The Enlarged Prostate...– PSA rises with both BPH and prostate cancer, so PSA alone ... •...
Transcript of The Enlarged Prostate...– PSA rises with both BPH and prostate cancer, so PSA alone ... •...
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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.