Enlarged Prostate (Benign Prostatic Hyperplasia – BPH)

The male reproductive system contains a small, walnut-sized gland known as the prostate, positioned between the bladder and the penis. Situated just in front of the rectum, the prostate surrounds the urethra, allowing the passage of urine from the bladder to the penis. This gland produces a fluid that nourishes and protects sperm. During ejaculation, the prostate releases this fluid into the urethra which is expelled with sperm as semen.

Sperm travel from the testes to the duct of seminal vesicles through the vasa deferential, which contributes fluid to semen during ejaculation. With age, there is a high likelihood of developing an enlarged prostate or benign prostatic hyperplasia (BPH). Approximately 80% of men are estimated to experience BPH, and over 40% of those with an enlarged prostate may require treatment to ease symptoms. It’s essential to note that BPH differs from prostate cancer and does not increase the risk of cancer. Nevertheless, it can lead to symptoms impacting one’s quality of life. Timely diagnosis and treatment can help prevent long-term complications.

Causes of Enlarged Prostate (BPH)

BPH is prevalent in individuals aged 50 and above and is considered an expected condition of the aging process. While the precise cause remains uncertain, alterations in male sex hormones associated with aging are believed to contribute.

An increased risk of BPH may be linked to a family history of prostate issues or any irregularities in the testicles. Notably, individuals who undergo testicle removal at a young age do not experience the development of BPH.

Symptoms of Enlarged Prostate (BPH)

Around half of men experiencing BPH have symptoms associated with the condition. These symptoms may include:

• Dribbling at the end of urination
• Weak urine stream
• Inability to urinate
• Straining while urinating
• Incontinence
• Incomplete emptying of the bladder
• Strong and sudden urge to urinate
• Slowed or delayed initiation of the urinary stream
• Pain during urination or the presence of bloody urine
• Needing to urinate 2 or more times during the night

Risk Factors for Enlarged Prostate (BPH)

• Age: Prostate gland enlargement typically remains asymptomatic in men below the age of 40. Around the age of 55, approximately 1 in 4 men begins to experience signs and symptoms, and by the age of 75, about half of men report some symptoms.
• Family history: If you have a blood relative, such as a father or brother, with prostate issues, your likelihood of experiencing problems increases.
• Geographic origin: Prostate enlargement is more prevalent among American and Australian men, whereas it is less common in Indian, Chinese, and Japanese men.

Test Diagnosis of Enlarged Prostate (BPH)

When examining for BPH, a medical practitioner typically initiates the process with:

• Questionnaire session: Thorough inquiry about your symptoms.
• Digital rectal exam: This examination assesses whether your prostate is enlarged or not.
• Urine test (urinalysis): It can help to find out an infection or other conditions that might lead to comparable symptoms.
• Prostate-specific antigen (PSA) blood test: The production of PSA by the prostate gland, a substance that aids in semen liquefaction, is normal. In the case of an enlarged prostate, PSA levels increase. However, elevated PSA levels can also result from factors such as recent medical tests, surgery, prostate cancer, or infection (prostatitis).
• Urinary flow test: Measures the strength and volume of urine flow.
• Post-void residual volume test: Determines if your bladder empties completely, often conducted using an ultrasound to measure remaining urine.
• Transrectal ultrasound: Provides prostate measurements and reveals specific prostate anatomy.
• Prostate biopsy: Utilizing a transrectal ultrasound, this procedure guides a needle to collect prostate tissue samples for microscopic examination, helping in the diagnosis or ruling out of prostate cancer.
• Urodynamic studies and pressure flow studies: Involves threading a catheter through the urethra into the bladder and slowly injecting water (or, less commonly, air) to measure bladder pressures and assess bladder muscle function.

Though prostate cancer and prostate gland enlargement are entirely different, they share some similar symptoms and may be diagnosed by some of the same tests. An enlarged prostate neither reduces nor increases the risk of prostate cancer. Even if you are undergoing treatment for an enlarged prostate, regular prostate exams are essential to screen for cancer.

Enlarged Prostate Treatment in India

There are numerous options for enlarged prostate treatment in India, and a considerable number of men may not exhibit any signs or symptoms of an enlarged prostate. In such instances, adopting a watchful-waiting approach might be the most suitable option, considering that enlarged prostates are non-cancerous.

Surgical Treatment Options for Benign Prostatic Hyperplasia (BPH)

Various surgical procedures are available to remove prostate tissue that obstructs the urethra. These procedures include:

• Transurethral resection of the prostate (TURP)
• Open prostatectomy
• Laser surgery

Transurethral Resection of the Prostate (TURP)

For a long time, TURP has been the usual way to treat an enlarged prostate treatment in India, and it’s the surgery that doctors often compare with other treatments. In TURP, a surgeon puts a lighted scope called a resectoscope into your urethra and uses small cutting tools to take away everything except the outer part of the prostate. This usually helps with symptoms quickly, and most men experience improved urine flow shortly after the procedure.

