Prostate normal & enlarged.

Medication that relaxes the muscles that surround the prostate channel

The anatomy of the bladder and prostate is such that a special muscle surrounds the urinary channel in

its course from the bladder into the prostate. These muscles are controlled by special nerves called

“alpha sympathetics”. In many men, increased tone of this muscle occurs with aging and can be a cause

of significant blockage of urinary flow without significant prostate growth. This muscle that runs

around the prostate channel can be relaxed by taking specific medications known as “alpha blockers”.

These drugs, Hytrin, Cardura or Flomax (terazosin, doxasin or tamsulosin), also are used to lower blood

pressure in some patients with hypertension. The smooth muscles around the neck of the bladder and

prostate are relaxed by these medications, and many men have both subjective and objective

improvement of their urinary flow. These improvement usually occur within the first few weeks of

taking these medications. These medications seem to work best in patients with smaller prostates, but

work in larger glands as well.

SURGICAL or PROCEDURES TREATMENTS FOR BPH

Transurethral RESECTION of the Prostate (TURP)

Transurethral resection of the prostate (TURP) has been the primary choice of treatment for the past 50

years for BPH that is causing obstruction of the bladder outlet

Approximately 400,000 transurethral resections of the prostate are performed annually in the United

States. TURP is a safe procedure with four out of five patients experiencing resolution of their voiding

symptoms with improvement of all of their urinary flow measurements. Essentially, TURP is the

removal of the obstructing portions of the prostate with a telescopic electric knife. The TURP requires

an anesthetic and takes about 30-60 minutes to perform. A tube or catheter is inserted into the bladder

and is left in place for 24 to 48 hours. The hospitalization lasts from 1-3 days and requires two weeks of

severe activity restrictions and another two weeks of modest restrictions. No treatment to date has

bettered the long term effectiveness of TUFT in alleviating obstruction caused by benign prostatic

hyperplasia.

But because TURP is a surgical procedure with some risks, and because of the costs and time off work,

other methods of therapy are being looked at intensively by the medical community. These include

medical treatments and alternative surgical treatments which are less complicated than transurethral

