50% of men. 90% of men PATIENT FACTSHEET: BPH CONDITION AND TREATMENTS. Want more information? What are the symptoms?

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1 PATIENT FACTSHEET: BPH CONDITION AND TREATMENTS What is Benign Prostatic Hyperplasia (enlarged prostate)? Benign prostatic hyperplasia (BPH) is a noncancerous enlargement of the prostate, the gland that produces seminal fluid. An enlarged prostate can affect urinary function, leading to frequent trips to the bathroom and disrupted sleep. But you don t have to live with BPH. NORMAL PROSTATE What causes it? Prostate enlargement occurs naturally as a man ages. No one knows exactly why the condition occurs, but it is one of the most common conditions amongst ageing men. 1 Who is affected? BPH affects BLADDER 50% of men aged & up to 90% of men aged ENLARGED PROSTATE CAUSING OBSTRUCTION BPH affects more than 1.8 million men over the age of 50 each year in the Australia 3 Up to 95% of men with moderate symptoms are unhappy and don t want to spend the rest of their life with these symptoms 4 If left untreated, BPH can lead to complications including infection; renal failure; and urinary, bladder, or kidney stones. 2,5 What are the symptoms? An enlarged prostate presses on the urethra (the tube that carries urine from the bladder), which can cause a number of problems commonly referred to as Lower Urinary Tract Symptoms (LUTS). Symptoms include: 6 Frequent urination during the day and/or night Sudden urge to urinate Burning, painful urination Weak urine flow Sensation the bladder is not empty after urination Inability to urinate Trouble stopping and starting urine flow. What are the treatment options for BPH? Taking the details of your condition into account, you and your doctor can work together on a treatment plan. It s important that you understand all the options available, and that you share your thoughts and concerns with your doctor. A growing trend for the treatment of an Enlarged Prostate is Photoselective Vaporisation of Prostate (PVP) this procedure uses laser light to remove excess prostate tissue. It offers less bleeding, a shorter hospital stay, and a faster recovery than traditional surgical options. 7 Want more information? Go to

2 PATIENT FACTSHEET: BPH Treatments 1 Watchful Waiting If symptoms are mild, doctors may recommend a watch and wait approach, asking patients to track their symptoms, before pursuing other courses of treatment. The doctor may also recommend lifestyle modifications, such as adjusting diet, evening fluid intake, and exercise patterns. 8 2 Medication Alpha blockers make it easier to urinate by relaxing the muscles around the neck of the bladder, while alpha reductase inhibitors are intended to shrink the prostate gland. In some cases, significant side effects and prescription drug costs make this a less desirable option. Procedure Considerations PROCEDURE COMPARISONS Photoselective Vaporisation of Prostate 3 Surgery Surgeries are performed as either minimally invasive, endoscopic procedures (without an incision through the skin) or as invasive procedures such as an open prostatectomy. Examples of endoscopic procedures are Photoselective Vaporisation of Prostate (PVP), Transurethral resection of the prostate (TURP) or Thermo Therapies such as radio frequency, cryo or microwave. An open prostatectomy is the removal of the inner portion of the prostate through an incision in the lower abdominal area. As with any surgical procedure, there are risks and costs which should be evaluated with your doctor. TURP Thermo Therapy Open Prostatectomy Minimally Invasive (Endoscopic) Tissue Removal Length of Stay in Hospital approx. 1 day 3 days 1 day 3+ days Suitable for use with Anti-Coagulant Medications BPH PATIENT SELECTION GRAPHIC GUIDE Therapy Type Mild BPH/LUTS Moderate BPH/LUTS Severe BPH/LUTS Medication Thermo Therapy Laser Therapy TURP Open Prostatectomy If you would like help assessing your BPH risk, take the International Prostate Symptom Score (IPSS) quiz and share the results with your doctor. 1. American Urological Association. Diagnosis and treatment recommendations. In: AUA Guideline on the Management of Benign Prostatic Hyperplasia. Linthicum, MD: American Urological Association Education and Research, Inc.; 2003;4: Barry M, Roehrborn C. Management of benign prostatic hyperplasia. Annu Rev Med. 1997;48: Data on file. 4. Bertaccini, A., Vassallo, F., Martino, F., Luzzi, L., Rossetti, S., Di Silverio, F., et. Al. Symptoms, bothersomeness and quality of life in patients with LUTS suggestive of BPH. Eur Urol. 2001;40 (Suppl 1): Benign enlargement of prostate. ADAM Health Illustrated Encyclopedia. adamcontent/enlarged-prostate. Accessed Oct. 21, Carter HB. Prostate Disorders: the Johns Hopkins White Papers. Baltimore, MD: Johns Hopkins Medicine; 2010: 1, Bachmann A, Tubaro A, Barber N, et al. 180-W XPS GreenLight laser vaporisation versus transurethral resection of the prostate for the treatment of benign prostatic obstruction: 6 month safety and efficacy results of the European multi-centre randomized trial The GOLIATH Study. Eur Urol. November 12, Epub ahead of press. 8. American Urological Association Education Research, Inc. American Urological Association Guideline: Management of Benign Prostatic Hyperplasia (BPH), Revised, 2010:Appendix 280,

