful," she tells WebMD. "It shouldn't be an issue unless fertility is a concern." Other possible side effects include blood loss requiring transfusion (rare), painful urination, recurring urinary tract infections, bladder neck narrowing, and blood in the urine.

​

“After TURP, the odds of erection problems range from 5% to 35%. However, this is often temporary -- and the ability to have an erection and an orgasm returns after a few months.

​

“TUIP (transurethral incision of the prostate): This procedure involves making cuts in the prostate instead of removing prostate tissue. These cuts reduce pressure on the urethra, making urination easier. Patients go home the same day, and wear a catheter for a day or two.

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“Symptom relief is slower with TUIP, compared with TURP. However, most men are satisfied with their ultimate symptom relief from this. Also, retrograde ejaculation is less common and less severe than after TURP. Risk of erection problems is similar to TURP.

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“Laser Surgery: This procedure uses a high energy vaporizing laser to destroy prostate tissue. It is done under general anesthesia and may require an overnight stay at the hospital. It provides immediate relief of symptoms, yet men may suffer from painful urination for a few weeks. In general this procedure causes less blood loss, and side effects can include retrograde ejaculation. These procedures include:

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• Transurethral holmium laser ablation of the prostate (HoLAP)

• Transurethral holmium laser enucleation of the prostate (HoLEP)

• Holmium laser resection of the prostate (HoLRP)

• Photoselective vaporization of the prostate (PVP)

“Open Prostate Surgery (Prostatectomy): When a transurethral procedure cannot be used, open surgery (which requires an incision in the abdomen) may be used. This allows the surgeon to remove tissue in the prostate. Open prostatectomy is typically done when the prostate gland is greatly enlarged, when there is bladder damage, if there are bladder stones, or if the urethra is narrowed. The inner part of the prostate is removed. This surgery is done under general or spinal anesthesia, and recovery can take a few weeks to several months.

“Side effects are similar to TURP, including blood loss requiring a transfusion, urinary incontinence, erection problems, and retrograde ejaculation.

“Herbal Therapies for an Enlarged Prostate

“Several herbal supplements are marketed for enlarged prostates. Saw palmetto, beta-sitosterol, and pygeum are all are widely used in Europe. They are available in the U.S. and don't require a prescription.

“However, researchers and doctors are cautious about advising patients to try herbal supplements. Because they are not FDA-regulated, there are concerns about a product's quality from batch to batch, according to the NIH's Office of Dietary Supplements. Also, the safety of an herbal product depends on many things -- the chemical makeup, how it works in the body, how it is prepared, and the dosage.

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“Something else to consider: Like any drug, an herbal remedy can affect how other medications or treatments work, or interact dangerously with your other medications. They can also have side effects. And, the AUA points out, they have not been well-studied for effectiveness or safety.

“Before trying any alternative treatment, learn as much as you can about it, the AUA says. Most importantly -- talk to your doctor before you try an herbal remedy. Many doctors consider alternative therapies like saw palmetto to "have no effect on symptoms, except as expensive placebos," Slawin tells WebMD.