Prostate Enlargement Protocol

Surgical treatments can include suprapubic and retropubic prostatectomies. A simple prostatectomy and a radical prostatectomy are very different procedures. The suffix -ectomy means the excision of an organ or gland, but not necessarily the complete organ or gland. A radical prostatectomy means the complete excision and removal of the gland. A radical prostat-ectomy is seldom done for treatment of prostate enlargement.

Transurethral Resection Procedure (TURP)
Radical prostatectomy has been called the Gold Standard for prostate cancer. TURP has been called the Platinum Standard for prostate enlargement. TURP uses a resectoscope, which utilizes a wire loop and electrocautery to remove tissue. TURP cleans out the urethral portion of the prostate. TURP is sometimes called a Roto-Rooter operation.

The resectoscope is a tube that is about 12 inches long and about 1/2 inch in diameter. The tube contains wires for the electrocautery loop, a light source, and a tube for irrigating water. The normal urethra is about 1/4 inch in diameter. The patient is usually given a spinal or general anesthesia before a 1/2-inch resectoscope is inserted.

The surgeon looks through the eyepiece and can see the obstructive portions of the prostatic urethra. He uses the wire loop to snip off pieces of the obstruction. Water is used to flush the cut pieces into the bladder. The electric wire loop cauterizes the tissue, so there will be only a small amount of bleeding.

Despite the cauterization, there may still be bleeding. It is possible that the patient could need at least 1 unit of transfused blood. With the AIDS concerns of today, a physician might suggest that the patient make an autologous donation of his own blood. If the patient needs it, using his own blood is the preferred option.

There is also a chance of infection resulting from the operation. Fortunately, antibiotics can control most infections.

After a TURP, most patients will have incontinence to some degree that is usually overcome in a short time. The reason for the incontinence is that the prostate is closely tied to the bladder. The bladder sphincter is usually damaged to some degree. If the surgeon is not very careful, the bladder sphincter can be damaged severely. In that case, there can be a lasting incontinence problem.

There is a secondary sphincter below the prostate. It is a musculomembraneous valve that can be trained and strengthened by Kegel exercises. To do a Kegel exercise, a man starts and stops his urine in midstream, trying to determine which muscles control voiding. By tightening and relaxing these muscles several times each day, the muscles can be strengthened enough to regain control in many cases.

One problem is that if the primary valve has been severely damaged, it may not be able to close when the man has an erection. The secondary musculo-membranous valve always opens when a man has an erection, so there may be times when there is leakage during sexual activity. No amount of Kegel exercises can overcome this problem.

During sexual arousal, ordinarily the bladder sphincter is tightly closed. However, if the bladder sphincter has been damaged, it may not be able to close. In this case, during ejaculation, the semen and sperm take the much shorter route into the bladder. This is called retrograde ejaculation. The man may have the same orgasmic sensation as before, but the ejaculate ends up in the bladder. If he still wants to father children, it is possible that the sperm can be filtered from the next voiding and used to impregnate his spouse.

TURP has been shown to be an effective treatment, and symptoms may be much improved. The improvement may last for several years, but it is possible that the prostate enlargement may reoccur. It is also possible that some men may later have erectile dysfunction or impotence. Some men may also have a bladder neck stricture or urethral contracture.

Transurethral Incision Prostatectomy (TUIP)
A TUIP is a fairly simple procedure in which cuts or slits are made in the prostatic portion of the urethra. This operation can be less traumatic than a TURP and has fewer side effects, but it may not be effective in all cases. The slits are usually made with a special scalpel, but they may also be done with a laser.

LASER Devices
There are several devices that use the laser for treating prostate enlargement. The word LASER is an acronym for Light Amplification by Stimulated Emission of Radiation. Ordinary light is made up of random incoherent wavelengths. A laser beam is made up of a single amplified coherent wavelength. There are several different types of lasers. Some are powerful enough to burn a hole through a diamond. Several types have been adapted for surgical procedures. There are several advantages to laser surgery. One advantage is that the laser coagulates and seals blood vessels so that there is little or no bleeding. The strength of the laser is dependent on the amount of electrical power fed to it. By controlling the input power, the depth of a cut (or ablation) can be monitored and controlled.

Alternatives to Surgery

Transurethral Microwave Thermotherapy
Transurethral Needle Ablation
High-Intensity Focused Ultrasound
Drug Treatments
Saw Palmetto Extract
Nettle Root Extract
Pygeum
European Phyto Extracts
Standardization

Transurethral Microwave Thermotherapy (TUMT)
TUMT seems to be a good alternative to surgery. If prostate cells are subjected to temperatures of about 45 °C, or 113 °F, they will die. The source of hyperthermia is high-frequency microwaves similar to those used in home microwave cooking ovens.

The microwave instrument systems are designed so that the temperature and the depth of heating are exactly controlled. A report presented at the 1993 American Urological Association convention listed results of 150 patients who had been treated with TUMT. The patients were subjected to 45 °C for about 60 minutes. (The American Urological Association may be reached at (410)727-1100.)

There was no need for anesthesia or hospitalization. There was little or no bleeding and little pain. There were no reports of retrograde ejaculation or significant changes in sexual function.

TUMT appears to offer very good results. The procedure offers an alternative for those men who are not good candidates for surgery.

Transurethral Needle Ablation (TUNA)
TUNA uses a low-level radiofrequency (RF) of about 490 kHz to create a temperature of 50-90 °C in the area to be ablated. The probe is a special catheter that has two flexible needles at the tip. The needles are deployed and inserted into the prostate through the urethra. The needles are about 45 degrees apart. They are shielded at their base so that urethral tissue is not damaged. When the RF energy is turned on, it passes from one needle to the other so that prostatic tissue between the needles is destroyed. The progress of the treatment can be viewed by a Transrectal Ultrasound (TRUS). The needles can be repositioned so that many areas of the prostate can be treated. The treatment can be an outpatient procedure with local anesthesia. The patient can leave soon after the treatment.

