Benign Prostatic Hyperplasia (BPH) Cure

For a young adult male, the prostate is typically the size of a walnut and weighs about 20- 25 grams. As a man ages into his 50s, the prostate tends to keep growing and can reach the size of a ping pong ball or apricot and weigh about 30 – 35 grams. As a man ages further or becomes predisposed to an enlarged prostate either by genetics or lifestyle choices, his prostate can grow even larger and reach the size of a tennis ball or greater.¹ Unfortunately, this additional growth can lead to a condition called benign prostatic hyperplasia, or BPH, which is the enlargement of prostate tissue to the point where the prostate begins putting pressure on the urethra and can partially or completely block urine flow from the bladder. The dictionary describes a “cure” as the relief or recovery from disease by implementing lifestyle changes, taking substances such as medication, or employing a treatment/procedure such as surgery. Although the jury is still out (some procedures are fairly new) as to whether there is a permanent benign prostatic hyperplasia cure. Aside from removing the entire prostate, many great BPH treatment options are available that can shrink the prostate, minimize BPH symptoms or eliminate symptoms completely if the appropriate treatment is chosen.

BPH is diagnosed and evaluated by a trained physician, usually a general practitioner (GP) or a urologist. An enlarged prostate can begin as a nuisance or inconvenience but gradually develop into a problem for some men when their BPH symptoms go from manageable to unmanageable. One can recover from BPH with the right treatment that addresses an individual’s specific BPH symptoms, and BPH can even be treated or cured permanently if the appropriate medicine, medical procedure, or surgery is performed. Benign prostatic hyperplasia may be treated via watchful waiting, medication, in-office procedures, or hospital surgeries. The best way to prevent a recurrence of and reverse BPH is to choose a medicine or medical procedure that provides long-lasting results. Once on medications, they will need to be taken long-term to remain effective. Medical procedures may last a lifetime, or need to be re-done from time to time, depending on the procedure. For some men, BPH can resolve without treatment with some lifestyle changes, but many men will still need to search for the appropriate treatment for a successful benign prostatic hyperplasia cure.

Medication for Possible BPH Cure

There are two primary classes of prescription medication (alpha-blockers and 5-alpha reductase inhibitors). Also, a combination of the two can be prescribed to treat and possibly cure BPH symptoms when watchful waiting (monitoring of symptoms without treatment) is no longer effective and BPH surgery hasn’t yet been considered.

• • Alpha-Blockers

    Common BPH medications such as Tamsulosin (Flomax), Alfuzosin (Uroxatral), or Silodosin (Rapaflo) are effective treatments, or possible cures, for some men because they relax the muscles of the bladder and prostate, which in turn makes it easier to urinate. They begin to work immediately, and if high blood pressure is also a concern, alpha-blockers can treat both issues. However, alpha-blockers may not help everyone, and the medication needs to be taken consistently for benefits to continue.

 

• • 5-Alpha Reductase Inhibitors (5-ARIs)

    These BPH medications suppress the ability of the 5-alpha reductase enzyme to turn testosterone into dihydrotestosterone (DHT). DHT plays an important role in prostate tissue growth. 5-ARIs like Finasteride (Propecia and Proscar) or Dutasteride (Avodart) may be an option for helping to shrink the enlarged prostate. However, they can take up to six months to begin addressing benign prostatic hyperplasia and providing benefits. They can come with undesired side effects for some men and the medication needs to be continued for results to continue.

 

• Combination BPH Medications

  A combination of an alpha-blocker and a 5-alpha reductase inhibitor may be prescribed by a doctor if one or the other isn’t providing relief for the enlarged prostate by itself. Also, when immediate relief from BPH symptoms is needed (alpha-blocker) and long-term prostate tissue size reduction is desired (5-ARIs), a combination protocol can be desirable.

