The prostate gland is located just under the bladder and at the top of the penis. It is about the size of a walnut. The urethra (the tube that urine flows through from the bladder to the tip of the penis) runs through the center of the gland. For medical purposes the prostate is divided into four (4) zones. The outermost layer is called the peripheral zone. This is where most prostate cancers occur. This makes up approximately 70% of a normal gland. The central zone is about 25% of a normal prostate gland. The transition zone is about 5% of the normal gland. This is the zone responsible for prostate enlargement issues. The last zone is the fibro-muscular zone or stroma. This does not contain any glandular parts, but consist of muscles and tissue.
As you can see in the illustrations, the urethra passes directly through the prostate gland. The Transition zone surrounds the urethra. The prostate continues to grow throughout a man’s lifetime. Due to the structure of the prostate, the transition zone grows down around the urethra and up into the bladder neck. As this is a gradual process, men do not realize that this is getting worse until noticeable Lower Urinary Tract Symptoms (LUTS) arise. The first illustration maps out the possible symptoms that may occur. When symptoms become bothersome is when men seek treatment. Treatment may consist of medication, surgery or both.
One of the first medications offered is alpha-adrenergic agonists. You may have heard of Flomax, Rapaflo, or Uroxatral to name a few. These medications act as smooth muscle relaxers. Relaxing the smooth muscle of the urethra and prostate decrease the amount of resistance the bladder has to push against to release urine. Side effects of these medications can include but are not limited to: dizziness, lightheadedness, decreased blood pressure and retrograde ejaculation.
Proscar (finasteride) and Avodart (dutasteride) are the next class of medications offered; these are called 5-alpha reductase inhibitors. These medications prevent the conversion of Testosterone to Di-hydrotestosterone (a more potent form of Testosterone). Stopping this process causes the prostate to decrease in size. This is a gradual process. However, as the transition zone of the prostate shrinks, urine passes easier. Side effects with these medications include but are not limited to: breast tenderness or enlargement, decreased libido (sex drive), erectile dysfunction, depression, and testicular pain. These happen very rarely.
Combination therapy is also an option. This is when both types of medication are used to achieve the desired results.
Dr. Kevin McVary specializes in the Green-Light Photovaporization of the Prostate. Trans Urethral Resection of the Prostate was once the gold standard, the Green-light procedure has taken over. This procedure has many benefits including, but not limited to: decreased blood loss, decreased hospital stay, decreased surgical complications and decreased risk of infection. Please follow the link below to learn more about Green-Light Laser surgery for BPH.