High-Intensity Focused Ultrasound (HIFU)
High Intensity Focused Ultrasound (HIFU) is being used to treat prostate enlargement, prostate cancer, and several other cancers. A special rectal ultrasound probe is used to treat prostate enlargement and prostate cancer. HIFU ablates benign prostatic tissue in a minimally invasive manner with low morbidity. HIFU is safe and effective for treating prostate enlargement. HIFU has also been successfully used to treat localized prostate cancer and other tumors.

Hytrin, Minipress, Flomax, and Cardura Drug Treatments
Many men would rather not have surgery or other invasive treatments. Several drugs can provide relief in many cases.

There are high blood pressure drugs called alpha-blockers, which act on the nervous system to relax the arteries. Quite often patients with prostate enlargement also present with hypertension, or high blood pressure. These drugs can have an effect on the smooth muscle of the prostate to some extent. Some of the blood pressure drugs used to treat prostate enlargement are Hytrin, Minipress, and Cardura.

The prostate is a musculoglandular organ. It is interlaced with smooth muscle much like the tubular musculature of the arteries. The smooth muscles of the arteries are controlled by the body's nervous system. In high blood pressure, the musculature of the arteries is in a state of contracture. Alpha-blockers cause the smooth muscles of the arteries, the prostate, and other smooth muscles to relax.

One disadvantage of alpha-blockers is that they may not be effective on some prostates. Another disadvantage is that many of the alpha-blockers can cause impotence. If a man has impotence problems with one drug, it may be possible to switch to a similar drug that will not have the same undesirable side effects.

Saw Palmetto Extract Alleviates prostate enlargement

How Saw Palmetto Works
The Optimal Extract from Saw Palmetto
Saw palmetto is a berry that grows on dwarf-type palm trees in Florida and much of the southeastern part of the country. Saw palmetto has been used extensively as a drug in Europe for some time. Because of the treatment successes in Europe, it has become very popular in the United States as a dietary supplement.

Studies have shown that saw palmetto produces improvement in those with prostate enlargement, resulting in the following clinical benefits:

Reduction of nocturnal urinary urgency
Increased urinary flow rate
Decreased residual urine volume in the bladder
Reduction in uncomfortable urination symptoms
Laboratory studies show an actual reduction in the size of the prostate gland in animals given saw palmetto extract.

A Belgian study (Current Therapeutic Research Clinical Experience) involving 505 men with benign prostate disease showed that saw palmetto improved urinary flow, reduced residual urinary volume and prostate size, and improved quality of life after only 45 days of treatment. After 90 days, 88% of patients and treating physicians considered the treatment effective. The researchers concluded by stating: "The extract of saw palmetto appears to be an effective and well-tolerated pharmacologic agent in treating urinary problems accompanying benign prostatic hypertrophy" (Braeckman 1994).

How Saw Palmetto Works
Hormonal imbalances (such as too much DHT and estrogen) have been blamed for prostate enlargement, but other factors have been identified as causes of the benign proliferation of prostate cells and accompanying urinary impairment.

Saw palmetto extract reduces DHT levels in prostate cells, thereby helping to block the growth stimulatory action of this testosterone metabolite (Marks et al. 2001). While most people think of saw palmetto as a DHT inhibitor, it functions via other mechanisms, which helps explain why so many men experiencing prostate enlargement find symptomatic relief. For instance, saw palmetto reduces smooth muscle contraction, which relaxes the bladder and sphincter muscles that cause urinary urgency (Gutierrez et al. 1996).

Studies show that saw palmetto also acts as a cyclooxygenase-2 (COX-2) inhibitor in the prostate gland, thereby exerting an anti-inflammatory effect. Since some cancer cells use the COX-2 enzyme to fuel proliferation, suppressing levels of COX-2 in the prostate gland could both ameliorate inflammatory enlargement and reduce prostate cancer risk. One study showed that the addition of saw palmetto extract reduced benign prostate cell growth by 20-50%, depending on the type of prostate cell tested (Goldmann et al. 2001).

While saw palmetto has been shown to inhibit prostate cell proliferation, its most profound effect may be to induce prostate cell apoptosis (programmed cell death) (Vacherot et al. 2000). A major focus of research is aimed at finding compounds that can purge the aged body (i.e., induce apoptosis) of senile cells that have lost their ability to function. The problem with aging is that we accumulate too many nonfunctional cells that will not differentiate properly and do not proceed through the orderly apoptosis process.

Senile cells contain many mutated genes that can easily turn these cells malignant. Apoptosis should be induced in aged cells, especially in the prostate gland. These senile prostate cells are barely functional but contribute to prostate enlargement and are ripe for mutation into cancer cells.

Senile cells send out signals that can damage nearby healthy cells. These senile cells also induce chronic inflammation syndrome as the immune system tries to kill these defective cells. Young people can easily dispose of damaged cells, but older people lose this ability. The effect of saw palmetto in killing off aged prostate cells means that from a molecular basis, it is doing exactly what it should to protect against prostate enlargement and prostate cancer; it is inducing apoptosis.

A meta-analysis review was made of 3139 men from 21 randomized trials lasting 4- 48 weeks. Of these studies, 18 were double-blinded. Compared to placebo, saw palmetto enhanced urinary clinical symptom scores, urine flow measures, and self-reported improvement assessments. When compared to finasteride (Proscar), saw palmetto produced similar results, but the adverse effects were less frequent in the groups receiving saw palmetto (Wilt et al. 2000).

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These statements have not been evaluated by the FDA. These products are not intended to diagnose, treat, cure, or prevent any disease