Advances in Treatment of Benign Prostatic Hyperplasia

Benign prostatic hyperplasia (BPH) is a noncancerous condition involving the overgrowth of normal tissue that enlarges the prostate gland. Enlargement often leads to bladder outlet obstruction and restriction of urine flow, with lower urinary tract symptoms as the chief clinical complaint. Symptoms include frequent urination (especially at night), urgency, burning or pain during urination, leakage of urine, and diminished stream. Evidence suggests that these symptoms may progress if BPH is untreated.

BPH is a natural consequence of aging. Each year, approximately 2 million men in the United States seek treatment for BPH. An estimated 50 percent of men in their 60s and up to 90 percent of men in their 70s and 80s experience symptoms of BPH. The prevalence of BPH is expected to increase in the United States as more men live longer.

At Mayo Clinic's Minnesota campus alone, urologists diagnose and treat more than 6,000 BPH patients a year, offering the full spectrum of treatment methods.

The Treatment Continuum

Selecting optimal treatment is highly individualized to each patient's overall health and extent of prostate enlargement. A spectrum of treatment options exists. By seeking care at a research-based prostate center, patients have the best chance of receiving optimal individualized care.

Behavioral and Medical Therapy

• Reducing caffeine intake
• Watchful waiting
• Long-term medication. a-Blockers relax the bladder outlet muscles and make urination easier. Adverse effects include orthostatic hypotension and failure to ejaculate. Finasteride and dutasteride may improve symptoms by reducing prostate size.

Minimally Invasive Treatment

• Laser-based photoselective vaporization of the prostate (PVP)
• Holmium laser enucleation of the prostate (HoLEP)
• Transurethral needle ablation
• Transurethral microwave therapy
• Interstitial laser coagulation
• Transurethral evaporation of the prostate (TUEP)

Surgical Intervention

• Transurethral resection of the prostate (TURP)
• Suprapubic or retropubic open surgical enucleation of prostate

Novel Therapeutics

• Botox injections
• Plant-based therapies

Newer Approaches

PVP green light laser treatment of BPH

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Photoselective vaporization of the prostate (PVP)
Developed at Mayo Clinic, PVP (GreenLight) laser therapy has been used successfully by Mayo Clinic urologists since 1997. PVP involves ablation of the prostate with high-energy potassium-titanyl-phosphate (KTP) or lithium triborate (LBO) laser to vaporize the obstructive tissue and provide relief of symptoms while minimizing damage to healthy tissue. PVP offers the advantages of outpatient treatment, faster recovery, and greater surgical control through operating in a bloodless field.

Holmium laser enucleation of the prostate (HoLEP)
HoLEP is the most recent advanced laser technique offered at Mayo Clinic. This laser application uses a powerful high-performance laser to carve out the entire prostate adenoma (leaving just the prostate capsule), flush it into the bladder, and cut it into smaller pieces that can be evacuated from the bladder without an incision. The tissue is then evaluated by a pathologist.

Although no direct randomized comparisons of treatment by PVP and HoLEP have been done, individual studies of HoLEP have found that holmium enucleation compares favorably with the open surgical enucleation for very large prostate glands. Results are lasting; long-term studies (>5 years) demonstrate very low likelihood of symptom recurrence.

Botulinum toxin injection

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Botox
A new study by Mayo Clinic urologists uses the clinical neurotoxin botulinum toxin (Botox) to relax the musculature of the prostate to allow urine to flow. Ultrasound guides the Botox injection to the overgrown portion of the prostate impinging on the urethra. The mechanism of Botox in the prostate is not completely understood, but early evidence shows durability up to one year. Refinements to produce more durable treatment effects are underway, suggesting that Botox is an emerging therapy that may expand options to men suited to medical control of BPH.