Should BPH Go Untreated?

October 26, 2023
An enlarged prostate, also called benign prostatic hyperplasia or BPH, is an affliction that most men will encounter as they grow older. BPH is not prostate cancer and it doesn’t lead to prostate cancer, but the symptoms can be similar and the two can coexist together.1 Experts believe that BPH is caused by genetics, environmental factors, and hormonal changes that occur as men age. BPH doesn’t typically affect young men, but by the time a man reaches his 40s and beyond, BPH symptoms can begin to show.2,3 Typical BPH symptoms include having to urinate more frequently at night, the starting and stopping of urine flow, the sudden urge to urinate, difficulty starting urination, and other symptoms related to the pressure that an enlarged prostate places on the urethra which drains urine from the bladder out of the body. Prostate tissue continues growing for most men throughout their lives and many men will experience BPH symptoms that can become bothersome, life-altering, or even a health threat. BPH treatment can include anything from watchful waiting to medication to invasive and minimally invasive procedures. Benign prostatic hyperplasia symptoms can range from mild to severe depending on a man’s unique anatomy, medical conditions, family history, and hormonal balance. Luckily, there are numerous BPH treatment options ranging from doing nothing at all to surgery. It’s up to each man who has BPH to decide how impactful their BPH symptoms are in their daily life and how invested they wish to become in search of symptom relief. If an enlarged prostate is left untreated it may not be a big deal for some men, but for other men, it can be life-changing or even life-threatening if the symptoms shut down urine elimination completely (acute urinary retention).

The Untreated Enlarged Prostate

A small number of very fortunate men will never be diagnosed with an enlarged prostate and the lower urinary tract symptoms (LUTS) often associated with the disease. These men may escape this fate through unique family genetics, hormonal differences, or castration early in life.4 However, most men will be diagnosed with BPH if they live long enough. Whether or not an enlarged prostate should go untreated or not depends on a variety of factors, including severity of symptoms, quality of life, possible complications from a procedure, family history, or medical conditions. Some men diagnosed with benign prostatic hyperplasia will show few to no symptoms and only find out that their prostate is enlarged through a digital rectal exam (DRE) or another diagnostic test. For these men, their BPH symptoms may not be bothersome enough to warrant immediate treatment or treatment at all, so a physician may suggest a period of waiting and watching (WAW) or watchful waiting where symptoms are monitored over time. Lifestyle changes such as managing fluid intake before bed, avoiding alcohol and caffeine, performing pelvic floor exercises, etc. can be implemented to determine if BPH symptoms improve. These minor life changes may effect enough change that the enlarged prostate doesn’t have to be treated – either for a while or even long-term.

The Treated Enlarged Prostate

Benign prostatic hyperplasia is a gradually progressive disease that typically affects men over the age of 50, but sometimes affects men in their 40s and even 30s. And the older a man gets, the more prone he is to developing BPH. As the prostate continues to grow larger, prostate tissue will further encroach on the urethra and possibly the bladder, causing additional BPH symptoms.  When watchful waiting (no intervention) is no longer effective or desired, the enlarged prostate must be treated to alleviate further progression of LUTS brought on by BPH. When the decision has been made to treat the enlarged prostate, there are many options from which to choose. Many men will transition from watchful waiting to the next step in the BPH treatment progression: Medication. Medication may be the only next step that some men will have to take since some BPH medication will relax the urethra and bladder neck enough to relieve symptoms so a normal daily routine can continue. Other BPH medications will stop the formation of dihydrotestosterone or DHT and begin to shrink the prostate over time, thus relieving LUTS brought on by BPH due to a smaller prostate. However, some men won’t like the side effects that BPH medication can bring to the table and will need to explore other treatment options such as minimally invasive BPH procedures.

Treatment Options for an Enlarged Prostate

If watchful waiting has run its course and BPH symptoms become moderate to severe and begin to significantly affect one’s daily life, or if complications such as regular urinary tract infections, urinary retention, kidney problems, or bladder stones are present, it may be necessary to seek out medical treatment. The three main categories of BPH medical treatment include:
  1. Medications: Several types of medication help treat mild to moderate BPH Symptoms. These include alpha-blockers, which work to relax the muscles of the prostate and bladder neck, and 5-alpha reductase inhibitors (5-ARIs), which prevent the conversion of testosterone to the more potent dihydrotestosterone or DHT. In blocking the formation of DHT, 5-ARIs help stall prostate size increases and eventually the prostate begins to shrink.
  2. Minimally Invasive Procedures: BPH procedures that are minimally invasive and can be performed in a doctor’s office setting include the prostatic urethral lift, water vapor, TUNA, and other office-based procedures. Minimally invasive procedures performed under general anesthesia and in a hospital setting include TURP, TUIP, laser surgery, and others.
  3. Surgery: In BPH cases that are more severe or where other medical conditions prohibit medications or minimally invasive procedures, surgical procedures such as open prostatectomy may be recommended. However, this is no longer very common since there is usually a minimally invasive procedure that can handle most situations.

Final Thoughts

It’s important to remember that benign prostatic hyperplasia is not prostate cancer, nor does it lead to prostate cancer. BPH is the normal enlargement of the prostate that comes with increased age in men. The ultimate decision to treat BPH or leave it untreated should be made in consultation with a urologist or a primary care provider if a urologist is not available. Overall health can then be reviewed and lifestyle changes can be proposed to address BPH symptoms. If lower urinary tract symptoms or LUTS brought on by BPH are mild and manageable through lifestyle and dietary modifications, a wait-and-see or watchful waiting period may be proposed. But, if BPH-induced LUTS is more moderate to severe, then medication or a minimally invasive BPH procedure may be the best course of action to address the life-altering symptoms that typically include hesitancy, urgency, frequency, and retention issues. The key takeaway is: If BPH symptoms are mild to moderate, there are many options available. However, if the prostate tissue has grown too large or in the wrong direction and symptoms become severe enough that urinary retention, and especially acute urinary retention, bladder stones, or kidney issues begin to become a larger problem, then minimally invasive surgery should be considered to avoid possible bladder or kidney damage.   References:  

All surgical treatments have inherent and associated side effects. Individual’s outcomes may depend on a number of factors, including but not limited to patient characteristics, disease characteristics and/or surgeon experience. The most common side effects are mild and transient and may include mild pain or difficulty when urinating, discomfort in the pelvis, blood in the urine, inability to empty the bladder or a frequent and/or urgent need to urinate, and bladder or urinary tract infection. Other risks include ejaculatory dysfunction and a low risk of injury to the urethra or rectum where the devices gain access to the body for treatment. Further, there may be other risks as in other urological surgery, such as anesthesia risk or the risk of infection, including the potential transmission of blood borne pathogens. For more information about potential side effects and risks associated with Aquablation therapy for Benign Prostatic Hyperplasia (BPH) treatment, speak with your urologist or surgeon. Prior to using our products, please review the Instructions for Use, Operator’s Manual or User Manual, as applicable, and any accompanying documentation for a complete listing of indications, contraindications, warnings, precautions and potential adverse events. No claim is made that the AquaBeam Robotic System will cure any medical condition, or entirely eliminate the diseased entity. Repeated treatment or alternative therapies may sometimes be required.

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