resection of the prostate

Cancer Health Resources Nutrition Treatments Options Natural Health Support

Cancer Health Resources Nutrition Treatments Options Natural Health Support

List of supplements, remedies, Advice that might help: Neck, Base of Tongue, and Tonsils, health resources, to use during and after your cancer treatment by A. M. 1. Aloe Vera Juice: You can find this at Whole Foods. I get "Lillie of the Desert" brand because it only has one other ingredient that is a stabilizer: citric acid. I try to stay away from preservatives as much as possible. Aloe Vera is great for the whole digestive tract from the mouth to the anus. You can gargle with it to get immediate results. It's good for taking care of the digestive tract as most of the immune system is located there. This is important because you are absorbing nutrients here. Regardless of where you are receiving radiation treatment it will be processed by the digestive system and destroy some of the "good" bacteria and flora in the digestive system. Aloe helps protect this. You can get Aloe Gel too to rub on the part of your body where you receive radiation in order to stop dryness. 2. Baking Soda: I get "Bob's Red Mill" brand also at Whole Foods in the baking supply section. I get this brand because I know, for sure, that it does not contain aluminum as other brands do. You can mix a teaspoon of this with water to gargle with. This will sterilize your mouth and throat. It will raise the Ph level in your mouth/throat, sterilize any soars in the mouth or prevent them altogether. Also, when you gargle keep it in your mouth for a while to get the full benefit. 3. Vitamin C: I don't think I need to say much about this. This helps your immune system fight off infections, detoxify cells. I get esther-C from Costco. It fights cancer as well. If you have trouble swallowing pills, you can get it in powdered form as well. I take between 10,000 to 15,000 mg's a day, spread out. 4. Turmeric: This is an aryuvedic herb, spice that is good for general detoxification especially of the liver. You can take a LOT of this, even to the point of turning yellow. You CAN NOT overdose on this. It helps against metastasis. Good brands are New Chapter, Organic India. 5. Proteolytic enzymes: These include pancreatic enzymes. These help digest not only food in order to get vital nutrients (because ALL cancer patients have a problem with digestion/absorption), but also to detoxify debris from tumors. 6. essiac tea: This is a highly regarded tea for fighting cancer. You can get this at a health food store, but I don't recommend it because it's too expensive to be worth it. I get it from this website: www.discount-essiac-tea.com . You have to prepare it yourself, but it is well worth it. I highly recommend this throughout treatment and after indefinitely. Follow directions carefully! 7. Vitamin D-3: More and more research is coming out all the time about the very powerful preventative and treatment of cancer with Vitamin D-3. The catch with this is that you can not supplement with vitamin A at the same time as it blocks the effects of vitamin D. It is better to get vitamin A from colorful fruits and vegetables. 8. Water: Stay hydrated! This seems obvious, but I find most people don't like to drink plain water. Make sure that it is filtered from chlorine etc. It's much better than buying water in plastic bottles. It is crucial to increase water intake in order to help with all bodily processes and to detoxify cells, tumor debris etc. Absolutely no soft drinks, especially diet soft drinks (nutrisweet is a cancer fertilizer). Although you might love coffee (I do!), it's highly discouraged because it dehydrates you and also drains minerals from your body which you need so much especially at this time. Green tea is great, any herbal tea that is good for the throat like red clover. No black tea because it dehydrates. 9. Soup: Soups are obviously easier for you to eat and digest. You can find no end to healthy recipes available on the internet. 10. Smoothies: If you find yourself discouraged from eating from pain of soars in the mouth/throat, smoothies are highly recommended. Whey protein is very beneficial for fighting cancer. It has been found, besides giving all essential amino acids, that it raises glutathione levels in healthy cells (protecting them from radiation) and depletes it in cancerous cells (making them more susceptible to radiation/hyperthermia treatment). You can add nut butters, blueberries, bananas, raw plain cocoa powder (no sugar), flax seed oil or hemp seed oil. This will give you energy and prevent weakness which not only affect you physiologically but emotionally. Even if you are eating relatively ok, I still suggest taking the whey protein to protect your body generally from the treatment. 11. Juicing: This is an excellent way to get nutrients your body is lacking and much easier than eating the same amount through chewing. Carrots, spinach, beets are at the top of the list for me. Greens are important too. You can get a decent juicer at costco. Like a Jack Lalain juicer. 12. Exercise: Walking is excellent. Especially out in nature or just a nice day. I walk in the evening for about an hour or hour and a half. Or it can be something you enjoy like tennis. This obviously helps to detoxify the body, but increases your sense of well-being. I would make this mandatory for the rest of your life! Side note: you may like swimming, but it is better to stay away from the chlorine in swimming pools. The ocean is much better relatively speaking. 13. Organic whole foods: Not the store, necessarily. I mean eat foods that are not processed. It means, to the best of your ability, get organically grown foods because non-organic foods more likely contain pesticides and/or are genetically modified. There is what is called a body burden or how much chemicals are accumulated in the body that do not come out. You can think of the body as a barrel that is being filled with these chemicals. When the barrel overflows the organs of detoxification (liver, kidneys) can not process efficiently and thus you are susceptible to disease. You are trying to help your body by eating things that are easily digestible which are whole organic foods that contain the nutrients and enzymes you need. They also help take out these chemicals that have been accumulated. 14. Relax: This is also very very important. Find a way to induce the relaxation response. You already know what the stress response and what it can cause/contribute to. The relaxation response induces healing. If you are open to meditation, yoga, praying, etc., do it! Laugh a lot, watch comedy movies, etc. Forget yourself in an enjoyable fashion everyday! We will add three more very effective suggestions from another graduated patient: 15. Use coconut paste (oil) to lubricate throat before and after treatment. It avoids a dry throat after the low-radiation treatment 16. Drink lemon water! just add a few drops of lemon in you drinking water bottle. I makes water alkaline and also helps to avoid having a dry throat. Drink this lemon water throat out the day. 17. Try to drink alkaline water, with a pH of about 8.0. You can consider to buy an Alkaline Water machine

