King Charles III will undergo surgery to treat 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.
An enlarged prostate, also known as benign prostatic hyperplasia or BPH, is a non-cancerous condition that commonly occurs in older men. At 60 years old, more than half of men have at least mild symptoms of BPH, including difficulty urinating and a feeling of urgency to urinate. But often the symptoms are not severe enough to require treatment.
This 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 man reacts is that the prostate enlarges. “It’s a normal aging process.”
The prostate is shaped like a donut surrounding the urethra, the tube that carries urine from the bladder to the penis. When the prostate grows, the tube is compressed, said Dr. Judd W. Moul, a urologist and prostate specialist at Duke University.
Most men noticed symptoms, he added. They urinate more often, they get up at night to urinate. Their urinary stream is weaker.
If symptoms worsen, men are usually treated with drugs to relax the prostate. Dr. Albertsen said doctors usually 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’s age – some may need surgery.
Buckingham Palace did not describe 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, giving more space to the urethra. This operation has been used for 100 years, Dr. Moul said.
Men who have TURP usually go home that day or the next and have a catheter to drain the urine for a 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 using 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 that the most experienced surgeon performs expertly.”
None of the operations are debilitating, Dr. Albertsen added.
Surgery for benign prostatic hypertrophy “is not serious,” he said.