Understanding Prostate Health Dr. Emilio Lastarria November 2, 2010 Overview of the Prostate and BPH Overview of the Prostate • Walnut sized gland at base of the male bladder • Surrounds the urethra • Produces fluid that transports sperm during ejaculation Prostate Conditions • Enlarged Prostate • Prostatitis • Prostate Cancer Each condition affects the prostate differently Aging and the Prostate • BPH affects more than 26 million men each year in the United States • Prostate grows to a normal size in teenage years and then begins to grow again around the age of 50 • By age 60, half of all men have an enlarged prostate • Affects most men by age 80 • Stress and diet are contributing to an increased presence of enlarged prostate in younger men What is BPH? • Benign Prostatic Hyperplasia (BPH) • Commonly known as enlarged prostate • Non-cancerous enlargement of the prostate gland – BPH is not an indication or a predictor of cancer – The opposite is also true – your PSA level is not an indicator of BPH Normal vs. Enlarged Prostate • As the prostate enlarges, pressure can be put on the urethra Normal Prostate • Causes urinary problems • It is usually not life-threatening In general, the size of the prostate does not correlate to severity of symptoms Enlarged Prostate 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 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 How is an Enlarged Prostate Diagnosed? • Medical History • Physical Exam • Symptoms – AUA Symptom Score • Bothersome – How much of a bother is it to you? Treatment Options Treatment Options for Enlarged Prostate • Watchful Waiting • Medication • Heat Therapy (TUMT) • Laser Therapy • Surgery (TURP) Different treatments are appropriate for different patients Treatment Option Watchful Waiting Advantages Disadvantages • No surgery • No drugs • No side effects • No improvements in symptoms • Risk that symptoms will worsen Treatment Option Medication Advantages Disadvantages • No surgery • Potential for symptom relief • Must be taken daily • Potential side effects - Lowered sexual drive, erection problems, nasal congestion and dizziness • High out-of pocket cost - Average daily cost Flomax $3.28 ($1,197/yr) Avodart $2.54 ($927/yr) • Over time may stop working Treatment Option Transurethral Microwave Therapy (TUMT) Advantages • • • • Safe and effective In-Office Procedure Short procedure time Can be performed with only a mild oral sedative Disadvantages • Catheterization required • Best for mild symptoms • Variable levels of short and long term functional improvements Treatment Option Surgery (TURP) Transurethral Resection of the Prostate Advantages Disadvantages • Proven approach • Surgical procedure risks: • Bleeding requiring transfusion • Retrograde ejaculation rate: 53 - 75% • ED rate of 6.3% • Persistent incontinence • General or regional anesthesia necessary • Catheterization required • Hospitalization required • Activities after surgery restricted for about 6 weeks An Advanced Treatment Option GreenLight Laser Therapy • Over 375,000 patients treated worldwide • Done in an outpatient setting and typically no overnight stay is required • Provides rapid long-lasting symptom relief • Dramatic urine flow improvement • Safe and effective for use in men in urinary retention, with large prostates or on anticoagulant therapy • Alternative to the cost, side effects and inconvenience of other therapies Per the American Urological Association guidelines, laser therapy provides equivalent symptom relief compared to TURP How GreenLight Laser Therapy Works: • Uses laser energy to remove excess prostate tissue by vaporization • Laser energy is delivered through a small, flexible fiber inserted in the urethra • The procedure can be performed in a hospital outpatient center or surgical center Side Effects • Hematuria – Blood in the urine • Bladder spasm or urgency • Irritation of urinary tract – frequent urination, burning sensation • Retrograde ejaculation - 36% for GreenLight Procedure - 53 - 75% for TURP Procedure Affect on Erectile Function • Does NOT affect Erectile function - There is no difference between pre-operative and post-operative function after treatment for men with either mild or no erectile dysfunction preoperatively. • Does NOT affect your ability to take erectile dysfunction medications Insurance Coverage • Covered by Medicare and most private insurance companies • Can be an economic alternative to the ongoing cost of medications What to Expect During Treatment • May be given medication to help you relax • IV sedation or anesthesia that will allow you to sleep through the procedure • Minimal to no discomfort Post-Treatment Expectations • Dramatic symptom improvement immediately • Typically able to leave outpatient facility within hours after treatment • Many patients leave without a catheter; however, if one is required it is typically removed in less than 24 hours • Can resume normal activities within a few days and strenuous activities within two weeks Thank You Questions?
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