3200 Blue Ridge Road, Suite 118
Raleigh, NC 27612 | Phone 919.571.4399
www.landmarkurologycare.com
Mini-Brochure

Home >> Men's Health >> Prostate Problems >> Treatment

Prostate Problems - Treatment

Prostatitis

The infectious form of prostatitis may be treated with antimicrobial medication. Acute prostatitis may be treated with antimicrobial medication for 7-14 days while chronic prostatitis may require 4 to 12 weeks of medication before the prostatitis is cleared.
The non-infectious form of prostatitis may be improved by taking hot baths, drinking more fluids, changing your diet, and ejaculating frequently (to drain the prostate gland and relax the muscles). If muscle relaxation improves your symptoms, your physician may prescribe alpha blockers, drugs that relax the muscle tissue in the prostate and allows urine to flow more freely.

Follow your physician's recommendations and be sure to follow-up in the office with your physician as instructed to make sure your prostatitis has been completely cleared, even if your symptoms have disappeared.

Men can monitor their response to treatment by filling out a baseline prostatitis symptom score questionnaire before starting treatment and again periodically during therapy. Click here to download a PDF with a prostatitis symptom score questionnaire, new window will open.

Prostate Enlargement and Bladder Outlet Obstruction

Medical Therapy - Symptoms of BPH are often exacerbated by other medications which the patient may be taking. Therefore, the medical management of BPH may be as involved with withdrawing or changing existing medications as adding new ones. Specifically anticholinergic type medications, narcotic analgesics, and sophorifics are detrimental to bladder function. Likewise, alpha adrenergic agents may increase resistance at the bladder neck. Smooth muscle relaxants are another category of drugs which may worsen symptoms of bladder outlet obstruction, because they adversely affect detrussor function.
Mechanical Therapies - At least two mechanical therapies for management of BPH deserve mention.
- Expandable intraurethral prostatic stent. This apparatus can be introduced through a standard cystoscope under assisted local anesthesia and then can be expanded merely by removing it from a sheath. The initial result is a 36-French lumen in the prostatic urethra which greatly facilitates voiding. Because this metal mesh causes little tissue reaction, infection and rejection are unlikely. However, there is an ingrowth of prostatic epithelium over time so that the wire mesh is ultimately covered by polypoid appearing collections of epithelial cells. The obvious potential complications of the use of this technology are transmigration of the stent into the bladder or through the prostate by direct pressure and erosion. A second risk is encrustation of the device over a long period of time. This treatment is generally reserved for patients who are poor surgical risks and who otherwise would require chronic indwelling urethral catheters.
- Balloon dilation of the prostate. This was one of the earliest forms of minimally invasive therapy for BPH. This strategy involved placing an inflatable balloon across the bladder neck in the prostatic urethra and then expanding it to 36-French. This results in a fracture of the adenoma which must then heal spontaneously. Clinically the procedure was well tolerated but the results were not durable. This procedure is currently seldom utilized.

Incisional / Ablative Therapies
- TUIP: Intermediate in effectiveness between the heat therapies and ablative therapies for BPH is transurethral incision of the prostate. This procedure is performed through a cystoscope and involves the use of an electrical device for dividing the bladder neck and prostate to the level of the veru montanum. This is accomplished by passing current through a cutting wire and then incising the bladder neck musculature, prostatic adenoma, and prostatic capsule. Because only a single incision is utilized there is minimal bleeding. No prostatic tissue is removed. In selected patients this has been a very useful procedure and reduces the risk associated with a standard transurethral resection of the prostate. Those patients most likely to benefit from TUIP are young patients with small lateral lobes and elevated bladder necks.
- TURP: The most effective surgical procedure for managing BPH is transurethral resection of the prostate (TURP). This classic procedure is performed through a cystoscope and involves the use of a cutting loop. The prostate is excavated from the level of the bladder neck to the veru montanum. This results in debulking of the lateral adenoma. TURP has resulted in the most objective improvement in flow rate and the best subjective improvement in symptoms. Patients with irritative voiding symptoms will often be unimproved by TURP. Morever, TURP is subject to a number of potential complications. Bleeding is a common problem and may occasionally be severe. The development of scar tissue at the bladder neck (bladder neck contracture) can result in significant obstruction post surgery. Because of the proximity of the external striated sphincter damage incurred during a TURP can result in continuous urinary incontinence. Up to 15% of men report erectile dysfunction or frank impotence following TURP, although the mechanism of the impotence in this setting is not well understood.
Minimally Invasive Laser Technology

Minimally invasive surgical therapies for prostate enlargement offer an attractive option for men that don’t respond to medical therapies or that don’t want to take medications for the rest of their lives. Drs. McClure and McRackan specialize in a procedure called GreenLight Laser Therapy of the prostate. They utilize a Laserscope Greenlight HPS (high performance system) Niagra Laser. The GreenLight PV or PVP (Photo-Selective Vaporization of the Prostate) is a minimally invasive alternative to traditional transurethral surgery. Performed under sedation as an outpatient procedure, the entire surgery takes about 45 minutes. A tiny quartz fiber is inserted through a small scope that is inserted into the penis under direct vision. Laser energy within the green light spectrum is used to vaporize a wide channel within the prostatic urethra. The body sloughs the vaporized tissue over the next several months, which is replaced by a healthy new urethral lining. Men are either discharged the same day or the following morning without a catheter. Side effects are minimal. The majority of men experience a rapid and significant improvement in their voiding symptoms and quality of life.

