Management of the Enlarged Prostate Gland

Most men will experience symptoms of the enlarged prostate gland. These slides will discuss the evaluation and treatment options of the enlarged prostate gland

1. Understanding Prostate Health

2. Neil Baum, M.D. Urology Neil Baum Urology 3525 Prytania St., Ste. 614, New Orleans, LA 70115 504-891-8454 Affiliations Touro Hospital Specializes In: General Urology

3. Physician Name Specializes In: [Include additional information about your practice]

4. Prostate Overview

5. Overview of the Prostate Walnut sized gland at base of the male bladder Surrounds the urethra Produces fluid that transports sperm during ejaculation Prostate grows to its normal adult size in a man’s early 20s; it begins to grow again during the mid-40s

6. Prostate Conditions 2 Enlarged Prostate or Benign Prostatic Hyperplasia (BPH) Prostatitis Prostate Cancer Each condition affects the prostate differently.

7. What is BPH? Commonly known as enlarged prostate, BPH means the prostate gland has grown larger than normal Normal adult size = approximately 1.5 inches in diameter Benign prostatic hyperplasia/enlargement can lead to bladder outlet obstruction which can cause lower urinary tract symptoms

8. What is BPH? BPH’s Relation to Prostate Cancer BPH is not prostate cancer BPH does not cause prostate cancer BPH symptoms are similar to those of cancer BPH may co-exist with prostate cancer 1 Prostate-Specific Antigen (PSA) levels alone do not distinguish BPH from prostate cancer . Both BPH and prostate cancer can cause elevated PSA levels .

9. Normal vs. Enlarged Prostate As the prostate enlarges, pressure can be put on the urethra causing urinary problems Prostate size does not correlate with degree of obstruction or severity of symptoms . Normal Prostate Enlarged Prostate

10. Recognizing the Symptoms of BPH Frequent urination during day and/or night Sudden urge to urinate Burning, painful urination Weak urine flow Sensation the bladder is not empty after urination Inability to urinate Trouble stopping and starting of flow

11. BPH Affects Quality of Life Many men who suffer from BPH may experience a reduction in quality of life . Up to 95% of men with moderate symptoms are unhappy and don’t want to spend the rest of their life with these symptoms . 51% of men say BPH interferes with one aspect of their normal life Studies show almost 50% of men experience sexual problems BPH also affects men’s partners quality of life, daily routines and relationships

12. BPH Affects Quality of Life

13. BPH – Who is at Risk? BPH affects more than 27 million men over 50 each year in the United States Affects 40-50% of men ages 51- 60 Affects 80%+ men over age 80 Obesity, higher body mass index (BMI) and lack of exercise may increase the risk of BPH

14. How is an Enlarged Prostate Diagnosed ? Medical History Physical Exam Prostate exam Digital rectal exam (DRE) Urinary Output Testing Peak urinary flow (QMAX) testing Post-void urine volume testing

15. Treatment Options

16. Treatment Options Treatment Options for Enlarged Prostate Watchful Waiting Medication Minimally Invasive Therapy Heat/Microwave (TUMT) Surgical Therapy TURP (Transurethral Resection of the Prostate) GreenLight™ Laser Therapy A variety of different treatments options are available and are appropriate for different patients.

17. Treatment Options Watchful Waiting Characteristics Best for men with mild symptoms Consists of yearly exams and no active intervention No surgery No drugs May involve lifestyle modification such as adjusting diet, evening fluid intake, medication use and exercise patterns Side Effects Symptoms may worsen or remain unchanged without lifestyle modification 1

18. Treatment Options Characteristics Intended for men with demonstrable prostatic enlargement Avodart ® inhibits prostate enlargement by 85-90% after 2 weeks and 94% average after 2 years . Proscar ® inhibits prostate enlargement by 70% after 4 years . No surgery required No drug interactions with other medications Side Effects Erectile dysfunction (ED)/ Impotence Lowered sexual drive/ libido Ejaculation disorders Lowers Prostate Specific Antigen ( PSA) levels up to 50%; can interfere with prostate cancer detection Medication 5-Alpha Reductase Inhibitors (e.g. Avodart ® and Proscar ® ) 1

