PROSTATE ENLARGEMENT:

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PROSTATE ENLARGEMENT

• New advancements in treatment

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PROSTATE ENLARGEMENT
A COMMON PROBLEM

• 50 of all men have
• an enlarged prostate
• by age 60
• 80 of men have an
• enlarged prostate
• by age 80

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SO, WHAT IS THE PROSTATE, ANYWAY?
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THE PROSTATE

• Small, walnut sized
• gland located below
• the bladder
• Surrounds the urethra
• Involved in
• reproductive
• function

Ureter
Ureter Opening
Prostate
Bladder
Prostatic
Urethra
Urethra
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PROSTATE ENLARGEMENT

• Also called benign prostatic
• hyperplasia (BPH)
• Benign growth of prostate gland
• Not cancer, nor does it lead to cancer

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THE NORMAL PROSTATE
Bladder

• Small
• Urethra unobstructed
• Free flow of urine

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THE ENLARGED PROSTATE

• Gradually increases
• in size
• Squeezes urethra
• Results in
• Difficulty in urination
• Incomplete bladderemptying
• Possible infection and kidney damage

Bladder
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CAN IT BE PREVENTED?

• Prostate enlargement is a
• natural part of aging

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SYMPTOMS OF PROSTATE ENLARGEMENT

• Weak urine stream
• Nighttime urination
• Frequent or urgent urination
• Starting and stopping of urination
• Hesitancy of stream
• Sensation of incomplete bladder emptying
• Painful or burning urination

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SYMPTOMS OF AN ENLARGED PROSTATE

• May vary with severity
• of condition
• Each patient experiences
• symptoms differently
• Symptoms may worsen
• without treatment

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TESTS YOUR DOCTOR MAY PERFORM

• Digital rectal exam (DRE)
• Ultrasound
• Urine flow study
• Cystoscopy

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THE GOOD NEWS IS PROSTATE ENLARGEMENT IS TREATABLE
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THREE TREATMENT CATEGORIES

• Drug therapy
• Surgery
• Minimally invasive treatments

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DRUG THERAPY OPTIONS

• Proscar (finasteride)
• Hytrin (terazosin)
• Cardura (doxazosin)
• Flomax (tamsulosin)

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DRUG THERAPY

• Advantages
• No surgery
• Effective for mild to moderate symptoms
• Disadvantages
• Lifelong commitment to therapy
• Effectiveness may decrease over time

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SURGICAL OPTIONS

• Transurethral resection of
• the prostate (TURP)
• Transurethral incision of
• the prostate (TUIP)
• Open prostatectomy

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TRANSURETHRAL RESECTION OF PROSTATE (TURP)

• Most common surgical
• option for enlarged prostate
• Transurethral
• through the urethra
• No incision through
• the abdomen

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TRANSURETHRAL RESECTION OF PROSTATE (TURP)

• Excess tissue
• removed one
• piece at a time
• Tissue flushed
• out of body
• Potential side effects
• impotence
• retrograde ejaculation
• incontinence

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TRANSURETHRAL INCISION OF PROSTATE (TUIP)

• Transurethral procedure
• Small cuts made in bladder neck and
• prostate to widen urethra
• No prostate tissue removed
• Less risk of side effects when compared
• to TURP
• Not suitable for large glands

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OPEN PROSTATECTOMY

• Used for very enlarged prostates
• Major surgery requiring
• abdominal incision
• Enlarged portion of prostate
• removed by surgeon
• Greater risk of surgical complications
• Longer recovery time

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MINIMALLY INVASIVE TREATMENTS

• Major advances made in treatment
• Advanced technology
• Advantages
• Designed to enhanced patient comfort
• Reduced risk of complications
• Potentially reduced side effects

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MINIMALLY INVASIVE TREATMENTS

• Transurethral microwave
• thermotherapy (TUMT)
• Transurethral needle
• ablation (TUNA)
• Interstitial laser coagulation (ILC)

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TRANSURETHRAL MICROWAVE THERMOTHERAPY (TUMT)

• Uses microwaves to
• heat and destroy excess
• prostate tissue
• Not effective for
• certain cases
• High power level may
• cause discomfort
• Treatment typically takes 1-2 hrs
• Many patients require
• retreatment1

1. Indigo Medical, Inc. BPH Advisory Panel
Meeting. Physicians Dialogue Expert Opinion
About Minimally Invasive Therapy for BPH. 1999
20.
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TRANSURETHRAL NEEDLEABLATION (TUNA)

• Uses radiowaves to
• destroy enlarged tissue
• Not effective for
• all cases
• Low risk of side effects
• Studies have shown
• that more than 27 of
• patients have elected
• TURP eventually1

1. Indigo Medical, Inc. BPH Advisory Panel
Meeting. Physicians Dialogue Expert Opinion
About Minimally Invasive Therapy for BPH. 1999
20.
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INTERSTITIAL LASER COAGULATION (ILC)

• One of the newest, most widely
• used minimally invasive therapies1
• Transurethral
• procedure
• Heat from laser
• coagulates excess tissue
• Excess tissue absorbed
• by body
• Gradual decrease
• of symptoms

1. Synergy Healthcare Market Share Information.
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INTERSTITIAL LASER COAGULATION (ILC)

• Precision of laser
• allows precise treatment
• of tissue
• Designed to minimize
• risk of damage to
• urethra and tissue
• around the prostate

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INTERSTITIAL LASER COAGULATION (ILC)

• Can be performed in
• outpatient setting
• Local anesthesia possible1
• Symptomatic relief
• comparable to TURP
• Reduced risk of
• incontinence and
• retrograde ejaculation

1. Greenberger M, Steiner MS. The University of
Tennessee experience with the Indigo 830e
laser device for the minimally invasive treatment
of benign prostatic hyperplasia interim
analysis. World Journal of Urology.
199816(6)386-91.
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THE ILC PROCEDURE

• Anesthetic administered
• Cystoscope inserted through urethra
• Special fiber optic inserted into
• prostate through scope
• Laser energy delivered to precise area
• Process repeated until sufficient
• tissue coagulated

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THE ILC PROCEDURE

• Takes usually less than 1 hour
• Short-term catheterization required post-op
• Initial symptom improvement typically within
• 3 to 4 weeks
• Symptoms typically continue to improve over
• 8 to 12 weeks

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CHOOSING THE BEST OPTION

• More options mean more
• difficult decisions
• Learn the facts
• Talk to your doctor

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REMEMBEREARLY DIAGNOSIS IS THE KEY TO SUCCESSFUL
TREATMENT
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EARLY DIAGNOSIS

• Annual prostate exams after age 50
• See your doctor immediately if you
• have any symptoms

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QUESTIONS?