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MAC00031-01 Rev G Financial support for this seminar has been provided by NeoTract, Inc., the manufacturer of the UroLift® System.
The Enlarged Prostate Symptoms, Diagnosis and Treatment
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Today’s Agenda
• What is BPH
• How it is diagnosed
• What are the treatment options
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Overview of the Prostate
• Walnut sized gland at base of the male bladder
• Surrounds the urethra
• Produces fluid that transports sperm during ejaculation
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BLADDER
PROSTATE
URETHRA
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Anatomy of a Prostate Over Time
The prostate grows to a normal size in teenage years and then begins to grow again around the age of 50
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PRO
STAT
E SI
ZE
Age 1 Age 15 Age 50 Ag 75 Age 5 Age 10 Age 25 Age 35
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Prostate Conditions
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Prostatitis • Swelling/Inflammation of the prostate
Prostate Cancer
• Very common cancer among men • Typically a slow growing cancer
Enlarged Prostate • Enlargement of the prostate gland
Each condition affects the prostate differently Having one condition does not mean
you will have another
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Aging and the Prostate
• Affects nearly 40 million men each year in the United States
• By age 60, 70% of all men have an enlarged prostate • Affects nearly 90% of men by age 80
Berry, et al., J Urol 1984 Roehrborn, et al., Prostate Cancer and Prostatic Diseases 2006; 2015 U.S. Census population estimates
40 60
Age 50
70
30
Age 60
90
10
Age 80
% of Men with BPH
% of Men without BPH
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What is BPH?
• Benign Prostatic Hyperplasia (BPH) is the clinical term for enlarged prostate
• Non-cancerous enlargement of the prostate gland – BPH is not an indication or a predictor of cancer
– PSA rises with both BPH and prostate cancer, so PSA alone cannot tell you which is the issue
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Normal vs. Enlarged Prostate
• As the prostate enlarges, pressure can be put on the urethra • Causes urinary problems • In general, the size of the prostate does not correlate to
severity of symptoms
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Normal Prostate Anatomy Enlarged Prostate (BPH) Anatomy
HYPERTROPHIED DETRUSOR
MUSCLE
OBSTRUCTED URINARY FLOW
PROSTATE
BLADDER
URETHRA
Roehrborn CG, McConnell JD. In: Walsh PC et al, eds. Campbell’s Urology. 8th ed. Philadelphia, Pa: Saunders; 2002:1297-1336.
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What Happens if BPH is Not Treated?
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Not treating enlarged prostate can lead to bladder deterioration
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BPH Disease Progression
10 Images courtesy Dr. Steven Gange
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Recognizing the Symptoms of BPH
• Frequent urination
• Multiple trips to the bathroom at night
• Sudden urge to urinate
• Difficult or painful urination
• Weak or slow urine flow
• Incomplete elimination of urine
• Stopping and starting of flow
11 Abrams, et al., Neurourology and Urodynamics 2002; Maximilian, et al., BJU Intl 2012
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BPH Affects Quality of Life
• Many men who suffer from BPH experience a reduction in quality of life – Avoiding travel – Interruption of leisure activities – Using the bathroom stalls instead of urinals – Disruption of sleep patterns
12 Abrams, et al., Neurourology and Urodynamics 2002; Maximilian, et al., BJU Intl 2012
For nearly half of men in the U.S. with BPH, their symptoms are severe enough to disrupt
their lifestyle and cause them to seek treatment
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How is an Enlarged Prostate Diagnosed?
• Medical history • Physical exam
– Bladder scan (Ultrasound) • residual urine assessment
– Digital Rectal Exam (DRE) • approximate prostate size • texture and symmetry
• Symptoms – AUA Symptom Score • How much of a bother is it to you?
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How is an Enlarged Prostate Diagnosed?
Optional Studies • Uroflow • Pressure flow studies • Transrectal Ultrasound (TRUS)
– With or without biopsy
• Cystoscopy
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International Prostate Symptom Score (IPSS)
Symptoms • Incomplete bladder
emptying • Frequency • Intermittency • Urgency • Weak stream • Straining • Nocturia
15 Abrams P et al. The standardisation of terminology of lower urinary tract function. Report from the International Continence Society. Am J . Obstet. Gynecol 2002 187: 116-126.
0-7 | Mild
8-19 | Moderate
20-35 | Severe
Regardless of the score, if your symptoms are bothersome you
should notify your doctor
How is the IPSS scored?
0-6
How is Quality of Life scored?
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Treatment Options for Enlarged Prostate
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Different treatments are appropriate for different patients
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Advantages • No surgery • Cheaper than drugs • No side effects
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Watchful Waiting
Disadvantages • May not have
symptom improvement • Risk that symptoms
will worsen
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Medication Flomax, Avodart, Duodart, Cialis
Medications/Herbal Remedies
Herbal Remedies
AUA Guidelines 2010, 2003 *Side effects may vary depending on medication type.
Advantages • No surgery • May provide enough symptom relief
Disadvantages • Must be taken daily, from now on • Potential side effects*
– Lowered sexual drive, erection problems, ejaculation problems, dizziness, lack of energy
• High out-of-pocket cost • Over time may stop working
Advantages • No surgery • No drugs • No side effects
Disadvantages • May not have symptom improvement –
none have shown benefit in clinical trials • Risk that symptoms will worsen • Potential down stream issues
– Bladder stones; bladder health, kidney function
• Future treatments may be less effective
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Roehrborn Urology Clinics 2016 McVary et al. J Sex Med 2013 Shore et al. Can J Urology 2014
Advantages • In-office procedure • Preserves sexual function
– No new and lasting problem with erections or ejaculation
• Rapid, durable relief – Typically return to
normal within 5-9 days • Typically no catheter
Disadvantages • Some discomfort • Potential for blood in urine • Increased urgency
after procedure
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Prostatic Urethral Lift (PUL) The UroLift® System
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How PUL Works
The delivery device is placed through the urethra to access the enlarged prostate.
The delivery device is removed, leaving a more open urethra.
Implants are placed through a needle that comes out of the delivery device to hold the enlarged prostate tissue out of the way.
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AUA Guidelines 2010, 2003 21
Heat & Steam-Based Therapies TUMT – Microwave; TUNA – Radiofrequency; Rezum
Advantages • In-Office procedure • Oral sedative • Paid by most insurers • Fewer side effects
than surgery
Disadvantages • Catheter for days
after treatment • 4-6 weeks until symptom relief • Potential for sexual dysfunction
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How Heat & Steam Based Therapies Work
http://www.prostatetreatmentindore.in/treatment-of-prostate-cancer.php 22
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Advantages • Maximizes flow and symptom relief • Removes prostate tissue • Durable • Low retreatment rate
AUA Guidelines 2010, 2003
Major Surgery TURP – Resection; Greenlight – Laser Vaporization
Disadvantages • Hospital procedure with general or
regional anesthesia • TURP requires hospitalization
– Laser shows less bleeding and typically no overnight hospital stay
• Catheter for 1-5 days • 6 weeks restricted activity • 10% have erectile problems • 40%-65% lose ejaculation • 3% incontinence • 7% strictures
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How TURP & Laser Based Therapies Work
24 https://www.indiamart.com/thechennai-speciality-klinic/endourology.html
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What Next?
• Pay attention to your symptoms before your appointment – Each solution has unique risks, benefits, and costs – Let’s find the right solution for YOU!
We are here to help improve your quality of life!
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Questions?
MAC00031-01 Rev G Financial support for this seminar has been provided by NeoTract, Inc., the manufacturer of the UroLift® System.