Thank you for viewing this educational presentation this module discusses medical treatments for non cancerous enlargement of the prostate called benign prostatic hyperplasia or bph enlargement of the prostate gland is common as a man ages and occurs due to non cancerous multiplication of the prostate cells this prostate growth is driven by the male hormone
Testosterone which is converted in the body to another hormone called dihydrotestosterone or dht the complex processes that ultimately lead to bph are beyond the scope of this presentation as the prostate enlarges it compresses inwards into the urethra or urine channel obstructing the flow of urine out of the bladder this obstruction occurs not only because of
Physical enlargement of the prostate but also because of increased numbers of muscle fibers in the prostate and/or increased tone in these muscle fibers these muscle fibers have a gripping or squeezing effect around the urethra obstruction of urine flow causes symptoms of a reduced urinary stream difficulty starting the stream and poor bladder emptying also as a
Result of obstruction to urine flow out of the bladder the bladder itself has to work extra hard to empty with time the bladder muscle can become thickened and more sensitive and the ability to hold large amounts of urine decreases as a result one might have to empty the bladder more frequently and might have stronger urges to urinate when left untreated bph can
Lead to total inability to urinate called urinary retention which requires insertion of a tube into the bladder or catheterization it can also result in blood in the urine weakening of the bladder bladder stones urinary tract infection or even kidney damage treatment for bph is usually recommended for the following reasons bothersome symptoms which affect one’s
Lifestyle worsening symptoms where one is at risk of progressing to a more serious situation and wanted consequences of obstruction including urinary retention infection kidney failure bladder stones and bleeding patients at risk of progressing to a more serious situation are those with a very large prostate size an elevated psa blood test severe symptoms poor
Bladder emptying as evidenced by an increased residual urine volume or a slow urine flow rate bph can however be successfully treated when it does occur treatment options include lifestyle changes and regular monitoring of symptoms supplements and phytotherapy medications that relax the muscle within the prostate called alpha blockers medications that shrink the
Size of the prostate called 5-alpha reductase inhibitors medications to relax the bladder called antimuscarinic s’ combination therapy using different types of medications together or surgical therapy in general treatment progresses from simple measures to more aggressive measures as the severity of the problem increases all of these treatments are discussed
In separate modules and your doctor can direct you to the material most pertinent to your situation men with small prostate and mild not too bothersome symptoms will often choose to avoid medications or surgery and go on a regular monitoring or watchful waiting program this involves introducing lifestyle changes to help improve symptoms than regular follow-up
Visits to reassess symptoms the impact of the symptoms on lifestyle and the size of the prostate depending on the situation other testing may be done such as a psa blood test a urine flow rate test and measurement of residual urine volume the big question of course for any man considering watchful waiting rather than medical or surgical treatment is what are the
Chances that things will worsen with time from several recent excellent studies we can now draw the following conclusions overall about 20% or one in five men with bph will have worsening of their symptoms over five years if no treatment is taken and approximately 10 to 25% of patients with moderate to severe symptoms will go on to require surgery within 3 to 4
Years numerous complementary alternative medicines have been described for treating prostate conditions including both bph and prostate cancer these include vitamins minerals and supplements such as multivitamins vitamin e calcium selenium zinc potassium and lycopenes herbs such as saw palmetto pygeum africanum green tea garlic echinacea and ginseng special
Diets including a low-fat low-salt and soy based or tomato based diets and asian traditional medicine such as acupuncture and chinese herbs many so called prostate health pills have been concocted for over-the-counter sale and most of these have some sort of plant extract in them the use of plant extracts to treat medical problems is called phytotherapy the
Two most commonly used agents are sera noaa repins commonly known as saw palmetto and pygeum africanum which is known as red stink wood or african plum these extracts are thought to have a dual action of reducing swelling and inflammation in the prostate as well as blocking and even reversing the growth of the prostate by far the most commonly used plant extract
To treat bph is called saw palmetto which is used by more than two million men in the u.s. to treat prostate symptoms a typical dose of saw palmetto is 160 milligrams twice daily well it is a safe product to take and causes few side effects how effective it is remains controversial several small studies have shown that it reduces symptoms and slows progression
Of disease however a recent well conducted study in the new england journal of medicine has shown that it may not have great benefit in relieving symptoms or improving flow rates in men with bph medical treatment of lower urinary tract symptoms may be directed at the prostate and/or at the bladder most commonly treatment is first aimed at relaxing muscle fibers
Within the prostate drugs which shrink the prostate size may be added for further benefit depending on the situation some men may also benefit from drugs aimed at relaxing the bladder this presentation addresses only those medications aimed at the prostate itself the first group of medications we will discuss are the so-called alpha blockers the prostate contains
Many muscle fibers these fibers squeeze or grip around the urine channel called the urethra this squeezing effect blocks the flow of urine out of the bladder and worsens urinary symptoms prostate muscle fibers are activated when certain chemicals trigger what are called alpha receptors on the muscle cells these alpha receptors can be blocked by medications to
Prevent them from being activated and this causes the prostate muscle fibers to relax loosening their grip around the urethra and easing urinary symptoms there are four common alpha blockers as listed here so called selective alpha blockers are able to target the prostate more with less action on other alpha receptors in other parts of the body these drugs alfe
Fuses in’ also called zap trou and tamsulosin called flomax generally have lesser side effects and can be started and kept at one simple dose the non-selective drugs such as docs assasin or cardia and torres assent or hydrant are more likely to cause some side effects and typically they have to be started at a low dose and gradually increased if you are prescribed