However, TURP has a limitation – it can only be done on prostates that are 60 cubic centimeters or smaller in size.

Complications

• Possibility of infection.
• Risk of water intoxication.
• Potential for erectile dysfunction.
• Possibility of urinary incontinence.
• Risk of significant bleeding even days after the surgery.
• Temporary need for a catheter to drain your bladder post-procedure.
• Limited ability to engage in only light activities until fully healed to minimize the risk of bleeding.

Open Prostatectomy

This surgery is typically performed when dealing with an exceptionally large prostate, bladder damage, or other complications like bladder stones. It’s named "open" because the surgeon makes a cut in your lower abdomen to access the prostate. Open prostatectomy is highly effective for treating significant prostate enlargement, but it comes with a notable risk of side effects and complications. Hospitalization for a few days is usually necessary, and there’s a higher likelihood of needing a blood transfusion.

Laser Surgery

Laser surgery, also known as laser therapy, employs high-energy lasers to eliminate or take out excess prostate tissue. This type of surgery typically provides immediate relief from symptoms and carries a lower risk of side effects compared to TURP. Laser surgery is particularly suitable for men on blood-thinning medications who cannot undergo other prostate procedures.

However, side effects are common in various prostate surgeries, including retrograde ejaculation (semen flowing backward into the bladder instead of out through the penis), erectile dysfunction (impotence), and loss of bladder control (incontinence).

Non-surgical treatment for Enlarged Prostate in India

Non-surgical enlarged prostate treatment in India – Prostatic Artery Embolization (PAE): It is a new procedure, comparable to TURP in symptom recovery with no reported side effects.

Patients undergo admission to the hospital on the procedure day following preliminary investigations. The embolization procedure involves the administration of anti-inflammatory drugs, pain medication, and antibiotics.

Under local anesthesia and through a unilateral approach, usually the right femoral artery, embolization is conducted. Initial pelvic angiography assesses the prostatic arteries. Subsequently, a 4 or 5-F angiography catheter is introduced to access the prostatic artery, and a 3-F coaxial microcatheter is advanced into the ostium of the prostatic artery. Non-spherical PVA particles are used for embolization. The goal is to achieve slow flow or near-stasis in the prostatic vessels, interrupting arterial flow and causing prostatic gland opacification.

Upon completion of embolization for both prostatic arteries, the catheter is removed. Patients can begin walking around their room without a urinary catheter after 4-6 hours, and on the same day, they can resume normal activities.

Advantages of Prostatic Artery Embolization (PAE)

• Suitable for any prostate size: PAE can be performed on prostates of any size.
• Minimal side effects/complications: Unlike TURP, PAE does not typically result in side effects or complications.
• No blood loss or need for transfusion: PAE involves no blood loss, eliminating the risk of requiring a blood transfusion.
• Cosmetically appealing: The procedure leaves no unsightly surgical scars, as it is conducted through a small incision in the groin region.
• Quick recovery and early activity: PAE contributes to a faster recovery, allowing for the early resumption of normal activities.
• Day care procedure: There is no need for hospital stays; PAE is performed on a day-care basis or with one-day hospitalization.
• Minimal pain: Most men experience little to no pain and can leave the hospital within a day after the intervention.
• Preservation of bladder control: PAE does not lead to the side effect of loss of bladder control (incontinence).
• Positive impact on sexual function: Unlike some procedures, PAE does not result in sexual dysfunction, and some patients even report improvement in sexual function after the intervention.
• Mild sedation instead of general anesthesia: PAE requires only mild sedation and not general anesthesia.
• Cost-effective: PAE is a more cost-effective option compared to surgery.
• High success rate: The overall success rate of PAE is reported to be more than 98%.

The Best Treatment Option for Enlarged Prostate Treatment in India: Non-surgical Approach—Prostatic Artery Embolization (PAE)

Prostatic Artery Embolization (PAE) is a non-surgical procedure performed by an interventional radiologist using a catheter to deliver small particles, blocking the blood supply to the enlarged prostate. Unlike surgical interventions, PAE preserves all prostate functions. The reduction in the size of an enlarged prostate usually occurs within 2–3 weeks post-embolization.

Exploring Enlarged Prostate Treatment in India

For those seeking enlarged prostate treatment in India, various options are available, including cost-effective non-surgical approaches. Prostatic Artery Embolization (PAE) stands out as a preferred non-surgical treatment, performed by skilled interventional radiologists.

The non-surgical prostate treatment cost in India varies, but these non-surgical options often prove to be affordable. Prospective patients can explore these choices for effective and economical solutions tailored to their medical needs, taking into account the affordability of enlarged prostate treatment cost in India.