Enlarged Prostates: Choice Of Treatment Needs Careful Consideration

Informed choices are essential

For many men, the symptoms of this condition are just annoying. But for some men, an enlarged prostate means going to the toilet so often that a good night's sleep has become a thing of the past. Most of the time the cause is an enlarged prostate, a condition doctors call "benign prostatic hyperplasia". One in five men in their 50s are affected - and the majority of men in their 70s will have symptoms.

The treatment choices have greatly expanded in recent years. However IQWiG's evaluation of the research raises questions about many surgical techniques. According to the Institute's Director, Professor Peter Sawicki, "Not everything that is new is necessarily an improvement. Better information is necessary to help men and their doctors weigh up the advantages and disadvantages of the various treatments."

To that end, IQWiG has published easy-to-understand summaries of the research in this area on IQWiG's website for the public, http://www.informedhealthonline.org. Included is information on managing prostate symptoms, medicines and surgical options as well as the stories of men who have used different treatments.

Most men with BPH symptoms will never need surgery

According to researchers' best estimates, about 3 out of every 10 men in Europe will handle their prostate symptoms without medication or surgery and perhaps only 1 in 10 will have surgery. The rest will use medications, including herbal medicines, if their symptoms become too troublesome.

"In Germany and other European countries, drugs called alpha blockers have taken over as the most common treatment choice for benign prostatic hyperplasia," said Professor Sawicki. "These drugs were originally developed to reduce high blood pressure, but prostate symptoms will also improve at least a little for 60% of the men who use them."

In analysing the research results for surgery, the Institute concluded that the original surgical procedures still have the best results. A few of the new surgical techniques appear to have good results - for example, possibly shortening the time needed in hospital. But more research is needed to confirm this. And most of the new techniques use equipment that has not yet been tested in enough trials.

"Prostate surgery can be very effective, but the adverse effects are a major concern for many men. Some of the newer techniques might have fewer adverse effects, but they may be so much less effective that the symptoms return, as bad as ever, within a couple of years," Professor Sawicki said.