The prostate is a relatively small gland underneath a man’s bladder. It’s only about the size of a walnut, but as a man ages it often enlarges… and then problems start.

When It’s Just Enlarged Prostate

It’s fairly common for a man’s prostate gland to expand with age. When it does, it squeezes the urethra, the tube that allows for easy urine flow, and that makes passing urine difficult. This enlargement is called benign prostatic hyperplasia, or BPH, for short.

The article Treating Prostate Problems offers a fairly good discussion of more basic methods for treating BPH, but here’s one quick note: One of the major advances in fighting this enlargement since the mid-80s has been treating BPH with drugs instead of surgeries. In particular, medications called alpha blockers are excellent in helping regulate urine flow. Flomax, Hytrin, and Uroxatral are just three such drugs.

The main side effect of these drugs is that they can lower blood pressure. If a man feels dizziness after starting one of these drugs for BPH, it would be wise to consult his doctor and see if another medicine would help or if another treatment is necessary.

Surgery for BPH

The good news is the last decade has brought less invasive surgeries for BPH. There’s an outpatient procedure in which a microwave heats and destroys overgrown tissue and an inpatient procedure using a laser to vaporize obstructive tissue. Both allow for better urine flow.

The American Urological Association (AUA) also notes the use of spring-like contraption called a stent inside the prostate. This is done without any anesthesia and it’s generally recommended for patients who, for one reason or another, are not considered good candidates for aggressive surgeries.

A wide range of these and other surgical options (in much more detail) can be found at the Urology Health website.

The Cancer Surgery Debate

Sometimes the prostate isn’t enlarged due to natural aging, but because of prostate cancer. In men 60 or younger, the general attitude among health experts is to go after the cancer aggressively because it’s more likely to be fatal in this age group. The most common procedure, according to the National Cancer Institute (NCI) is radical prostatectomy, a procedure that removes the entire prostate and often nearby tissues.

One of the dangers of a prostatectomy is that it may damage the nerves that allow for an erection. The NCI notes that sometimes a technique called “nerve-sparing surgery” may be viable, but it’s not always an option.

In older men (especially 75 and up) prostate cancer tends to be fairly slow growing. So many doctors talking to older patients suggest a process called “watchful waiting.” That means coming back for regular check-ups to see if the cancer is progressing before trying surgery. Some may suggest radiation therapy to fight the disease. If an older patient is fighting several other health problems, watchful waiting may be the best option.

Ultimately every patient should be evaluated individually and then engage in a careful discussion with their physician, either primary care or urologist, about the pros and cons of various treatments.

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