3 INTERNATIONAL PROSTATE SYMPTOM SCORE (IPSS) Name: Date of birth: / / Date completed: / / Circle one response per question: 1 Incomplete Emptying How often have you had the sensation of not emptying your bladder? 2 Frequency How often have you had to urinate less than every two hours? 3 Intermittency How often have you found you stopped and started again several times when you urinated? 4 Urgency How often have you found it difficult to postpone urination? 5 Weak Stream How often have you had a weak urinary stream? 6 Nocturia How many times did you typically get up at night to urinate? None 0 1 time 1 2 times 2 3 times 3 4 times 4 5 times 5 Add the numbers corresponding to your answers to questions 1 6: TOTAL: 1 7 MILD 8 19 MODERATE SEVERE Quality of Life Due to Urinary Symptoms If you were to spend the rest of your life with your urinary condition just the way it is now, how would you feel about that? Delighted 0 Pleased 1 Mostly Satisfied 2 Mixed 3 Mostly Dissatisfied 4 Unhappy 5 Terrible 6

4 AUA PATIENT SYMPTOM SCORE QUESTIONNAIRE The American Urological Association (AUA) has created this symptom index to give you and your physician an understanding of the severity of your enlarged prostate symptoms. Question Incomplete emptying: Over the past month, how often have you had a sensation of not emptying your bladder completely after you finished urinating? None Less than 1 time in 5 Less than half the time About half the time More than half the time Almost always YOUR SCORE Frequency: Over the past month, how often have you had to urinate again less than 2 hours after you finished urinating? Intermittency: Over the past month, how often have you found that you stopped and started again several times when you urinated? Urgency: Over the past month, how often have you found it difficult to postpone urination? Weak stream: Over the past month, how often have you had a weak urinary stream? Straining: Over the past month, how often have you had to push or strain to begin urination? Nocturia: Over the past month, how many times did you most typically get up to urinate from the time you went to bed at night until the time you got up in the morning? SYMPTOM SCORE Add up the points for all questions to determine the severity of your symptoms TOTAL: If you scored 8 points or higher, you should consult your doctor. Symptom Score (Severity): 0 to 7 (Mild) 8 to 19 (Moderate) 20 to 35 (Severe)...continued over the page

5 RATE YOUR CURRENT SATISFACTION These questions are intended to help evaluate your satisfaction with your current enlarged prostate therapy. If you are not completely satisfied, ask your doctor about other treatment options. How much do you agree or disagree with each of the following statements about your enlarged prostate treatment? Check one answer for each. Question I am completely satisfied with the symptom relief I m getting with my current enlarged prostate symptoms. Strongly Agree Agree Neutral Disagree Strongly Disagree I do not like the idea of taking daily medications indefinitely to relieve my enlarged prostate symptoms. I am bothered by one or more of the side effects of enlarged prostate medications (such as lowered sexual drive, erection problems, dizziness, low blood pressure, nasal congestion). Are you interested in learning more about non-medication based treatment options that may improve your BPH symptom relief beyond what you are currently getting? yes no After you have completed these forms, please present this to your doctor and ask him/her to discuss your enlarged prostate treatment options. Disclaimer: This questionnaire is meant for informational purposes only and may not be used for self-diagnosis. Please consult your doctor or qualified healthcare provider regarding your condition and appropriate medical treatment. This publication is presented by Boston Scientific Corporation, a company committed to transforming lives through innovative medical solutions that improve the health of patients around the world. CAUTION: The law restricts these devices to sale by or on the order of a physician. Indications, contraindications, warnings and instructions for use can be found in the product labelling supplied with each device Copyright Boston Scientific Corporation. All rights reserved. ANZ_PSST_17013 AA MAR 2017