General Diet/Nutrition Suggestions This article is a copy from one of our blogs, in answer to a nutrition suggestions: "Hi, thank you so much for your reply above about your treatment being very good for tonsil cancer metastasis to the lymph node. I have a different question: I see a lot of great info on your site about hyperthermia and low-dose radiation; what about nutrition? What nutritional treatments do you give and is this included in the price of an individual’s treatment? I’m asking more and more questions now that I’m gravitating toward your institution!!" A. M., I will tell you my personal experience regarding nutrition, as well a personal research I did over 20 years talking to patients at our clinic. “Is not much what you eat, but what you don’t eat!” All diets are good; some work for certain people and others for different people, because we all are different! But this is the million dollars question and answer! What is tho only common thing on ALL diets? That all of them eliminate junk food! As simple as that! If you watch our video testimonies, http://www.vci.org/cancer_treatments_miscell/patient-video-testimonies.htm, when I interview those patients, they all told me they did not follow any special diet, but they eliminated sugars, because cancer cells feed on sugar (junk food #1). They also said “I just to eat well” what ever that means for each one of them, “I try to cut on dairies” (other not too good food, believe it or not!) They also said “I exercise, do my walks, go to the gym, run, to the beach (we are just 4 miles from the beach), and drink a lot of water. I can also tell you that the three women with breast cnacer who turned into a raw food diet, got cured! I’m my self vegetarian (red meat and too much meat is not advisable either) since I was 19 years old. I became vegan ten years ago, and for the last 2+ years I’m following a raw food diet with my wife; not 100% but a great percentage of green vegetables, fruits, nuts, seeds, sprouted bread, and the best chocolate deserts in town made by my wife!!! The benefits of the raw food are just incredible: - I don’t get sick during the holidays season any longer - I don’t get sick during flu season either - have more energy - look 10 years younger, and probably my body is younger than people who follow the SAD (Standard American Diet) Summarizing, you have to be and informed person (as you are, because you found us and you are considering this less toxic treatment as an alternative to conventional therapies!) and keep researching for what it is best for you. We do not recommend any special diet in particular, but we can guide you to local practitioners in the area, like Dr. Dana Churchill, N.M.D., Holistic, Naturopathic, Homeopathic; you can get more information on his web site: http://www.heartfeltmedicine.com/. I highly recommend Dr Churchill; you can even call him now and he will give you some advice. Hoping you got some value from this answer, and you make the best decision for you, Carlos Caridad Administrator Valley Cancer Institute

www.urologyatlanta.urologydomain.com/images/uploaded/AUA/Prostate_enlarged.pdf

www.urologyatlanta.urologydomain.com/images/uploaded/AUA/Prostate_enlarged.pdf

UBC HKIN 191 - Bladder Anatomy

How the Body Works : Release of Urine

Lower Urinary Tract Symptoms in Men | Doctor | Patient UK

Lower Urinary Tract Symptoms in Men | Doctor | Patient UK

Lower Urinary Tract Symptoms in Men

Lower urinary tract symptoms (LUTS) are storage, voiding and postmicturition symptoms affecting the lower urinary tract. LUTS can significantly reduce men's quality of life, and may point to serious pathology of the urogenital tract.¹ Symptoms are often nonspecific and large studies of patients have failed to show any correlation between LUTS and a specific diagnosis.² LUTS are common and not necessarily a reason for suspecting prostate cancer.³ Patients tend to fall into 3 categories:⁴

• Mild symptoms: mainly require reassurance and exclusion of cancer or risk of future complications.
• Troublesome symptoms, suitable for medical treatment.
• Those requiring surgical treatment.

Epidemiology

• Lower urinary tract symptoms (LUTS) are a common problem, especially for older men. It has been reported that 90% of men aged 50 to 80 years suffer from potentially troublesome LUTS. The prevalence of storage symptoms increases from 3% in men aged 40 to 44 years to 42% in those aged 75 years or older.¹
• The prevalence of nocturia in older men is about 78%. Older men have a higher incidence of LUTS than older women.⁵
• Around one third of men will develop urinary tract (outflow) symptoms, of which the principal underlying cause is benign prostatic hyperplasia (BPH).
• Once symptoms arise, their progress is variable and unpredictable with about one third of patients improving, one third remaining stable and one third deteriorating.