Click here for further information about GreenLight Laser Therapy for prostate enlargement and to view an informative video about GreenLight Laser Therapy.

As with all medical interventions, particularly surgical interventions, the key to successful outcomes is patient selection. For instance, TURP has a high probability of retrograde ejaculation and would be a poor selection in a young man for whom fertility is an issue. In that patient population a less invasive and less aggressive approach such as microwave therapy or transurethral incision of the prostate would be more appropriate.

Likewise, in older patients or patients in poor health, a laser-induced prostatectomy or a prostatic stent might be a better choice. Even after appropriate measures have been taken to exclude alternative causes of LUTS, the prevailing attitude of most clinicians and patients is that at least a trial of medical therapy should be tried. After that, a sober evaluation of the risks and benefits of surgical intervention should be undertaken.

[Top]

Complementary Therapies

Prostate enlargement is one of the most common reasons that men over the age of fifty see a urologist. In fact, if men live long enough, they will all develop prostate enlargement. Just the same, men with mild to moderate prostate enlargement symptoms can usually be treated expectantly. On the other hand, men with severe prostate enlargement symptoms are best managed with either drug therapies or surgery. Plants or plant extracts have been used since ancient times to treat urinary problems. Popularly known as phytotherapy (‘phyto’ means plant), herbal therapies cost less, have fewer side effect than prescription medication, and they are often effective. Click here to download a PDF with complementary therapies for prostate enlargement, new window will open.

[Top]

Prostate Cancer

Once the diagnosis of prostate cancer is made, the physician will review all treatment options available to the patient. Further studies to evaluate the extent or stage of disease may be necessary to assist in making a decision about treatment.

An alternative approach to the management of early prostate cancer is known as "active surveillance," in which patients do not have surgery right away but are closely followed by their doctors to see if their tumors begin to grow or spread.

A study published in the September 12, 2002, issue of the New England Journal of Medicine, reports that Scandinavian men with early prostate cancer who had surgery were less likely to die of prostate cancer itself than men who received active surveillance. However, after an average of six years of follow-up, overall survival was about the same in the two groups of patients.

A second article in the same issue of the journal, reports that quality of life was also similar in the two groups, although surgery and active surveillance have different adverse effects. Sexual problems and urinary incontinence were more common in men who had surgery, whereas difficulty passing urine was more common in men who received active surveillance.

Questions still remain about the long-term benefits of surgery vs. active surveillance for patients with early prostate cancer, said Richard Kaplan, M.D., of the National Cancer Institute's Cancer Therapy Evaluation Program. "Six years is a relatively short follow-up period," he said. "It's possible that with longer follow-up an overall survival advantage for surgery will emerge." Subsequent studies with longer follow-up have demonstrated a statistically significant survival advantage for surgery vs. active surveillance.

There are many different treatment options and combinations of treatments depending on the stage of disease and the age and health of the patient. Generally the treatments available for prostate cancer include the following:

Complementary Therapies

A substantial body of in vitro laboratory and animal data and evolving epidemiological and human in vivo data suggest that complementary therapies such as dietary and lifestyle interventions and botanical and nutritional supplements and vitamins can complement conventional therapies to modulate the initiation, promotion, and progression of prostate cancer, improve quality of life, and prolong survival.

Click here to download a PDF with further information about complementary therapies for prostate cancer.

Advanced prostate cancer is comprised of a heterogeneous population of androgen-dependent, androgen-sensitive, and androgen-insensitive (castrate-resistant) prostate cancer cells, which explains why androgen deprivation therapy – the primary treatment for advanced prostate cancer – is not curative. This article explores an accumulating body of scientific evidence that natural therapies can alter biology of androgen insensitive prostate cancer cells and slow PSA doubling time.

Click here to download a PDF with further information about complementary therapies for androgen – insensitive prostate cancer.

