King Charles III will undergo a procedure to address an enlarged prostate in a hospital next week. The 75-year-old British monarch’s diagnosis is common among men his age and experts say typical treatments are not dangerous.
Enlarged prostate, also known 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 symptoms of BPH, 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 testosterone and estrogen levels begin to change. 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 aging process.”
The prostate is shaped like a donut that surrounds the urethra, the tube that carries urine from the bladder to the penis. As the prostate grows, the tube gets squeezed, says Dr. Judd W. Moul, a urologist and prostate specialist at Duke University.
Most men notice the symptoms, he added. They urinate more often, get up at night to urinate. Their urine flow is weaker.
If symptoms become more severe, men are usually treated with drugs to relax the prostate. Dr. Albertsen said doctors typically start by prescribing an alpha blocker, such as 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’ age – some may need surgery.
Buckingham Palace did not describe on Wednesday the procedure Charles would undergo. But experts say the most common and appropriate treatment is transurethral resection of the prostate, or TURP. A surgeon scrapes the inside of the prostate gland, giving more room to the urethra. The operation has been used for 100 years, Dr. Moul said.
Men who have TURP usually go home that day or the next and bring a catheter to drain urine for the next day or two.
More recently, new surgical treatments have been introduced, including an electric cutting ring 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 operations have the same goal: to reduce the size of the prostate.
“The best operation,” said Dr. Moul, “is the one which the most experienced surgeon performs expertly.”
Neither operation is debilitating, Dr. Albertsen added.
Surgery for benign prostatic hypertrophy is “not a big deal,” he said.