Presentation

See also separate articles Genitourinary History and Examination (Male) and International Prostate Symptom Score (IPSS).

• Filling symptoms: urinary frequency, urgency, dysuria, nocturia.
• Voiding symptoms (previously 'obstructive'): poor stream, hesitancy, terminal dribbling, incomplete voiding, overflow incontinence (occurs in chronic retention).
• Also enquire about: haematuria, fever, loin and pelvic pain, past history of renal calculi, past history of urinary tract infections (UTIs), sexual/erectile difficulties, constipation, medications andbone pain.
• Signs: palpable bladder, rectal examination (prostate: size, tenderness, nodules), check for loin pain and/or renal masses, perineal sensation.
• Lower urinary tract symptoms include frequency, urgency, hesitancy, dysuria, haematuria, reduced flow, dribbling, nocturia, incontinence and pelvic pain.
• Some patients develop acute retention.
• Others develop chronic retention with overflow incontinence and, on rare occasions, renal failure.

Early prostate cancer does not cause bladder outflow obstruction and any LUTS are usually due to coincidental benign prostatic hyperplasia (BPH).⁴

Assessment¹

• General medical history to identify possible causes and comorbidities, including a review of all current medication (including herbal and over-the-counter medication).
• Examination of the abdomen, including external genitalia (see also separate article Genitourinary History and Examination) and a digital rectal examination.
• Examination should include blood pressure, signs of uraemia, enlargement of the bladder, kidneys and the prostate, and palpable nodes.
• Urine dipstick test to detect blood, glucose, protein, leukocytes and nitrites.
• Men with bothersome LUTS should complete a urinary frequency volume chart.
• Renal function tests (serum creatinine test, estimated glomerular filtration rate) should only be performed if renal impairment is suspected.

Referral for specialist assessment

Refer men for specialist assessment if they have:¹

• Bothersome lower urinary tract symptoms (LUTS) that have not responded to conservative management or drug treatment.
• LUTS complicated by recurrent or persistent UTIs.
• Urinary retention.
• Renal impairment thought to be due to lower urinary tract dysfunction.
• Suspected urological cancer.
• Stress urinary incontinence.

Other indications for referral include immediate referral for acute retention of urine and acute renal failure, and urgent referral (to be seen within 2 weeks) for visible haematuria and culture negative dysuria.⁶

Specialist assessment¹

• Flow-rate and post-void residual volume measurement.
• Urinary frequency volume chart.
• Cystoscopy and/or ultrasound imaging of the upper urinary tract only when clinically indicated, e.g. history of: recurrent infection, sterile pyuria, haematuria, profound symptoms, pain or chronic retention.
• Multichannel cystometry if men are considering surgery.
• Offer pad tests only if the degree of urinary incontinence needs to be measured.
• Consider PSA testing if:
• LUTS are suggestive of bladder outlet obstruction secondary to prostate enlargement.
• The prostate feels abnormal on rectal examination.
• The patient is concerned about prostate cancer.

Differential diagnosis

• Benign prostatic hyperplasia (BPH) with obstruction.
• Detrusor muscle weakness and/or instability.
• UTI.
• Chronic prostatitis.
• Urinary tract stones.
• Malignancy: prostate cancer or bladder cancer.
• Neurological disease, e.g. multiple sclerosis, spinal cord injury, cauda equina syndrome.
• Polyuria (e.g. secondary to diabetes mellitus, excessive fluid intake, diuretics, etc.).

Management¹

• For men whose lower urinary tract symptoms (LUTS) are not bothersome or complicated, give reassurance, and give information and advice on lifestyle measures such as:
  • Fluid intake (moderation of fluid intake is important but excessive reduction of fluid intake can cause a worsening of symptoms and increased risk of infection).
  • Reduction in the intake of fluids containing alcohol, caffeine and artificial sweeteners together with avoidance of carbonated drinks is often advised.
  • The patient should be reviewed if symptoms change or become worse.
• For men with mild or moderate bothersome LUTS, discuss active surveillance (reassurance and lifestyle advice without immediate treatment and with regular follow-up) or active intervention (conservative management, drug treatment or surgery).
• Offer men considering treatment for LUTS an assessment of their baseline symptoms with a validated symptom score, e.g. International Prostate Symptom Score (IPSS).
• Surgical treatment is generally reserved for men who have failed or are unable to tolerate drug treatment, or for those who have developed complications.⁵

