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?