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Treatments for Prostate Enlargement
An enlarged or swollen prostate (also known as benign prostatic hyperplasia) doesn’t go away on its own. In this podcast, Dr. Christopher Runz of UM Shore Regional Health talks about ways to recognize the disruptive symptoms of an enlarged prostate and what you can do to find relief.
Featured Speaker:
Dr. Runz practices all aspects of adult urology, with a special interest in minimally invasive approaches in the treatment of urologic malignancy. His special interests include da Vinci robotic prostatectomy for prostate cancer and laparoscopy to treat kidney tumors.
In addition, he performs minimally invasive treatments for kidney stones; treats prostate symptoms (BPH), including REZUM steam therapy and treats men for low testosterone and erectile problems.
Christopher Runz, DO
Christopher Runz, DO is a urology expert in Cambridge, Queenstown and Easton and is affiliated with UM Shore Regional Health - Dorchester/Easton, University of Maryland Community Medical Group and UM Shore Regional Health - Easton Surgery Center. Read his full bio and watch videos at https://www.umms.org/find-a-doctor/profiles/dr-christopher-louis-runz-do-1740250307Dr. Runz practices all aspects of adult urology, with a special interest in minimally invasive approaches in the treatment of urologic malignancy. His special interests include da Vinci robotic prostatectomy for prostate cancer and laparoscopy to treat kidney tumors.
In addition, he performs minimally invasive treatments for kidney stones; treats prostate symptoms (BPH), including REZUM steam therapy and treats men for low testosterone and erectile problems.
Transcription:
Treatments for Prostate Enlargement
Scott Webb: Welcome to Live Greater. A health and wellness podcast brought to you by the University of Maryland Medical System. We put knowledge and care within reach. So you have everything you need to live your life to the fullest. This podcast is sponsored by UM Shore Regional Health. I'm Scott Webb, and many of a certain age are familiar with the effects of an enlarged prostate. And though there's not much we can do to prevent our prostates from becoming enlarged. There are lots of medications and minimally invasive procedures that can help. And joining me today to take us through the symptoms, diagnosis and treatment options is Dr. Christopher Runz. He's a urology Hexpert in Cambridge, Queenstown and Easton affiliated with UM Shore Regional Health.
Dr. Runz, thanks so much for your time today. We're gonna talk about the prostate. So let's do that. What is the prostate and what does it do?
Dr. Christopher Runz: Well, the prostate is a part of the male urinary. And the prostate is located right underneath the urinary bladder. And when we urinate the bladder pushes urine out through the middle of the prostate and then out the male urethra. The prostate itself, its job is to make semen. And 90% of the male ejaculate is semen. Only 5% is sperm. And semen. It really just nourishes sperm and helps transport them up through the uterus and the Philippian tube to fertilize an egg. So it basically nourishes and helps support and transport sperm.
Scott Webb: I see what you mean. And of course, men of a certain age, we understand that The prostate can get enlarged. Right. So why does it get enlarged? And what's the scientific name for it?
Dr. Christopher Runz: The prostate grows about one to 2% by volume. Every year in men that term that most men have heard is BPH which stands for benign or non-cancerous prostate enlargement. And the male hormone. Testosterone is part of that reason why benign prosthetic. Hyperplasia basically means that the number of cells that make up our prostate increase every year and they also increase in size. And when they get large, you'll get these larger nodules of prostate tissue that then can create an obstruction of the urinary outflow channel through the prostate. That's often referred to as benign prosthetic enlarge. Benign meaning it is non-cancerous.
Scott Webb: Right. Non-cancerous. And so when we think about BPH and who's at risk or what the risk factors are, what are they?
Dr. Christopher Runz: Every man is going to get BPH if they live long enough. So to give you just a rough idea in men, between the ages of say 60 and 70 years old, 70% of those men have benign prostate enlargement. When you get over age 70 at least 80 plus percent have been on prosthetic enlargement. But the way that we know we're experiencing that is we experience urinary tract symptoms. That's how we know. Oh, yep. I'm starting to have some mild obstruction of the urinary flow. Symptoms of BPH are weaker stream. Or what we call urinary hesitancy, where we're standing, initiating the flow of urine, but it doesn't start for a number of seconds. That's urinary hesitancy intermittency, where the stream is start, stop, start, stop loss of force of the stream and and dribbling afterwards.
Scott Webb: Yeah. I think most of us, especially, again, men of a certain age, as we get past 50 and start pushing towards 60 we're at least a little familiar with BPH. How do you diagnose BPH?
