BENIGN PROSTATIC HYPERPLASIA

The prostate is a gland about the size of a walnut that is only present in men. It is located just below the bladder and surrounds the urethra, the tube through which urine flows from the bladder and out through the penis. The gland is divided into three zones, peripheral, transitional and central. In Benign Prostatic Hyperplasia (BPH), there is an overgrowth of cells in the central portion of the prostate. This constricts the urethra, reduces the flow of urine and makes it difficult for the patient to empty his bladder.

BPH is very common, affecting about one third of men over 50. Although it is not prostate cancer, the symptoms of BPH are similar to those of prostate cancer

The most common treatments for BPH are drugs and surgery. Alpha-blockers are drugs that relax the muscles at the neck of the bladder and in the prostate, thereby reducing the pressure on the urethra and increasing the flow of urine. 5-alpha-reductase inhibitors work by inhibiting the production of a hormone called DHT, which contributes to prostate enlargement.

Surgical options include transurethral resection of the prostate (TURP), in which a long thin instrument is used to shave off sections of the enlarged prostate. In transurethral incision of the prostate (TUIP), small cuts are made in the neck of the bladder and the prostate, reducing the obstruction of the flow of urine. In an open prostatectomy an incision is made in the lower abdomen in order to remove the central part of the prostate.

Mayo Clinic urologists are actively investigating drugs and treatments, developing novel therapies and conducting ongoing research into new treatments and minimally invasive procedures. The following are summaries of recent and current research projects in benign prostatic hyperplasia.

• The development and expansion of minimally invasive therapies for benign prostatic hyperplasia.
• Minimally invasive technologies to treat patients with symptomatic BPH, including heat-based treatments such as transurethral microwave thermotherapy, interstitial devices such as interstitial laser coagulation and transurethral needle ablation, high-intensity focused ultrasound, and water-induced thermotherapy. Addition research on these therapies, as a novel combination therapy for adenocarcinoma of the prostate could lead to important improvements in treatment of BPH.
• Peyronie's disease is a medical condition characterized by the development of a lump on the shaft of the penis. This lump is a scar (plaque) that forms on the lining (tunica) of the erectile body (corpus cavernosum) and is believed to be the result of injury to the penis. Researchers are investigating new approaches for Peyronie's Disease (PD). Since PD is known to respond better to treatment in the earlier stages of the disease, an early trial of inexpensive, safe and well-tolerated oral therapy is often initially recommended. Additional research is needed to understand this disease and develop new therapeutic regimes.
• The role of transurethral microwave heat therapies using standardized treatment protocols and patient selection as opposed to transurethral resection of the prostate and other established BPH treatment modalities to improve safety, efficacy, and patient comfort.
• Evaluation of the potential of post-implant computed tomography trans-rectal ultrasound (CT/TRUS) image fusion. Additional research in this area could improve the ability to reproduce the effects of various levels of post-implant radiation.