Enlarged prostate: the best new treatments
There’s now a raft of minimally invasive options for men suffering from the troublesome symptoms of an enlarged prostate (BPH). We look at the latest.
There’s now a raft of minimally invasive options for men suffering from the troublesome symptoms of an enlarged prostate (BPH). We look at the latest.
Three million men in the UK suffer from benign prostatic hyperplasia (BPH), the medical term for an enlarged prostate that can block or narrow the prostatic urethra, the tube through which urine passes. This includes around 70% in their sixties and 80% over 70.
It’s the condition King Charles was treated for in hospital in 2024, during which time his cancer was discovered (although you can have BPH and cancer at the same time, they are separate conditions).
The traditional treatments have been drugs and an operation called TURP (Transurethral resection of the prostate), which involves cutting away prostate tissue, and typically requires a one-to-three-day hospital stay, together with three to four weeks’ recovery.
But there’s a whole range of less invasive treatments which are becoming more available at NHS hospitals, although this can depend on where you live. They aim to treat the bothersome urinary symptoms so familiar to many older men.
These lower urinary tract symptoms (LUTS) include frequent urination, getting up multiple times during the night to go to the loo, problems starting the urine flow, a weak urine stream, stopping and starting urination, dribbling at the end of urination and an inability to fully empty the bladder.
Retired marketing manager Mark Squire, 62, woke almost hourly through the night to pee and had to urinate four or five times before lunch the next day.
“I rarely had a refreshing night’s sleep,” he says.
Mark first noticed symptoms of BPH in his early fifties and was prescribed tamsulosin, an alpha-blocker that helps relax the muscles in the prostate and bladder to open. Although this helped, as time went on he began to experience dizziness and light-headedness (common side-effects) and those trips to the loo were getting more frequent. His GP referred him to a urologist to discuss possible TURP surgery.
Mark wasn’t keen.
“My father, now in his eighties, had TURP and experienced temporary post-operative problems such as urine leakage and dribbling and didn’t recommend it,” he explained.
He was also deterred by potential long-term side-effects. The most common, the release of semen into the bladder, affects 65-75% of men. Around 10% also experience erectile dysfunction, and, in those who do, a decline in libido and sexual satisfaction. And five to 15% need a reoperation.
So when his consultant said he was trialling iTind, a new minimally invasive procedure that eliminated these risks and is performed as a day case, Mark jumped at the opportunity.
iTind involves inserting a temporary implant made of a “smart metal” called nitinol (an alloy of nickel and titanium) into the prostate. It is put in folded via a tube and opens out to form a cage, similar to that surrounding the cork on a bottle of fizz.
The procedure, which involves being sedated with a local or general anaesthetic, takes just a few minutes. The device is in place for a week and exerts gentle pressure, which reshapes the prostatic urethra, creating a wider opening for urine to flow down. There is no burning or cutting tissue away and no need for a permanent implant. It is removed a week later in a similarly short time. It’s suitable for all and works best for those with smaller and medium-sized prostates.
Neil Barber, clinical lead for urology at Frimley Health NHS Foundation Trust, has been performing the procedure for eight years. It now has conditional approval from the government’s drugs advisory body, the National Institute for Health and Care Excellence (NICE), so it’s available on the NHS provided the surgeon is trained and keeps a record of results. Currently available in around 14 NHS hospitals, as well as privately, an increasing number of surgeons are in training.
“It’s an alternative not just to TURP but to medication,” says Barber.
“The usual trajectory is for the GP to prescribe tablets and only if the patient doesn’t tolerate these or they don’t work to go on to surgery, a model I would like to change.
“It is an attractive option for active older men, and it carries no risk of sexual dysfunction, something men these days care far more about than their fathers or grandfathers.”
The oldest man he has operated on was in his late seventies.
A controlled trial of 81 participants that tracked men for more than four years, published in the Minerva Urology and Nephrology Journal, reported “significant, long-lasting symptom relief” and “improved quality of life with no late post-op complications”. Just 4% needed further surgical treatment.
Another study, published in the Journal of Endourology in 2023, concluded that “no changes were observed in sexual and ejaculatory function”. Trials are also underway looking at the potential of iTind for men with urinary retention, a condition linked to BPH that affects one in ten over 70 and one in three in above 80.
An ongoing global trial comparing iTind with UroLift, another minimally invasive procedure, is in progress and could lead to full NICE approval within five years.
Other alternatives to TURP include:
What is it? A minimally invasive procedure that takes less than 15 minutes, involving inserting tiny implants that hold the enlarged prostate out of the way, alleviating blockage of the urethra and restoring urine flow.
Best for: men with moderately enlarged prostate (30-80ml).
What is it? A robotic treatment performed under general or spinal anaesthetic using a powerful, sterile water jet to remove prostate tissue. It takes around 45 minutes.
Best for: men with any size prostate.
What is it? A 10-15 minute minimally invasive procedure done under local anaesthetic. It involves injecting steam to shrink the prostate.
Best for: moderate to severe LUTS caused by BPH and moderately enlarged prostate (30-80ml).
More information on BPH treatment options.
Steer clear of fizzy drinks, caffeine, alcohol and artificial sweeteners. They can aggravate symptoms.
Hydrate well during the day – aim for eight glasses – but avoid fluids two hours before bed to cut night-time loo visits.
Fill up on fibre. Constipation can make symptoms worse. We need 30g of fibre a day.
Try “double voiding”. Wait 20-30 seconds after a pee then try to go again. It can help empty your bladder fully. Check with your doctor first that you don’t have a urinary infection.
Check your meds. Some medications, such as antidepressants and decongestants, can make lower urinary tract symptoms worse.
Train your bladder. This can help cut down trips to the toilet and involves learning how to hold more urine. Hold on when you need to pee and delay it a bit longer each time. Do this slowly over several weeks.
(Image credit: GettyImages)
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