[Top]

Surgery

Patients in good health who are younger than 70 years old are usually offered surgery as treatment for prostate cancer. The following types of surgery are used:

Open radical prostatectomy: A surgical procedure to remove the prostate, surrounding tissue, and nearby lymph nodes. There are 2 types of radical prostatectomy:
- Radical retropubic prostatectomy: A surgical procedure to remove the prostate through an incision (cut) in the abdominal wall. Removal of nearby lymph nodes (called a pelvic lymphadenectomy) may be done at the same time. A pathologist views the tissue under a microscope to look for cancer cells. If the lymph nodes contain cancer, the doctor will not remove the prostate and may recommend other treatment.
- Radical Perineal prostatectomy: A surgical procedure to remove the prostate through an incision (cut) made in the perineum (area between the scrotum and anus).
Robot-assisted Radical Prostatectomy: It is now possible to remove the prostate laparoscopically with the aid of a robot. The advantages of robot-assisted radical prostatectomy include a quicker convalescence with comparable results in terms of cancer control, and return of sexual and urinary function.

Drs. McRackan and McClure specialize in robot-assisted surgery for prostate cancer. Click here to download a PDF with further information about this innovative procedure, new window will open.

Impotence and leakage of urine from the bladder or stool from the rectum may occur in men treated with surgery. Fortunately, both types of incontinence are usually temporary. Once their catheters are removed following surgery, about half of men initially experience some degree of urinary incontinence. Within three months half of these men have regained urinary control and the vast majority (97%) of men regain acceptable urinary control within 12 months following surgery. Involuntary loss of stool (fecal incontinence) is unusual following a Radical retropubic prostatectomy. About 10% of men initially experience some degree of fecal incontinence following a Radical Perineal prostatectomy, but this too usually improves with time. Physical therapy can also improve bowel control.

Click here to download a PDF entitled "Overview of the Management of Post-prostatectomy Urinary Incontinence" by Mark W. McClure, MD, FACS Cheryl McClure Elliott, RN, MSN, ANP

Impotence following radical prostate surgery occurs in 25-50% of men. In most cases, doctors can use a technique known as nerve-sparing surgery to preserve the nerves that are necessary to achieve an erection. Furthermore, erections can continue to improve up to four years following surgery. In the meantime, various medications can improve erectile function while the natural healing process is taking place. This type of surgery may save the nerves that control erection.

[Top]

Radiation therapy

Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells. There are two types of radiation therapy. External radiation therapy uses a machine outside the body to send radiation toward the cancer. Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer. The way the radiation therapy is given depends on the type and stage of the cancer being treated.

Impotence and urinary problems may occur in men treated with radiation therapy.

Hormone therapy

Hormone therapy is a cancer treatment that removes hormones or blocks their action and stops cancer cells from growing. Hormones are substances produced by glands in the body and circulated in the bloodstream. The presence of some hormones can cause certain cancers to grow. If tests show that the cancer cells have places where hormones can attach (receptors), drugs, surgery, or radiation therapy are used to reduce the production of hormones or block them from working.

Hormone therapy used in the treatment of prostate cancer may include the following:

Luteinizing hormone-releasing hormone agonists can prevent the testicles from producing testosterone. Examples are leuprolide, goserelin, and buserelin.
Antiandrogens can block the action of androgens (hormones that promote male sex characteristics). Two examples are flutamide and bicalutamide.
Drugs that can prevent the adrenal glands from making androgens include ketoconazole and aminoglutethimide.
Orchiectomy is a surgical procedure to remove one or both testicles, the main source of male hormones, to decrease hormone production.
Estrogens (hormones that promote female sex characteristics) can prevent the testicles from producing testosterone. However, estrogens are seldom used today in the treatment of prostate cancer because of the risk of serious side effects.

Hot flashes, impaired sexual function, and loss of desire for sex may occur in men treated with hormone therapy.

[Top]

Additional Information about cancer

For more information on the diagnosis of prostate cancer and the treatment options available visit the American Cancer Society's Web site.

Cancer is a major illness, but not everyone who gets cancer will die from it. Close to 9 million Americans alive today have a history of cancer. For them, cancer has become a chronic (on-going) health problem, like high blood pressure or diabetes. Just like anyone with a chronic health problem, people who have cancer must get regular checkups for the rest of their lives, even after cancer treatment ends. But unlike other chronic health problems, if you have cancer you probably will not need to take medicine or eat special foods once you have finished treatment. Click here to visit the National Cancer Institute website.

If you have cancer, you may notice every ache, pain, or sign of illness. Even little aches may make you worry. While it is normal to think about dying and healthy to explore your feelings about death, it is also important to focus on living. Keep in mind that cancer is not a death sentence. Many people with cancer are treated successfully. Others will live a long time before dying from cancer. So, make the most of each day while living with cancer and its treatment.

For additional information about prostate cancer diagnosis and treatment, visit the Memorial Sloan-Kettering Cancer Center’s website.

[Top]

Need more information on health and wellness?
Click here for a link to health and wellness recommendations from the National Institute of Health.