An enlarged prostate can be clearly recognized by the doctor by means of various examinations. We explain which treatment options are indicated for which symptoms and when surgery is necessary. In addition, you can become active yourself, and with some tips prevent an enlargement of the prostate.
How is the diagnosis made?
To find the diagnosis, the doctor will first take the medical history (including medications taken) and ask exactly about the symptoms and the frequency of urination during the day and at night. In many cases, a standardized questionnaire is used for this purpose. This is followed by a palpation of the prostate via the rectum, often coupled with an ultrasound – both via the rectum and the abdominal wall. This allows the kidneys and urinary bladder to be assessed at the same time and residual urine to be determined. In addition, the blood and urine are examined, also to rule out malignant changes. Depending on the need, further tests may follow, such as cystoscopy or an X-ray examination (excretory urogram). During urine stream measurement, the doctor checks the strength of the urine stream.
What therapy is available?
Treatment depends on the symptoms and the examination findings, especially the measurement of the urinary stream. If symptoms are only mild, “watchful waiting” (wait and check regularly) is indicated – in about one-third of men, they improve spontaneously over time. In the second third, prostate problems remain constant; in the rest, they worsen visibly.
Treatment with over-the-counter and herbal preparations.
In mild symptomatology, medicines with few side effects and herbal medicines, which are available without prescription in pharmacies, have their place. These include extracts of nettle root, saw palmetto fruit, pumpkin seeds and rye pollen. The plant extracts have a decongestant and anti-inflammatory effect, but do not prevent prostate growth. However, they can postpone the time of an operation in which the excess prostate tissue is peeled out. Tip: The preparations do not take effect immediately, but must be taken over several weeks to achieve an effect. In any case, regular checkups with a urologist are important.
Treatment with prescription drugs
If symptoms are clear, the doctor will prescribe alpha-blockers (with the active ingredients doxazosin, prazosin, terazosin or tamsulosin). These have a relaxing effect on the bladder neck, the urethra and the muscles in the prostate, thus facilitating urination. Their plus point is that the effect is instantaneous. The main side effects of the drugs are circulatory disorders and dizziness. If the prostate tissue is significantly enlarged, finasteride is used. This interferes with the hormone metabolism of the prostate gland: it prevents the conversion of the hormone testosterone into dihydrotestosterone. Symptoms are significantly improved after at least six months of use; however, only about half of men respond to the therapy.
Prostate surgery
If the medication no longer works and the symptoms become very distressing, surgery is inevitable – in cases of urinary retention, overflow bladder, kidney congestion and damage, it is mandatory. The goal is to remove the proliferating tissue, leaving the actual prostate capsule intact. You can think of it like an orange: The flesh is peeled out, the peel remains. There are a number of different surgical methods; the specialist must decide which is suitable. The most common is transurethral resection (TURP), in which the tissue is planed off by an electric snare inserted through the urethra. A newer method is the more gentle vaporization of the prostate tissue by means of a laser in the green light range (greenlight laser). Surgery should be performed in large specialized clinics to keep risks low. Nevertheless, BPH surgery is a routine procedure today.
What can I do myself?
Some studies suggest a link between diet and prostate enlargement. Certain secondary plant compounds in particular are thought to be able to prevent enlargement (polyphenols, for example in grapes, pomegranates, spices) or even prostate cancer (phytoestrogens, for example in spinach, broccoli, soybeans and carotenoids, for example in carrots, tomatoes, green vegetables).If you are already suffering from mild discomfort, the following tips can alleviate it:
- Wear comfortable underwear made of natural fibers.
- Give in to the frequent urge to urinate – otherwise there is a risk of overfilling and overstretching the bladder, increasing the discomfort.
- Make sure they have regular bowel movements – so there is no additional pressure on the urinary tract.
- Do not sit too long, but stand and walk in between every now and then.
Enlargement and cancer – risk increased?
According to previous findings, there is no direct link between the development of benign enlargement and malignant cancer of the prostate. As a rule, benign growth originates from the inner portions of the prostate gland, while the germ cell of prostate cancer is located in the outer lobules of the gland. However, it is possible for both diseases to occur coincidentally at the same time or one after the other. Although prostate cancer occurs much less frequently than benign BPH, early detection and clarification by the physician is of great importance. It is therefore important to attend regular annual check-ups from the age of 45. In this way, early damage can be detected in time. The costs are covered by the statutory health insurance funds.