A third medication class (phosphodiesterase inhibitors), which includes Sildenafil (Viagra) and Tadalafil (Cialis), may help some men with benign prostatic hyperplasia symptoms.^2,3

BPH medication can be a treatment or a possible cure for some symptoms, but for others, the benefit never fully materializes. Most men will need to remain on BPH medication for life (indefinitely) to realize a curative effect unless the medication stops working or a procedure is chosen. This is because BPH medication only works as long as it is taken regularly. Once BPH medication is no longer in the system, symptoms can return immediately or over time depending on the BPH symptoms and the medication being taken.

Procedures for Possible BPH Cure

Apart from a prostatectomy, where most or all of the prostate is removed and a long-term BPH cure is likely, some newer, minimally invasive, BPH treatment procedures are the closest scientists have yet come to a possible cure for BPH if long-term medication doesn’t solve the problem. The BPH procedures below can vary in their BPH curative effects: Some will offer long-lasting and possibly lifelong relief from BPH symptoms and others may only offer relief for a while and may need to be repeated years down the road. Others show promise of offering a long-term solution or cure for BPH symptoms, but are newer and don’t yet have data showing they will last a lifetime.

• • Aquablation therapy

    As an FDA cleared benign prostatic hyperplasia surgery that can be performed on an enlarged prostate of any size and shape, this advanced, minimally invasive, highly effective, and one-of-a-kind procedure utilizes heat-free water ablation to remove excess prostate tissue without impacting important urinary and sexual structures. Because of its unique doctor and map-guided robotic precision, Aquablation therapy has become popular for its versatility, effectiveness, and durability. Risks include low rate of retrograde ejaculation⁴.

 

• • Holmium Laser Enucleation (HoLEP)

    Also called laser prostatectomy, HoLEP is a minimally invasive laser therapy that removes problematic prostate tissue using laser energy via a telescope inserted into the urethra and up to the bladder. HoLEP is an option for men with large prostates or who are on blood thinners. Some men will experience temporary urinary incontinence after surgery, but it typically resolves with pelvic floor exercises within a few months. However, most men will experience retrograde ejaculation with HoLEP.⁵

 

• • Prostatectomy (Simple)

    The simple prostatectomy is an open, traditional, and more invasive surgical procedure for men suffering from benign prostatic hyperplasia typically with large prostates over 100 grams, damaged bladders, or those who might suffer other limitations. As robotic-assisted simple prostatectomies have grown in popularity, simple prostatectomy isn’t being used as often as it once was since it has a higher risk of complications and a longer recovery time. Risks from this BPH surgery include retrograde ejaculation.⁶

 

• • PVP GreenLight Laser

    A minimally invasive outpatient surgical procedure, laser-initiated photo-vaporization of the prostate (PVP) utilizes high-powered GreenLight Laser therapy to remove excess, problematic prostate tissue through laser vaporization with very little blood loss. This procedure is beneficial for those on blood thinners or anticoagulants and for men who have larger prostates. Recovery time is typically a few days and the procedure usually doesn’t require an overnight hospital stay. Risks include irritative symptoms and retrograde ejaculation.⁷

 

• • Rezum

    One of the newer minimally invasive procedures to address benign prostatic hyperplasia, Rezum harnesses the thermal energy from water vapor to remove or ablate excess prostate tissue that is causing BPH symptoms. It is a procedure developed for use in small to medium size prostates up to 80 grams.⁸ Men with larger prostates will need to consider a different therapy. After the Rezum procedure, the body goes through an inflammatory response which may make urinary symptoms worse for the first few weeks. Urinary and sexual side effects after the procedure are reported as minimal.

 

• • Transurethral Resection of the Prostate (TURP)

    Considered the “gold standard” of prostate surgeries for nearly 100 years since first being introduced in the United States in 1926, it has helped an untold number of men with their enlarged prostate-related urinary symptoms. A surgical instrument called a resectoscope is inserted into the urethra where a doctor can view the prostate and determine how much prostate tissue to remove so urine can flow freely from the bladder once again. Retrograde ejaculation is a risk with TURP.⁶

 

• Urolift

  This minimally invasive BPH procedure is unique because it utilizes small, permanent prostate implants to lift and hold the enlarged prostate back from the urethra so urine can more freely flow again. The implants lift and hold the prostate away from the urethra, so nothing is removed. There is no cutting, heating, or destroying of prostate tissue. Urolift implants can provide fast, in-office relief for patients with 100-gram or less prostates who don’t want to undergo a surgical procedure and longer downtime.⁹ Men with larger prostates aren’t candidates and will need to find another procedure.