Dr. Christopher Runz: In men that have these symptoms before they get overly bothersome, hopefully they usually address it with their primary care doctor and occasionally with urologists. But when you start having symptoms of urgency, frequency, weak stream hesitancy really the first thing that we do as urologists is we have them do a flow study where they'll come in and they'll urinate into a special machine that gives us a quantitative view of the force of the stream. And actually quantifies how fast it is. Peak flow, average flow. We do a quick bladder scan and we see if the bladder's emptying and how much is being left behind. Call it residual volume. Usually we'll do a digital rectal exam just to make sure there aren't any nodules on the prostate, which would be suspicious for a possible prostate cancer. And a PSA blood test is usually the initial work up.
Scott Webb: Yeah, so pretty comprehensive to get to the bottom of things, if you will. What are the treatments for an enlarged prostate?
Dr. Christopher Runz: In men that have proven obstruction on Euro flow it's broken down really into medication versus minimally invasive surgical techniques. So usually first line it's medications. And the way to think about medications is there's two different types. And most people are familiar with the medication Flomax. It's actually generic that the actual name is, Taloon, but what medications. Flomax do is they help dilate the tube in the middle of the prostate by relaxing the smooth muscle around the prostate. So it's really plumbing. So if you think of just, fluid through a tube, if you make that tube bigger you'll get better flow.
You'll empty, better, and most men's symptoms dramatically improve be that way for many years, just with a selective alpha blocker like Flomax, and there's a number of them on the market. Alfusoze and Tamsilofe and Lidoxen. In men that as years go by their obstructive symptoms get worse and they come back in and they say, look, things are getting worse. I'm on this one drug there is a second drug that is used in combination which is a prostate reduction, which doesn't open up the channel like that first class medications, but it actually stops the prostate from growing, by blocking an enzyme in prostate cells that converts testosterone to its active form DHT.
And it will shrink the prostate at most 20 to 25%. But can take six plus months to actually work. So that's what we call maximum medical therapy for BPH. If medications no longer work then you get into surgical options, minimally invasive surgical options. There are two different ways to look at that. There's the standard TURP or transurethral resection of the A lot of guys will refer to that as the Roto Rooter where you literally are put under anesthesia in the operating room and through a special scope down through the penis, we resect out the central part of the prostate to make that channel larger, 1 sometimes outpatient, but usually an overnight stay in the hospital.
That has been the standard of care for 40 plus years in neurology. However, in the last 15, 20 years, there are a number other. Minimally invasive options to open that channel up. Usually outpatients such as green light, laser vaporization also done under anesthesia general anesthesia. It really depends on the size of the prostate as to what procedures gonna work best. So in patients who are medications, aren't working, we assess the volume with either ultrasound or CT scan of the prostate. In prostates that are, say greater than 80, 90 gram , that's a bigger prostate. And today the best options for that are a particular laser surgery called laser and nucleation of the prostate, which is done under general anesthesia on an outpatient basis.
Where we enucliate the central part of the gland that's causing the obstruction. And that's then Morcelated and removed without the typical surgical approach of making incisions, all done through a scope. It probably what gets a lot of attention with men, because it's advertised fairly heavily and it's relatively new in the last seven to 10 years are the office based procedures. So in patients whose prostate are under 80 to 90 grams, but larger than 25, 30 grams. There are in-office procedures where, you don't need to go to the operating room. You don't need to go under general anesthesia. You're not staying overnight. But it is done by numbing the prostate and numbing the penis and passing a scope, and either steaming the prostate which is called resume thermal therapy, water, thermal therapy which opens up the prostate.
Requiring a catheter for about five days. And it really is a very effective treatment that's been around for just about seven years now. There is another office based procedure also done in the same fashion with just local anesthesia called Eurolift where you're actually supporting the prostate by tacking it up from the inside or lifting the prostate lobes to open the channel up. And both are very effective procedures.
Scott Webb: It really sounds like there's a lot of options. I think for most of us, it's like good that we start with the medications. Let's start there, and we'll, work our way up to some of this newer technology, minimally invasive stuff. Are there any lifestyle changes that we can make to help with BPH?
Dr. Christopher Runz: Unfortunately our prostates grow every year and there's really no way to stop that. There has been some discussion out there about plant-based diets and phyto therapies. I don't think that there's any really robust data to show that dramatically decreases your risk of prostate growth here after year and BPH.
Scott Webb: It's been really educational today. Doctor, as we wrap up, what are your takeaways when we think about enlarged prostate BPH, what you would like ,men to do if they're suffering, and so on?
Dr. Christopher Runz: What's so exciting today about it is how much easier the minimally invasive procedures are today than the more invasive transurethral resection of the prostate, being put under anesthesia, staying overnight in the hospital. So technology has really improved greatly so that these in-office procedures are very effective for the majority of prostates. The other would be the medications today are very good. They're also generic. The vast majority of these are all generic products now. And they're very safe products.
