The prostate is a male gland about the size and shape of a walnut. It surrounds the urethra just below the bladder, where it adds fluid to semen before ejaculation.
Benign Prostate Hyperplasia
The prostate gland commonly becomes enlarged as a man ages. This condition is called benign prostatic hyperplasia (BPH) or benign prostatic hypertrophy. As the prostate enlarges, it may squeeze the urethra and affect the flow of the urinary stream. The lower urinary tract symptoms (LUTS) associated with the development of BPH rarely occur before age 40, but more than half of men in their 60s and up to 90 percent in their 70s and 80s have some LUTS. The symptoms vary, but the most common ones involve changes or problems with urination, such as a hesitant, interrupted, weak stream; urgency and leaking or dribbling; more frequent urination, especially at night; and urge incontinence. Problems with urination do not necessarily signal blockage caused by an enlarged prostate.
Rezūm™
The Rezūm system uses thermal energy in the form of sterile water vapor (steam) to remove the extra tissue cells generated in the prostate by BPH. The steam is created using radiofrequency power and administered in controlled doses through a needle ablation through the urethra. Condensation releases the stored thermal energy of water vapor against the walls of the cells in the treatment zone. Removal of the tissue – which is eventually absorbed by the body – reduces the urethra obstruction, relieving lower urinary tract symptoms of BPH and improving urine flow.
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UroLift®
A new, minimally invasive treatment called UroLift now allows doctors to treat an enlarged prostate by peeling back excess tissue using tiny implants to reduce pressure on the urethra. It’s the first BPH treatment that does not remove prostate tissue. It also does not affect sexual function. UroLift is often performed under local anesthetic, with no catheter or overnight stay in the hospital.
The UroLift System is an alternative for patients looking for something other than drug therapy or more invasive surgery. Treatment might be right for you if any of the following apply:
- You do not want to take another pill every day.
- You have tried BPH medication but are unhappy with the side effects.
- You do not want to undergo major surgery due to potential surgical risks of side effects and complications.
- You want a BPH treatment that preserves your sexual function.
- You want to regain your quality of life with minimal downtime.
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HOLAP
Hartford HealthCare also offers a holmium laser ablation of the prostate (HOLAP) procedure. This is an outpatient procedure that helps to open an obstructing prostate, and does not require the patient to stay overnight. Using this laser also reduces bleeding during the operation, and aims to reduce irritable symptoms afterwards.
Prostate-Specific Antigen (PSA) Testing
Prostate-specific antigen (also known as PSA), is released by the prostate gland into the blood. PSA testing measures how much of this antigen is in the blood. High PSA levels can be caused by an enlarged prostate or an infection, or – less frequently – by prostate cancer. PSA testing is used to screen for prostate cancer in men who have no symptoms, and can help to detect some prostate cancers in their early stages.
Because many prostate cancers grow slowly, many men with prostate cancer will die of something other than prostate cancer. Even with faster-growing prostate cancers, finding the cancer early may not help you live longer. Some prostate cancers will be fatal no matter when they are found or how they are treated. So PSA testing is a bit controversial.
False-Positive Results with PSA Testing
PSA testing can frequently show high levels of PSA that aren't caused by cancer. If your PSA test is high, it’s likely that more testing will be ordered to make sure you don’t have prostate cancer. Some testing, like prostate biopsies, can even be harmful when they cause an infection.
False-Negative Results with PSA Testing
It’s important to know that PSA tests are not foolproof, and may miss some cancers. The most serious prostate cancers usually do cause high PSA levels. However, not all prostate cancers cause high PSA results. There is the possibility of a false-negative result.
Overdiagnosis of Prostate Cancers
PSA testing can uncover prostate cancers that would not be aggressive or cause serious health issues. A PSA test alone can’t reveal what kind of prostate cancer you have. Only a biopsy can do that. So it’s important not to get cancer treatment that you don’t really need, especially as surgery and radiation can cause damage to healthy tissue as well.
When is PSA Testing Recommended?
The American Cancer Society (ACS) advises men to talk with their doctors about testing and treatment before deciding whether to have PSA testing. The ACS advises talking to a doctor about testing:
- At age 50 for men who are at average risk of getting prostate cancer and are expected to live at least 10 more years.
- At age 45 for men at high risk, such as African Americans and men who have a first-degree relative (father, brother, or son) who had prostate cancer when he was younger than 65.
- At age 40 for men at an even higher risk, such as those with several first-degree relatives who had prostate cancer at an early age.
The American Urological Association (AUA) recommends that:
- Men under age 40 should not have PSA screening.
- Men ages 40 to 54 who are at average risk should not have routine PSA screening.
- Men ages 55 to 69 should talk with their doctors about having the test. They also recommend having it every 2 years rather than every year to reduce the harms.
- Men ages 70 and older (or any man with less than a 10- to 15-year life expectancy) shouldn't have routine PSA screening.