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Decision Aid For Benign Prostatic Hyperplasia

AMBULATORY CARE:

What you need to know about decisions for benign prostatic hyperplasia (BPH):

You can work with your healthcare provider to make decisions about being screened or treated for BPH. Screening is a test done to find BPH early. Screening is different from diagnosis because screening is used before you first start to have signs or symptoms. This means management or treatment can start early. You can also help plan treatment if BPH is found with screening, or you develop it later on. Your treatment choices include nonsurgical options and surgery. Your healthcare provider may recommend nonsurgical treatments first. Learn about the benefits and risks of nonsurgical treatment and surgery so you can make an informed choice.

What you need to know about BPH:

  • BPH is an enlarged prostate. The prostate is a small gland that is part of the reproductive system. It sits around your urethra (tube that carries urine out of your bladder). The prostate is usually about the size of a walnut. An enlarged prostate will press on the urethra. This can cause problems with storing urine or emptying your bladder completely.

  • BPH is common in men older than 40 years. The risk increases with age.
  • Benign means it is not cancer. BPH is not a life-threatening condition, but it can cause problems with your daily activities. BPH usually gets worse over time. Left untreated, BPH can also lead to blood in your urine, bladder stones, or kidney failure.
  • Talk to your healthcare provider if you think you have signs or symptoms of BPH. Examples include problems starting your urine to flow, or an urgent need to urinate. You may be woken from sleep by the need to urinate.

How to know if you are a good candidate for BPH screening:

Screening may be helpful for you if any of the following is true:

  • You are 40 years or older.
  • You have a family history of BPH or other prostate problems.
  • You have symptoms of BPH that cause problems with your daily activities or quality of life.
  • You want to have treatment as early as possible if needed.
  • You have heart disease or take a beta-blocker medicine.

How screening is done:

  • The International Prostate Symptom Score is a set of questions about your ability to urinate over the past month. You will be asked how often you have any of the following:
    • A feeling of not fully emptying your bladder when you urinate
    • A need to urinate again within 2 hours after you last urinated
    • Urine that stops and starts several times when you urinate
    • An urgent need to urinate that you could not put off
    • A weak urine stream
    • Trouble starting your urine flow, or a need to push or strain to get it to start
    • Being woken from sleep because you needed to urinate
  • A digital rectal exam is used to check the size of your prostate. Your healthcare provider will insert a gloved finger into your rectum. The provider will be able to feel your prostate. The exam may be repeated over time to check the prostate size.
  • A PSA test is used to measure the amount of a protein made by your prostate gland. A blood sample is taken for this test. A high PSA level can increase your risk for more severe urination problems or the need for surgery.

Benefits and risks of screening:

Talk with your healthcare provider about the risks and benefits of screening:

  • Benefits include finding BPH early. This means you can make more decisions about treatments. The PSA test can also find prostate cancer early. Treatment of prostate cancer is more successful when it starts early.
  • Risks include a false belief that you will not develop BPH if your screening result is negative. Even though your screening result is negative, you may still develop it later on. You may also need more tests if you have problems urinating but screening shows you do not have BPH.

Questions to ask your healthcare provider to help you make decisions about screening:

  • How high is my risk for BPH?
  • How often do I need to have screening?
  • Where is the screening done?
  • Do I need to do anything to get ready to have screening?

What happens after you have screening:

You will meet with your healthcare provider to go over the results of your screening. You may need more tests to diagnose anything that showed up on the screening test. Common tests include a urine test to check for an infection or a biopsy (tissue sample) to check for cancer. You may also need tests to measure the amount of urine left in your bladder after you urinate. The force of your urine flow may also be measured. You and your healthcare provider can talk about your treatment options. Together you can decide which treatment is right for you.

How BPH is treated, and the benefits of treatment:

  • Watchful waiting means you do not receive treatment right away. Your signs and symptoms will be monitored over time to see if they get worse. Your healthcare provider may recommend ways to improve or track your symptoms during watchful waiting. Examples include drinking less liquid or urinating on a regular schedule. Your provider may also recommend lifestyle changes. For example, your symptoms may improve if you lose weight or have less caffeine if needed. You may be asked to keep a record of your symptoms and when you urinate. The record will include when you urinate, how easy or difficult it was, and any changes in urination. You will bring the record to follow-up visits to help you and your provider decide on treatment you may want to try.
  • Medicines may be given to help your symptoms and to prevent BPH from getting worse. Medicines may help relax certain muscles to make it easier for you to urinate. You may also need medicine to make your prostate smaller or to relieve an overactive bladder. Medicines may start to relieve your symptoms quickly. Medicines can improve your quality of life. You may also be able to manage your symptoms without surgery if medicine keeps your BPH from getting worse.
  • Surgery may be used to relieve your symptoms if other treatments do not work. An ablation is surgery that uses a needle to destroy extra tissue that is causing your symptoms. A laser may instead be used to destroy the tissue. Your prostate may be heated. A tool that gives off heat is inserted into your urethra. Prostate tissue is destroyed, and no other tissues are damaged. Parts of your prostate may be removed during another type of surgery.

Risks of BPH treatment:

  • Watchful waiting may allow BPH to get worse and be more difficult to treat than at an early stage. If you have a high PSA level, you may need to have BPH treated right away.
  • Medicines can cause certain side effects, such as erectile dysfunction (ED) or a lowered sex drive. You may also develop urinary retention (trouble starting your urine to flow). Some medicines can cause hypotension (low blood pressure) when you stand, or dizziness.
  • Surgery can damage tissue around your prostate. Surgery can also increase your risk for trouble urinating, incontinence (leaking), or urinary retention. You may bleed more than expected during surgery or develop an infection. You may also need to be treated again if the surgery you have does not relieve your symptoms.

Questions to ask your provider to help you make decisions about treatment:

  • How will I feel if I continue to have these symptoms for the rest of my life?
  • Which medicines may work best to treat my symptoms?
  • What other steps can I take to decrease my symptoms?
  • Will I have to take medicine for the rest of my life?
  • What side effects might happen with each medicine I can try?
  • Am I a good candidate for surgery?
  • Which surgery may work best to treat my symptoms?
  • Where is the surgery done?
  • How long is recovery after surgery?
  • What are the possible side effects of surgery?

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

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