Scott Webb: Yeah. Safe and affordable. We certainly like that as patients. So,Doctor, thanks so much for your time today and you stay well.
Dr. Christopher Runz: Thank you.
Scott Webb: This episode is sponsored by UM Shore Regional Health with locations in Caroline, Dorchester, Kent queen Annes and Talbot counties. UM Shore Regional Health is dedicated to bringing world class care to the communities of Maryland's Midshore region. UM Shore Regional Health, where the health of the Eastern shore comes first. And find more shows like this one at umms.org/podcast. And thank you for listening to Live Greater, a health wellness podcast brought to you by the University of Maryland Medical System. We look forward to you joining us again.
Treatments for Prostate Enlargement
Scott Webb: Welcome to Live Greater. A health and wellness podcast brought to you by the University of Maryland Medical System. We put knowledge and care within reach. So you have everything you need to live your life to the fullest. This podcast is sponsored by UM Shore Regional Health. I'm Scott Webb, and many of a certain age are familiar with the effects of an enlarged prostate. And though there's not much we can do to prevent our prostates from becoming enlarged. There are lots of medications and minimally invasive procedures that can help. And joining me today to take us through the symptoms, diagnosis and treatment options is Dr. Christopher Runz. He's a urology Hexpert in Cambridge, Queenstown and Easton affiliated with UM Shore Regional Health.
Dr. Runz, thanks so much for your time today. We're gonna talk about the prostate. So let's do that. What is the prostate and what does it do?
Dr. Christopher Runz: Well, the prostate is a part of the male urinary. And the prostate is located right underneath the urinary bladder. And when we urinate the bladder pushes urine out through the middle of the prostate and then out the male urethra. The prostate itself, its job is to make semen. And 90% of the male ejaculate is semen. Only 5% is sperm. And semen. It really just nourishes sperm and helps transport them up through the uterus and the Philippian tube to fertilize an egg. So it basically nourishes and helps support and transport sperm.
Scott Webb: I see what you mean. And of course, men of a certain age, we understand that The prostate can get enlarged. Right. So why does it get enlarged? And what's the scientific name for it?
Dr. Christopher Runz: The prostate grows about one to 2% by volume. Every year in men that term that most men have heard is BPH which stands for benign or non-cancerous prostate enlargement. And the male hormone. Testosterone is part of that reason why benign prosthetic. Hyperplasia basically means that the number of cells that make up our prostate increase every year and they also increase in size. And when they get large, you'll get these larger nodules of prostate tissue that then can create an obstruction of the urinary outflow channel through the prostate. That's often referred to as benign prosthetic enlarge. Benign meaning it is non-cancerous.
Scott Webb: Right. Non-cancerous. And so when we think about BPH and who's at risk or what the risk factors are, what are they?
Dr. Christopher Runz: Every man is going to get BPH if they live long enough. So to give you just a rough idea in men, between the ages of say 60 and 70 years old, 70% of those men have benign prostate enlargement. When you get over age 70 at least 80 plus percent have been on prosthetic enlargement. But the way that we know we're experiencing that is we experience urinary tract symptoms. That's how we know. Oh, yep. I'm starting to have some mild obstruction of the urinary flow. Symptoms of BPH are weaker stream. Or what we call urinary hesitancy, where we're standing, initiating the flow of urine, but it doesn't start for a number of seconds. That's urinary hesitancy intermittency, where the stream is start, stop, start, stop loss of force of the stream and and dribbling afterwards.
Scott Webb: Yeah. I think most of us, especially, again, men of a certain age, as we get past 50 and start pushing towards 60 we're at least a little familiar with BPH. How do you diagnose BPH?
Dr. Christopher Runz: In men that have these symptoms before they get overly bothersome, hopefully they usually address it with their primary care doctor and occasionally with urologists. But when you start having symptoms of urgency, frequency, weak stream hesitancy really the first thing that we do as urologists is we have them do a flow study where they'll come in and they'll urinate into a special machine that gives us a quantitative view of the force of the stream. And actually quantifies how fast it is. Peak flow, average flow. We do a quick bladder scan and we see if the bladder's emptying and how much is being left behind. Call it residual volume. Usually we'll do a digital rectal exam just to make sure there aren't any nodules on the prostate, which would be suspicious for a possible prostate cancer. And a PSA blood test is usually the initial work up.
Scott Webb: Yeah, so pretty comprehensive to get to the bottom of things, if you will. What are the treatments for an enlarged prostate?