Conservative management

Storage symptoms:

• Overactive bladder (OAB): supervised bladder training, advice on fluid intake, lifestyle advice and, if needed, containment products.
• Supervised pelvic floor muscle training for men with stress urinary incontinence caused by prostatectomy. Advise men to continue the exercises for at least 3 months before considering other options.
• Do not offer penile clamps.
• Containment products:
  • For men with storage LUTS (particularly urinary incontinence):
  • Temporary containment products (e.g. pads or collecting devices) to achieve social continence until a diagnosis and management plan have been discussed.
  • External collecting devices (sheath appliances, pubic pressure urinals) before considering indwelling catheterisation

Voiding symptoms:

• Consider intermittent bladder catheterisation before indwelling urethral or suprapubic catheterisation if LUTS cannot be corrected by less invasive measures.
• Bladder training is less effective than surgery.
• Men with postmicturition dribble should be shown how to perform urethral milking.

Drug treatment

• Offer drug treatment only to men with bothersome LUTS when conservative management options have been unsuccessful or are not appropriate. Do not offer homeopathy, phytotherapy or acupuncture.
• Moderate-to-severe LUTS: offer an alpha-blocker (alfuzosin, doxazosin, tamsulosin or terazosin).
• Overactive bladder: offer an anticholinergic.
• LUTS and a prostate estimated to be larger than 30 g or prostate specific antigen (PSA) greater than 1.4 ng/mL, and high risk of progression: offer a 5-alpha reductase inhibitor (5-ARI).
• Bothersome moderate to severe LUTS, and a prostate estimated to be larger than 30 g or PSA greater than 1.4 ng/mL: consider an alpha-blocker plus a 5-ARI.
• Storage symptoms despite treatment with an alpha-blocker alone: consider adding an anticholinergic.
• Consider offering a late afternoon loop diuretic for nocturnal polyuria.
• Consider offering oral desmopressin for nocturnal polyuria if other medical causes have been excluded and the man has not benefited from other treatments. Measure serum sodium 3 days after the first dose. If serum sodium is reduced to below the normal range, stop desmopressin treatment.
• If LUTS do not respond to drug treatment, discuss active surveillance (reassurance and lifestyle advice without immediate treatment and with regular follow-up) or active intervention (conservative management or surgery).

Management of retention

• Acute retention (see separate article Acute Urinary Retention):
  • Immediately catheterise men with acute retention.
  • Offer an alpha-blocker to men before removing the catheter.
• Chronic retention (see separate article Chronic Urinary Retention):
  • Chronic urinary retention is defined as residual volume greater than 1 litre or presence of a palpable/percussible bladder. (see diagram):
  • Serum creatinine (renal function tests) and imaging of upper urinary tract.
  • If impaired renal function or hydronephrosis:
    • Catheterise.
    • Consider offering catheterisation before offering surgery. Consider offering self-administered or carer-administered intermittent urethral catheterisation before offering indwelling catheterisation
    • Surgery. If surgery is not suitable, continue or start long-term catheterisation. Consider offering intermittent self-administered or carer-administered catheterisation instead of surgery in men whom you suspect have markedly impaired bladder function.
  • Normal renal function and no hydronephrosis:
    • If there are no bothersome LUTS then treat as for impaired renal function or hydronephrosis.
    • If there are bothersome LUTS then consider offering surgery on the bladder outlet without prior catheterisation. If surgery is not suitable, continue or start long-term catheterisation. Consider offering intermittent self-administered or carer-administered catheterisation instead of surgery in men whom you suspect have markedly impaired bladder function.

Surgery

Surgery for voiding symptoms:

• Offer surgery only if voiding symptoms are severe or if drug treatment and conservative management options have been unsuccessful or are not appropriate.
• Surgery for voiding LUTS presumed secondary to benign prostate enlargement:
  • All: monopolar or bipolar transurethral resection of the prostate (TURP), monopolar transurethral vaporisation of the prostate (TUVP) or holmium laser enucleation of the prostate (HoLEP).
  • Estimated prostate size smaller than 30 g: transurethral incision of the prostate (TUIP) as an alternative to other types of surgery (see above)
  • Estimated prostate size larger than 80 g: TURP, TUVP or HoLEP, or open prostatectomy as an alternative.

