Decision aid for men with urinary symptoms due to an enlarged prostate

Who is the leaflet for?

This leaflet is a decision aid for men with bothersome urinary symptoms caused by an enlarged benign (non-cancerous) prostate gland.

Overview

Treatments for an enlarged prostate are designed to relieve bladder outflow obstruction, thereby increasing the flow of urine and improving urinary symptoms.

All treatments have side effects, some of which are temporary or reversible and others that are permanent. Generally, the more effective a treatment is at improving urinary symptoms, the higher the likelihood of it having unwanted side effects, particularly on sexual function. This decision aid gives an overview of different types of treatment options for men with urinary symptoms due to an enlarged prostate based upon the balance of effectiveness at relieving urinary symptoms and the potential for unwanted side-effects.

Sometimes symptoms can come back after initially responding to treatment. This may be because the prostate gland continues to grow. This may mean that you require further treatment. The length of time for which each treatment is effective at controlling your symptoms will be different for each option.

It is important to realise that there are other factors that are relevant when considering treatment options. These include your prostate size and shape, as well as any other medical conditions that you might have. Your doctor or specialist nurse will be able to advise which treatments are suitable for you.

This decision aid is designed to facilitate discussion between you and your doctor or specialist nurse and is not designed to be used in isolation to determine your treatment. There are additional information sheets available for the specific treatments and your doctor will be able to provide you with these. Please also see references below for online access to these resources.

Some treatments for an enlarged prostate are not available at Addenbrooke’s. Your doctor or specialist nurse will be happy to discuss these alternatives with you, and refer you to another hospital that does offer these treatments if you wish.

This leaflet gives information regarding treatments that can improve urinary symptoms. Sometimes an enlarged prostate can cause complications such as retention of urine (the flow of urine stops altogether). Under these circumstances, some of the treatments outlined in this information leaflet will not be suitable. Please discuss this with your doctor or specialist nurse.

Decision aid for men with urinary symptoms due to an enlarged prostate including Medication, Minimally Invasive Surgery and Surgery

Medication

Effectiveness: Low
Risk of unwanted side effects: Low

• Limited effectiveness at relieving urinary symptoms
• Symptoms tend to worsen over time
• Side effects usually mild and reversible on stopping treatment

Minimally Invasive Surgery

Effectiveness: Medium
Risk of unwanted side effects: Medium

• More effective than medication at relieving urinary symptoms but not as effective as surgery
• Durability of effect beyond 5 years unclear and treatment may need to be repeated
• Side effects usually mild/ moderate and short-term (no adverse effects on sexual function)

Surgery

Effectiveness: High
Risk of unwanted side effects: High

• Very effective at relieving urinary symptoms
• Durable effect
• Side effects usually mild/ moderate but rarely severe
• Long term incontinence of urine is rare (~1%) but most men have a change in sexual function (dry ejaculation ~80%)

Contacts/further information

Urology specialist nurses: 01223 274608

References

• Holmium Laser Enucleation of Prostate (HoLEP) Reference
• Transurethral Resection of Prostate (TURP) Reference