Although there is no “official” cure yet for benign prostatic hyperplasia that applies to all men outside of removing the enlarged prostate altogether, there are a good number of effective BPH medications and outpatient and inpatient BPH procedures that provide temporary, long-term, and possibly even permanent BPH relief depending on the individual and the treatment chosen. Throughout time, a BPH cure has been elusive, but science and technology have finally caught up and men diagnosed today with BPH have an excellent chance of addressing it for the first and very possibly the last time during their lives.

 

References:

1.  https://utswmed.org/medblog/what-we-know-about-your-prostate/

2. Ko WJ, Han HH, Ham WS, Lee HW. Daily use of sildenafil 50mg at night effectively ameliorates nocturia in patients with lower urinary tract symptoms associated with benign prostatic hyperplasia: an exploratory multicenter, double-blind, randomized, placebo-controlled study. Aging Male. 2017 Jun;20(2):81-88. doi: 10.1080/13685538.2016.1204290. Epub 2017 Feb 21. PMID: 28590828.

3. Brock G, Broderick G, Roehrborn CG, Xu L, Wong D, Viktrup L. Tadalafil once daily in the treatment of lower urinary tract symptoms (LUTS) suggestive of benign prostatic hyperplasia (BPH) in men without erectile dysfunction. BJU Int. 2013 Nov;112(7):990-7. doi: 10.1111/bju.12251. Epub 2013 Aug 13. PMID: 23937669.

4. Gilling PJ et al. Five-year outcomes for Aquablation therapy compared to TURP: results from a double-blind, randomized trial in men with LUTS due to BPH. Can J Urol. 2022 Feb;29(1):10960-10968

5. Kim SH, Yang HK, Lee HE, Paick JS, Oh SJ. HoLEP does not affect the overall sexual function of BPH patients: a prospective study. Asian J Androl 2014: 16:873-7

6. Couteau N, Duquesne I, Frédéric P, Thiounn N, Timsit M-O, Mejean A, Pinar U, Audenet F. Ejaculations and Benign Prostatic Hyperplasia: An Impossible Compromise? A Comprehensive Review. Journal of Clinical Medicine. 2021; 10(24):5788

7. Massimiliano Spaliviero, Kurt H. Strom, Xiao Gu, Motoo Araki, Daniel J. Culkin, and Carson Wong. Does Greenlight HPS^TM Laser Photoselective Vaporization Prostatectomy Affect Sexual Function? Journal of Endourology. Dec 2010.2051-2057

8. https://www.rezum.com/home.html

9. https://urolift.com

Important Safety Information

All surgical treatments have inherent and associated side effects. Individual’s outcomes may depend on a number of factors, including but not limited to patient characteristics, disease characteristics and/or surgeon experience. The most common side effects are mild and transient and may include mild pain or difficulty when urinating, discomfort in the pelvis, blood in the urine, inability to empty the bladder or a frequent and/or urgent need to urinate, and bladder or urinary tract infection. Other risks include ejaculatory dysfunction and a low risk of injury to the urethra or rectum where the devices gain access to the body for treatment. Further, there may be other risks as in other urological surgery, such as anesthesia risk or the risk of infection, including the potential transmission of blood borne pathogens. For more information about potential side effects and risks associated with Aquablation therapy for Benign Prostatic Hyperplasia (BPH) treatment, speak with your urologist or surgeon. Prior to using our products, please review the Instructions for Use, Operator’s Manual or User Manual, as applicable, and any accompanying documentation for a complete listing of indications, contraindications, warnings, precautions and potential adverse events. No claim is made that the AquaBeam Robotic System will cure any medical condition, or entirely eliminate the diseased entity. Repeated treatment or alternative therapies may sometimes be required.

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