PressBox talked with Chesapeake Urology’s Dr. Sankar Kausik about the symptoms and treatment for benign prostatic hyperplasia (BPH) and what all men should know about the risks, testing recommendations and more.
PressBox: What is benign prostatic hyperplasia (BPH)?
Dr. Sankar Kausik: Just as a little bit of a background, the prostate is a walnut-shaped organ at the base of the bladder. As men get older, what commonly happens is that a non-cancerous condition of the prostate called BPH starts to occur. That enlargement of the prostate then starts to compress the channel that men urinate through, because the channel that you urinate through goes through the prostate. That’s typically what we talk about when we refer to BPH. BPH symptoms are the sequela of symptoms that occur as the prostate gets enlarged as men get older, thereby compressing the urinary channel.
PB: When should men look to get tested for BPH? Should they do so even if they’re not experiencing symptoms?
Dr. K: There are two conditions that happen in the prostate. One is the benign condition, the non-cancerous condition, that I was referring to earlier, which is BPH. The other is a tumor or cancer developing in the prostate. What we recommend, and what the American Cancer Society and American Urological Association recommend, is screening for prostate cancer. When men should start testing depends on family, race, and other factors, but testing typically starts in the 40’s as a baseline, and then yearly starting in the 50s.
We don’t routinely screen for BPH unless it has some sort of impact on your urinary health or a man has changes in urination that affects his quality of life. However, prostate cancer screening is something that starts in a man’s 40s and extends out to the 50s. This is can also depend on race, age, and family history. For instance, African Americans are at higher risk for prostate cancer, so testing may start earlier.
PB: What are some of the common symptoms among men with BPH?
Dr. K: Typically, the first thing that men will notice is a change in their urinary stream, or a gradual weakening of the urine stream over the course of years. That’s a common symptom of prostate enlargement. [Another one is] difficulty starting urination – which is called hesitancy, meaning they go to the bathroom and they know their bladder is somewhat full, but it just takes a while for the stream to get started, or the stream starts and stops. These are common symptoms of an obstructive pattern of an enlarged prostate.
As the prostate becomes enlarged and it obstructs the urinary channel, the bladder then has to develop muscles to get the urine through. This can manifest with symptoms of urgency, which is a sudden, strong urge to urinate, going frequently to the bathroom because they don’t always empty when they go, and then most bothersome to a lot of men is waking up several times during the night to urinate. These are the typical gamut of symptoms – the change in stream as well as the frequency and urgency and waking up at night.
PB: What are some of the treatments that men can receive if they have BPH?
Dr. K: A lot of it depends on the severity of their symptoms. Some of the tests that we do in the office determine what their bladder looks like and the size of the prostate. If the testing in the office shows that they empty the bladder well and the urine is clear and the PSA – which is a blood test for prostate cancer – is normal and their symptoms are mild, then sometimes just behavioral therapies will help. What I mean by that is if you tend to wake up more at night, then cut down on the amount of fluid you drink in the evening. If you have issues with frequency and urgency, then cutting down on things like caffeine or dietary irritants that may make you have to go to the bathroom may be sufficient in people who have mild, livable symptoms.
As the symptoms progress and men are increasingly bothered by them, there are medications that can alleviate many of the symptoms. They are effective, but the downside of medication is that they are a long-term commitment, meaning that BPH medications are only effective for the period of time that they’re taken.
Historically, the only other treatment option we really had for men aside from medication was a fairly invasive surgical procedure called the TURP procedure. Fortunately, with the advances in technology and new therapies coming into the forefront, we are now able to offer many men minimally invasive procedures in the office setting. These procedures allow many men to forgo medical therapy and avoid more traditional invasive surgical procedures that may have some sexual side effects.
PB: What are some of those newer treatments?
Dr. K: The UroLift procedure, which is a minimally invasive option that entails the placement of small, permanent implants in the prostate which lift or hold the enlarged prostate tissue out of the way so it’s no longer blocking the urethra, which relieves the urinary symptoms. UroLift is a good alternative to medications and more invasive surgical procedures and is typically performed as an outpatient procedure which does not involve cutting or scraping. The advantages there are that it is an effective office-based procedure, there is no catheter after the procedure, and it offers a quick recovery with no sexual side effects such as erectile dysfunction. There is Rezum, a water vapor therapy which shrinks the prostate by using steam which reduces and removes obstructive tissue surrounding the prostate. There are also newer therapies, including Aquablation. Chesapeake Urology was the first in Maryland to offer and perform Aquablation, which is the only heat-free BPH procedure to remove prostate tissue using the power of water with robotic precision. Aquablation opens up the passageway and provides relief from BPH symptoms without sexual side effects. Aquablation is a hospital-based robotic-assisted procedure that requires an overnight stay.
We’re also excited to offer Prostatic Artery Embolization (PAE), which is done in conjunction with interventional radiologists at the IR Centers at Chesapeake Urology. PAE is a minimally invasive treatment that helps improve the symptoms of BPH without sexual side effects. Microscopic round microspheres (particles) are injected into the arteries that feed the prostate gland. Once inside the prostatic arteries, these beads block the blood flow to the regions of the prostate affected by BPH, reducing swelling in the gland that causes urinary symptoms. And finally, there’s iTind, which stands for temporarily implanted nitinol device. This in-office, minimally invasive therapy utilizes a temporary device to gently reshape the urethra, widening the opening so urine can flow freely. After 5 to 7 days, the device is completely removed, resulting in rapid symptom relief. Chesapeake Urology was the first to offer this in Maryland. We have a number of exciting and highly effective treatments that we can offer men who have BPH.
PB: How can men reach out to Chesapeake Urology?
Dr. K: Finding us is relatively easy. Our website chesapeakeurology.com is available, and you can select a provider near you or one who specializes in BPH care. There’s also our toll-free number, 855-405-7100, to schedule an appointment. We have offices throughout Maryland, including Anne Arundel, Baltimore, Harford, Howard, Carroll, Montgomery, Prince George’s, Wicomico, and Worcester counties as well as in Baltimore City and Sussex County, DE. With over 85 physicians and 25 advanced practice providers, it’s easy to access a specialist at a location convenient to you.
