Dr. Matthew Lief is an expert in diagnosing and treating a variety of common and complex prostate conditions.
The prostate is a small chestnut sized organ that sits deep in the male pelvis. It is intricately connected to urinary and sexual function in men. As men age the prostate can become larger and interfere with urination. In the early stages of enlargement, men will experience what is called non obstructive voiding symptoms. These consist of urinary urgency, frequency, waking up at night and in some cases uncontrollable leakage. In the later states men develop obstructive symptoms as the prostate gets even larger. The flow of urine becomes weaker, there is straining to void, hesitancy and a feeling of incomplete emptying. In the advanced stages there may be complete inability to urinate requiring a catheter be inserted or the need for surgery arises.
Many men can be managed without medications, and just making certain changes to their fluids. Avoiding caffeine especially coffee and soda in many cases will help control an enlarged prostate as well as not drinking fluids for several hours before going to sleep. Prostate supplements may have some benefits as well in the early stages. Medications are also used when symptoms are more severe and the medications generally fall into two different classes. One are the alpha blockers (tamsulosin, alfuzosin, Rapaflo and others), these drugs relax the prostate tissue and make it easier for the urine to flow though the prostate gland. These drugs take effect quickly usually within a week or two. The other major class of drug are the 5 alpha reductase inhibitors (finasteride, Proscar and Avodat), these medications take between 3-6 months to work but over time will shrink the size of the prostate making urination less of a problem. They also lower the PSA by 50%.
In some cases prostate surgery is required. The Green Light Laser is an excellent procedure that can eliminate years of suffering and is performed as an outpatient. Other procedures can be done as well such as a TURP which is more invasive than the laser but equally effective. Some office procedures, such as microwave, and TUNA have been done but success rates are not as good as with the laser or TURP.
When the prostate becomes enlarged or inflamed (infection, prostatitis), sexual function can be affected, resulting in decreased or painful ejaculation and erectile issues. These cases can be treated with antibiotics and other medications.
Prostate cancer is the number one cancer in men after skin cancer in the USA. Many cases are low grade and can be treated with active surveillance. Higher grade tumors generally are treated with either surgery or radiation. MRI can be used to help determine the extent of the cancer or whether a biopsy is required.