Should Prostate Enlarged patients be operated at early stage of the disease?
Patients diagnosed as prostate enlargement, who are on chronic single or combined therapy, and have their symptoms well controlled, sometime keep asking whether they should have surgery or keep the therapy all life long instead.
According to the previous studies, if it is clear that surgery is superior than watchful waiting in term of results, there is no evidence that early surgical intervention will prevent complications due to bladder outlet obstruction.
Then surgery for prostate enlargement has to be done not to prevent the related complications but only to treat real bother symptoms. Patient with only mild to moderate symptoms have not to be treated in a prevention setting. The only expected benefit for patients under chronic therapy is to be medication free after surgery.
Regarding the surgery, nowadays we have several options that sometime are not complete in removing the enlarged tissue and require re-do over time. However, they are as invasive as a cystoscopy with very low complication rate. Moreover, in the last years, the laser enucleation techniques have been challenging the traditional trans-urethral resection of prostate (TURP) in terms of results and safeness.
In conclusion, patient with uncomplicated mild symptomatic prostate enlargement, with or without chronic medication, the surgery should be considered only if some benefits are expected. According to current knowledge, early preventive surgery is not justify.