The Enlarged Prostate Symptoms, Diagnosis and Treatment MAC00031-01 Rev G Financial support for this seminar has been provided by NeoTract, Inc., the manufacturer of the UroLift System. 1
Today s Agenda What is BPH How it is diagnosed What are the treatment options 2
Overview of the Prostate Walnut sized gland at base of the male bladder BLADDER Surrounds the urethra PROSTATE Produces fluid that transports sperm during ejaculation URETHRA 3
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 PROSTATE SIZE Age 1 Age 5 Age 10 Age 15 Age 25 Age 35 Age 50 Ag 75 4
Prostate Conditions Prostatitis Swelling/Inflammation of the prostate Prostate Cancer Enlarged Prostate Very common cancer among men Typically a slow growing cancer Enlargement of the prostate gland Each condition affects the prostate differently Having one condition does not mean you will have another 5
Aging and the Prostate Age 50 Age 60 Age 80 60 40 30 70 10 90 % of Men with BPH % of Men without BPH 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 6
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 7
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 Normal Prostate Anatomy Enlarged Prostate (BPH) Anatomy BLADDER HYPERTROPHIED DETRUSOR MUSCLE PROSTATE URETHRA OBSTRUCTED URINARY FLOW Roehrborn CG, McConnell JD. In: Walsh PC et al, eds. Campbell s Urology. 8th ed. Philadelphia, Pa: Saunders; 2002:1297-1336. 8
What Happens if BPH is Not Treated? Not treating enlarged prostate can lead to bladder deterioration 9
BPH Disease Progression Images courtesy Dr. Steven Gange 10
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 Abrams, et al., Neurourology and Urodynamics 2002; Maximilian, et al., BJU Intl 2012 11
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 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 Abrams, et al., Neurourology and Urodynamics 2002; Maximilian, et al., BJU Intl 2012 12
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? 13
How is an Enlarged Prostate Diagnosed? Optional Studies Uroflow Pressure flow studies Transrectal Ultrasound (TRUS) With or without biopsy Cystoscopy 14
International Prostate Symptom Score (IPSS) Symptoms Incomplete bladder emptying Frequency Intermittency Urgency Weak stream Straining Nocturia How is the IPSS scored? 0-7 Mild 8-19 Moderate 20-35 Severe How is Quality of Life scored? 0-6 Regardless of the score, if your symptoms are bothersome you should notify your doctor 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. 15
Treatment Options for Enlarged Prostate Different treatments are appropriate for different patients 16
Watchful Waiting Advantages No surgery Cheaper than drugs No side effects Disadvantages May not have symptom improvement Risk that symptoms will worsen 17
Medications/Herbal Remedies Medication Flomax, Avodart, Duodart, Cialis Herbal Remedies AUA Guidelines 2010, 2003 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 *Side effects may vary depending on medication type. No surgery No drugs No side effects Advantages 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 18
Prostatic Urethral Lift (PUL) The UroLift System 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 Roehrborn Urology Clinics 2016 McVary et al. J Sex Med 2013 Shore et al. Can J Urology 2014 19
How PUL Works The delivery device is placed through the urethra to access the enlarged prostate. Implants are placed through a needle that comes out of the delivery device to hold the enlarged prostate tissue out of the way. The delivery device is removed, leaving a more open urethra. 20
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 AUA Guidelines 2010, 2003 21
How Heat & Steam Based Therapies Work http://www.prostatetreatmentindore.in/treatment-of-prostate-cancer.php 22
Major Surgery TURP Resection; Greenlight Laser Vaporization Advantages Maximizes flow and symptom relief Removes prostate tissue Durable Low retreatment rate 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 AUA Guidelines 2010, 2003 23
How TURP & Laser Based Therapies Work https://www.indiamart.com/thechennai-speciality-klinic/endourology.html 24
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! 25
Questions? MAC00031-01 Rev G Financial support for this seminar has been provided by NeoTract, Inc., the manufacturer of the UroLift System.