King Charles III will have a procedure to address an enlarged prostate at a hospital next week. The 75-year-old British monarch’s diagnosis is common among men his age, and experts say that typical treatments are not dangerous.
An enlarged prostate, known also as benign prostatic hyperplasia, or BPH, is a noncancerous condition that occurs frequently among older men. By age 60, more than half of men have at least mild BPH symptoms, which include difficulty urinating and a sense of urgency to urinate. But often the symptoms are not severe enough to require treatment.
The condition is analogous to menopause in women, said Dr. Peter Albertsen, a urologist and prostate specialist at the University of Connecticut. Menopause usually begins around age 50 when levels of testosterone and estrogen start changing. The same thing happens in men, Dr. Albertsen said, and at the same age.
“We think it’s the changing ratio of testosterone to estrogen,” he said. “The way the male responds is that the prostate enlarges. It’s a normal process of aging.”
The prostate is shaped like a doughnut surrounding the urethra, the tube that carries urine from the bladder to the penis. When the prostate grows, the tube gets squeezed, said Dr. Judd W. Moul, a urologist and prostate specialist at Duke University.
Most men notice symptoms, he added. They urinate more often, they get up at night to urinate. Their urine stream is more feeble.
If symptoms get more severe, men usually are treated with medications to relax the prostate. Dr. Albertsen said that doctors typically start by prescribing an alpha blocker, like terazosin (Hytrin), doxazosin (Cardura), tamsulosin (Flomax), alfuzosin (Uroxatral) or silodosin (Rapaflo).
Another choice is finasteride (Proscar or Propecia), which blocks the conversion of testosterone to dihydrotestosterone, the hormone that causes the prostate to enlarge.
If the prostate continues to grow despite medical treatment — which can happen when men reach Charles’s age — some may need surgery.
Buckingham Palace did not describe on Wednesday the procedure Charles would undergo. But experts say that the most common and appropriate treatment is a transurethral resection of the prostate, or TURP. A surgeon scrapes out the inside of the prostate gland, giving the urethra more space. The operation has been used for 100 years, Dr. Moul said.
Men who have a TURP usually go home that day or the next, and have a catheter to drain urine for the next day or two.
More recently, new surgical treatments have been introduced, including an electrical cutting loop to destroy prostate tissue, steam to vaporize prostate tissue and a system that uses implants to hold the prostate away from the urethra.
Although the techniques vary, all the operations have the same goal — making the prostate smaller.
“The best operation,” Dr. Moul said, “is the one the most experienced surgeon does expertly.”
None of the operations is debilitating, Dr. Albertsen added.
Surgery for benign prostatic hypertrophy “is no big deal,” he said.
