Prostate enlargement, or benign prostatic hyperplasia, in medical speak only requires treatment when it causes bothersome voiding symptoms.
Options include medications or surgery, the choice of treatment depending on the individual's medical characteristics and personal preferences.
- alpha-blockers such as tamsulosin which improve the symptoms of voiding
- 5ARI's such as dutasteride that can reduce the size of the prostate and reduce progression of prostate enlargement.
Surgical options include:
- Urolift: a new minimally invasive technique where the prostate is pulled apart by sutures. This is usully used in small prostates, the main benefit is very rapid recovery and the absence of sexual or ejaculatory side effects
- Greenlight laser vaporization of the prostate: obstructive prostate tissue is vaporized by laser, results may not be durable for larger prostates, and tissue is not tested by cancer
- holmium laser enucleaton of the prostate: I believe this is the best surgical treatment for BPH. The transitional zone of the prostate is completely cored out with a laser fiber and then removed with a morcellator. This procedure is durable because it removes all BPH tissue, there is a 1% reoperation rate at 14 years, and suitable even for very large prostates greater than 100 cc. Recovery is just as quick as Greenlight laser surgery.
- TURP: the traditional method where obstructive prostate tissue is removed by shaving with a hot knife