Dr. Christopher Runz: In men that have proven obstruction on Euro flow it's broken down really into medication versus minimally invasive surgical techniques. So usually first line it's medications. And the way to think about medications is there's two different types. And most people are familiar with the medication Flomax. It's actually generic that the actual name is, Taloon, but what medications. Flomax do is they help dilate the tube in the middle of the prostate by relaxing the smooth muscle around the prostate. So it's really plumbing. So if you think of just, fluid through a tube, if you make that tube bigger you'll get better flow.
You'll empty, better, and most men's symptoms dramatically improve be that way for many years, just with a selective alpha blocker like Flomax, and there's a number of them on the market. Alfusoze and Tamsilofe and Lidoxen. In men that as years go by their obstructive symptoms get worse and they come back in and they say, look, things are getting worse. I'm on this one drug there is a second drug that is used in combination which is a prostate reduction, which doesn't open up the channel like that first class medications, but it actually stops the prostate from growing, by blocking an enzyme in prostate cells that converts testosterone to its active form DHT.
And it will shrink the prostate at most 20 to 25%. But can take six plus months to actually work. So that's what we call maximum medical therapy for BPH. If medications no longer work then you get into surgical options, minimally invasive surgical options. There are two different ways to look at that. There's the standard TURP or transurethral resection of the A lot of guys will refer to that as the Roto Rooter where you literally are put under anesthesia in the operating room and through a special scope down through the penis, we resect out the central part of the prostate to make that channel larger, 1 sometimes outpatient, but usually an overnight stay in the hospital.
That has been the standard of care for 40 plus years in neurology. However, in the last 15, 20 years, there are a number other. Minimally invasive options to open that channel up. Usually outpatients such as green light, laser vaporization also done under anesthesia general anesthesia. It really depends on the size of the prostate as to what procedures gonna work best. So in patients who are medications, aren't working, we assess the volume with either ultrasound or CT scan of the prostate. In prostates that are, say greater than 80, 90 gram , that's a bigger prostate. And today the best options for that are a particular laser surgery called laser and nucleation of the prostate, which is done under general anesthesia on an outpatient basis.
Where we enucliate the central part of the gland that's causing the obstruction. And that's then Morcelated and removed without the typical surgical approach of making incisions, all done through a scope. It probably what gets a lot of attention with men, because it's advertised fairly heavily and it's relatively new in the last seven to 10 years are the office based procedures. So in patients whose prostate are under 80 to 90 grams, but larger than 25, 30 grams. There are in-office procedures where, you don't need to go to the operating room. You don't need to go under general anesthesia. You're not staying overnight. But it is done by numbing the prostate and numbing the penis and passing a scope, and either steaming the prostate which is called resume thermal therapy, water, thermal therapy which opens up the prostate.
Requiring a catheter for about five days. And it really is a very effective treatment that's been around for just about seven years now. There is another office based procedure also done in the same fashion with just local anesthesia called Eurolift where you're actually supporting the prostate by tacking it up from the inside or lifting the prostate lobes to open the channel up. And both are very effective procedures.
Scott Webb: It really sounds like there's a lot of options. I think for most of us, it's like good that we start with the medications. Let's start there, and we'll, work our way up to some of this newer technology, minimally invasive stuff. Are there any lifestyle changes that we can make to help with BPH?
Dr. Christopher Runz: Unfortunately our prostates grow every year and there's really no way to stop that. There has been some discussion out there about plant-based diets and phyto therapies. I don't think that there's any really robust data to show that dramatically decreases your risk of prostate growth here after year and BPH.
Scott Webb: It's been really educational today. Doctor, as we wrap up, what are your takeaways when we think about enlarged prostate BPH, what you would like ,men to do if they're suffering, and so on?
Dr. Christopher Runz: What's so exciting today about it is how much easier the minimally invasive procedures are today than the more invasive transurethral resection of the prostate, being put under anesthesia, staying overnight in the hospital. So technology has really improved greatly so that these in-office procedures are very effective for the majority of prostates. The other would be the medications today are very good. They're also generic. The vast majority of these are all generic products now. And they're very safe products.
Scott Webb: Yeah. Safe and affordable. We certainly like that as patients. So,Doctor, thanks so much for your time today and you stay well.
Dr. Christopher Runz: Thank you.
Scott Webb: This episode is sponsored by UM Shore Regional Health with locations in Caroline, Dorchester, Kent queen Annes and Talbot counties. UM Shore Regional Health is dedicated to bringing world class care to the communities of Maryland's Midshore region. UM Shore Regional Health, where the health of the Eastern shore comes first. And find more shows like this one at umms.org/podcast. And thank you for listening to Live Greater, a health wellness podcast brought to you by the University of Maryland Medical System. We look forward to you joining us again.