Professional Documents
Culture Documents
Hypertrophy
Hyperplasia
Enlargement
BPH
Benign Prostatic Hyperplasia
Microscopic
Proliferation of stromal (fibromuscular) and
epithelial (prostate secretory glands) in the
transitional zone
Macroscopic
Enlarged Prostate; DRE, TRUS, CT, MRI
Static (epithelial/having a large blockage)
Dynamic (increased tone of muscle fibers)
Clinical
LUTS: storage vs. voiding vs. both (nonspecific)
BPH
By the numbers:
14 million US men
(not all seek medical attention)
Annual cost of $4 billion per year
BPH
Incidence and Epidemiology
Most common benign tumor in men
Prevalence
20% in men 41-50
50% in men 51-60
Increase by 10% per 10 years
Familial component likely
Higher incidence in higher income & higher education
Metabolic syndrome increases likelihood of BPH
Anatomy
BPH
Evaluation:
International Prostate Symptoms Score
(IPSS)/AUA Symptoms Index:
0-35 points for symptoms and severity
LUTS:
0-7 Mild
8-18 Moderate
>18 Severe
BPH
Treatment Options:
1. Watchful waiting
2. Phytotherapeutics
3. Medical management
Alpha blockers
5 Alpha reductase inhibitors (5 ARIs)
Phosphodiesterase inhibitors (PDE5i)
Combination therapy
4. Minimally invasive techniques
5. Surgical techniques
Watchful Waiting
Decrease PM fluids
Decrease caffeine/ETOH/bladder irritants
Timed voids/double voids
Review Rx list and optimize
Treat constipation
Phytotherapy
Phytotherapeutic agents are standardized
herbal preparations consisting of complex
mixtures of one or more plants which
contain as active ingredients plant parts or
plant material in the crude or processed
state.
Last year, the US herbal supplement
market was $7.4 billion.
Phytotherapy
Phytotherapeutic agents are commonly
prescribed in Europe for LUTS, and in the
US 30-90% of patients seen by urologists
for BPH/LUTS may be taking them
The US market for dietary supplements to
treat LUTS or just to keep the prostate
healthy is around $1.5 billion per year
Phytotherapy
Product Variability
Evaluation and use of these products are
complicated by variations in the plants
themselves as well as the process to extract
the desired components.
Study (Feifer et al., 2002), showed that 3/6
samples of saw palmetto was less than 20%
of the amount stated on the label and two of
these had less than 5%
Phytotherapy
Major Issues with phytotherapy:
1. The clinical benefits of phytotherapeutic agents for
BPH are still uncertain
2. Saw Palmetto is the most widely used nutraceutical
for BPH
3. The mechanism of action of phytotherapeutic agents
on BPH are thought to be weakly similar to finasteride,
decreasing testosterones effects on the prostate
4. There is significant interbrand and intrabrand
variability
5. The presumed safety of these products has never
been fully confirmed
Rare scientific head to head comparisons with
standard treatments
Phytotherapy
Saw Palmetto
African Plum
South African Star Grass
Stinging Nettle
Rye-Pollen Extract
Pumpkin Seeds
Other: Soy, Grape Juice, Cactus Flower,
Zinc, Selenium
Alpha-Blockers
Basis of therapy:
The dynamic (increased muscle tone) part of BPH
A component of BPH and bladder obstruction is
mediated by alpha adrenergic receptors associated
with prostatic smooth muscle.
Alpha-Blockers
Classification
Nonselective:
Phenoxybenzamine 10mg BID
Alpha-1
Terazosin (Hytrin) 5 or 10mg qDay
Doxazosin (Cardura) 4 or 8mg qDay
Alfuzosin (Uroxatral) 10mg qDay
Transurethral Laser
Surgery
Usually a side-firing laser is
placed through cystoscope
Holmium, Greenlight/PVP,
Thullium
Laser destroys/vaporizes
prostatic tissue
As good as a TURP with
similar potential
complications
Conventional Surgical Therapy
Surgical Open
Prostatectomy
In cases where the
prostate is too large
for a TURP or if the
bladder has very large
stones
Open incision or with
DaVinci Robot
Opens the prostatic
capsule and scoops
out the prostatic tissue
Other treatments
UroLume urethral stent
Migration, worsening irritative symptoms
Encrustation and prostatic ingrowth
Medical Treatment
Types of Surgery
Questions?