19. Treatment Options Characteristics Intended for men with mild to severe symptoms Clinical studies measuring symptom scores for Flomax ® and Uroxatra showed a reduction in symptom severity No surgery required Work almost immediately Side Effects Sudden drop in blood pressure can occur Headache Dizziness and/or fainting Weakness or Fatigue Congestion Painful erection or abnormal ejaculation 16 Can have drug interactions with other medications Medication Alpha-Blockers (e.g. Flomax , Rapaflo

20. Minimally Invasive Therapy Transurethral Microwave Therapy (TUMT ) Characteristics Intended for men with moderate to severe symptoms Non-surgical procedure Outpatient capability Lack of sexual side- effects Can be performed without anesthesia Side Effects Average catheterization time = 2 weeks Urinary retention Urinary Tract Infections Variable levels of short and long term functional improvements Retreatment rates: 32-39% Treatment Options

21. Treatment Options Surgical Therapy TURP Uses electricity to superheat a thin metal band that cuts the prostate tissue into small chunks Characteristics Intended for men with moderate to severe symptoms Most common type of BPH surgery Post-void residual Improved Quality of Life scores Provides symptom relief Demonstrated improved QMAX (volume of urine per sec) Demonstrated improved prostate volume Side Effects TUR Syndrome Bleeding requiring transfusion Retrograde ejaculation rates: 53-75 % Erectile Dysfunction (ED): 6.3% 18 Activities after surgery restricted for about 6 weeks

22. Surgical Therapy GreenLight ™ Laser Therapy Uses a laser to vaporize away the prostate tissue Side Effects The side effects and complications of laser therapy are similar to TURP Retrograde ejaculation 36% for GreenLight Procedure Urgency/frequency Dysuria Hematuria/blood in the urine Bleeding and transfusion events happen less often than TURP, but GreenLight has a slightly higher risk of retreatment in 5 years (based on earlier technology) Treatment Options

23. Surgical Therapy GreenLight ™ Laser Therapy Uses a laser to vaporize away the prostate tissue Characteristics Intended for men with moderate to severe symptoms 25 Over 500,000 patients treated worldwide 21 Done in an outpatient setting Provides long-lasting symptom relief Significant, immediate urine flow improvement after the procedure Safe and effective for use in men in urinary retention, with large prostates or on anticoagulant therapy Treatment Options

24. Clinical Comparison GreenLight TURP Length of Hospital Stay 1.1 days 3.4 days Length of Catheterization 12.2 hours 44.5 hours

25. GreenLight Pre and Post-Op Pre-Op Immediate Post-Op 3 Months Post-Op

26. Effect on Erectile Function Does NOT affect erectile function There is no difference between pre-operative and post-operative erectile function after treatment for men with either mild or no erectile dysfunction pre-operatively .

27. Insurance Coverage TURP and GreenLight are covered by Medicare and most private insurance companies .

28. Am I Eligible For This Treatment? Consultation with your Urologist is required to determine if GreenLight is the best treatment option for you. Potential candidates may include men who are: Not satisfied with medication therapy Medication ineffectiveness, costs, side effects Don’t want to take medications Want better symptom relief than medications provide 19 O n anti-coagulation therapy Mildly to severely symptomatic 2

29. In Summary What is the prostate and how does it work? Enlarged prostate = BPH Treatment Options Watchful Waiting Medication Minimally Invasive Therapy Heat Therapy Surgical Therapy TURP GreenLight Laser Therapy

30. Brief Summary Brief Summary – Risk Information for GreenLight™ The GreenLight™ laser system is intended for incision/excision, vaporization, ablation, hemostasis and coagulation of soft tissue, including photoselective vaporization of the prostate for benign prostatic hyperplasia (BPH). The laser system is contraindicated for patients who: are contraindicated for surgery, have calcified tissue, require hemostasis in >2mm vessels, have uncontrolled bleeding disorders, have prostate cancer, have acute urinary tract infection (UTI) or severe urethral stricture. Possible adverse events include, but are not limited to, irritative symptoms (dysuria, urgency, frequency), retrograde ejaculation, hematuria, urinary incontinence, erectile dysfunction, hematuria - gross, UTI, bladder neck contracture/outlet obstruct, urinary retention, perforation - prostate, urethral stricture. Prior to using these devices, please review the Operator’s Manual and any accompanying instructions for use for a complete listing of indications, contraindications, warnings, precautions and potential adverse events. Rx Only