Surgery for storage symptoms:

If offering surgery for storage symptoms, consider offering only to men whose storage symptoms have not responded to conservative management and drug treatment.

• Detrusor overactivity (do not offer myectomy to manage detrusor overactivity):
  • Cystoplasty: the man must be willing and able to self-catheterise. Serious complications include bowel disturbance, metabolic acidosis, mucus production and/or mucus retention in the bladder, urinary tract infection and urinary retention.
  • Bladder wall injection with botulinum toxin (botulinum toxin does not currently have UK marketing authorisation for this indication. The man needs to be willing and able to self-catheterise.
  • Implanted sacral nerve stimulation.
• Stress urinary incontinence:
  • Implantation of an artificial sphincter.
• Intractable urinary tract symptoms if cystoplasty or sacral nerve stimulation are not clinically appropriate or are unacceptable to the man: consider offering urinary diversion.

Long-term catheterisation and containment

• Consider offering long-term indwelling urethral catheterisation if medical management has failed and surgery is not appropriate, and the man:
  • Is unable to manage intermittent self-catheterisation; or
  • Has skin wounds, pressure ulcers or irritation that are being contaminated by urine; or
  • Is distressed by bed and clothing changes.
• Indwelling catheters for urgency incontinence may not result in continence or the relief of recurrent infections.
• Permanent use of containment products should only be considered after assessment and exclusion of other methods of management.

Prognosis⁷

• Men with lower urinary tract symptoms (LUTS) and small or moderate sized prostates will improve appreciably with lifestyle advice and alpha-blocker therapy.
• Men with LUTS and large prostates are at significant risk of disease progression particularly if they have additional risk factors such as age >70 years or flow rate less than 12 ml/s. These men will benefit from treatment with lifestyle advice and 5-alpha reductase inhibitors (5-ARIs).
• 5-ARIs reduce the risk of acute urinary retention and the likelihood of prostatectomy by 50-60% compared with placebo.
• The combination of 5-ARI and alpha-blocker is more effective in delaying the clinical progression of the disease and in improving LUTS and maximal urinary flow rate, than either drug alone.
• After six months of treatment with a 5-ARI, prostate specific antigen (PSA) levels will be reduced by 50%. Therefore PSA values for patients on long-term therapy should be doubled to allow appropriate interpretation and avoid masking the early detection of localised prostate cancer.

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Document references

1. Lower urinary tract symptoms, NICE Clinical Guideline (May 2010); The management of lower urinary tract symptoms in men
2. Abrams P; New words for old: lower urinary tract symptoms for "prostatism". BMJ. 1994 Apr 9;308(6934):929-30.
3. Urological cancer - suspected, Clinical Knowledge Summaries (2000)
4. Lower Urinary Tract Symptoms in the Male, NHS Scotland Centre for Change and Innovation, Patient Pathway, July 2005; Clinical investigation and management pathway
5. Boyle P, Robertson C, Mazzetta C, et al; The prevalence of lower urinary tract symptoms in men and women in four centres. The UrEpik study. BJU Int. 2003 Sep;92(4):409-14. [abstract]
6. Referral Advice, NICE Clinical Guideline (2001); A guide to appropriate referral from general to specialist services
7. British Association of Urological Surgeons; Primary care management of male lower urinary tract symptoms (LUTS). February 2004 (included in Obstetrics, Gynaecology and Urology Section of Eguidelines - requires registration and password)

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Internet and further reading

• Prostate - benign hyperplasia, Clinical Knowledge Summaries (March 2009)
• Benign Prostatic Hyperplasia Site, Bandolier
• Prostate Cancer Risk Management, NHS Cancer Screening Programmes
• Benign Prostatic Hypertrophy, European Association of Urology Guideline (2004)

Acknowledgements EMIS is grateful to Dr Colin Tidy for writing this article. The final copy has passed scrutiny by the independent Mentor GP revi