One of these medications it is important to follow the dosage schedule set out by your doctor and try to get to the maximum dose that you can tolerate this table shown here lists the most common dosages of the four main alpha blockers alpha blockers are considered the so-called first-line treatment for men with symptoms of bph who are bothered enough to take
Medication to relieve these symptoms it should be pointed out that certain alpha blockers such as dachshund and terezin are also used as blood pressure lowering drugs in some patients numerous studies have shown that these medications are highly effective in relieving urinary symptoms caused by an obstructing prostate at least 60% of patients will experience
Relief of symptoms with a 30 to 40 percent improvement in some scores and the 15 to 30 percent improvement in urine stream furthermore many patients who are totally unable to urinate may be able to do so after starting these medications these medications work quickly and their effectiveness should be seen within the first couple weeks or so from clinical studies
We know that their effect can hold for at least up to four years however these drugs do not stop the prostate from growing further or prevent the development of complications such as urinary retention or the need for surgery later on within a five-year period about 15 to 40 percent of patients in fact will ultimately fail and go on to surgical treatment alpha
Blockers are safe and they are well tolerated by patients like any medication side effects may be experienced these medications can cause a drop in blood pressure which may cause dizziness for this reason it is usually advised that they be taken at bedtime other side effects include nasal congestion headache and tiredness retrograde ejaculation wear by semen goes
Backwards into the bladder instead of forwards during climax occurs most commonly with tamsulosin this may be experienced by three to ten percent of men taking this drug there are no effects on erections or sex drive and in some cases the drugs can actually improve overall sexual functioning you should always discuss possible drug interactions with your doctor
For example alpha blockers can have an effect on blood vessels they can cause or accentuate a slight drop in blood pressure when taken with other blood pressure lowering drugs or antihypertensives and erectile dysfunction drugs or pde5 inhibitors such as viagra if you are taking these types of medications it is important that you have your blood pressure checked
After you start the alpha blocker just to be safe certain alpha blockers may need to be avoided if you are taking certain erectile dysfunction drugs as mentioned alpha blockers are usually taken at bedtime and take about two weeks or so to achieve their maximum effect the selective drugs tamsulosin and elf you zhesan are more expensive than the others and this
May factor into a decision about medication to prescribe it is important to note that none of these drugs will affect your psa level which is the blood test commonly done to check the prostate now we will introduce another common type of bph drug prescribed called 5-alpha reductase inhibitors as we have reviewed the male hormone dihydrotestosterone or dht fuels
The growth of prostate cells dht is a product converted from the hormone testosterone 5 alpha reductase inhibitors block the conversion of testosterone to dht and stop the growth of prostate gland cells unlike alpha blockers 5 alpha reductase inhibitors can actually shrink the physical size of the prostate and reverse the process of enlargement in general these
Drugs are reserved for men with bothersome urinary symptoms who have large prostates and/or a mildly elevated psa level at least above 1.5 men with small prostates may not benefit from these drugs as their symptoms are more likely to be due just to the squeezing effect of the muscle in the prostate 5 alpha reductase inhibitors may also be used in men with blood
In their urine when it is felt that this blood is caused by an enlarging prostate and other causes have been ruled out the 2 5 alpha reductase inhibitors currently on the market are due tas deride or avodart and fine asteroid or proscar deut asteroid is taken once daily as a 0.5 milligram dose while finasteride is taken as a 5 milligram daily dose interestingly
Finasteride is also marketed under the brand name propecia which can be used to help prevent hair loss in the correct patients 5 alpha reductase inhibitors have been shown to reduce prostate size by 20% improve urinary symptoms by 30% improve urine flow rate and reduce the risk of developing complete urinary retention or requiring surgery it is important to
Understand that unlike alpha blockers these drugs may take three to six months or more to have a good effect peaking at two years they work however their effect can last at least five years and is noted on the last slide they can prevent the development of complications finally it is very important to understand that these medications will lower your psa value
By about one half so you will have a new baseline psa after starting the drug and will have to double your value to get your true psa level because these drugs affect the balance of male hormones in the body 5 alpha reductase inhibitors can have more significant sexual side effects than alpha blockers as shown on this slide about 6% of men may experience a lowered
Sex drive about 8% experienced reduced erections and 4% may notice a decrease in the amount of ejaculate or semen expelled during orgasm a small number of men may even experience some breast swelling or tenderness these side effects tend to be mild and usually decline over time finally as mentioned earlier one of these drugs is also marketed for hair loss and a few
Men taking these medications may experience a reversal or slowing of the balding process sometimes both alpha blockers and 5 alpha reductase inhibitors are used in combination the reasoning behind combination therapy is shown here an alpha blocker is used to provide quick relief of bph symptoms but as discussed it does not prevent further growth of the prostate
So a 5 alpha reductase inhibitor is added to shrink the prostate and provide a more lasting benefit the effect of the 5 alpha reductase inhibitor of course takes many months to take effect and in the meantime the patient will experience relief from the alpha blocker once the effect of the 5 alpha reductase inhibitor sets in the alpha blocker can often be stopped
For large prostates combination therapy is felt to provide a better long-term effect and will lower the risk of developing complications of bph the downside to combination therapy other than cost is that the potential side effects of the two drugs can be additive in other words a patient may be more likely to have some type of side effect than if he was only on
One type of medication alone treatment of bph depends on the severity of symptoms the degree of bother caused by them the presence of complications such as complete retention of urine and the risk of worsening symptoms were development of complications prescription medications are the first-line treatment for bph when symptoms are bothersome alpha blockers are
Usually the first medications tried and these work by relaxing the muscle in the prostate and loosening its grip around the urine channel 5 alpha reductase inhibitors are added when the prostate is large and these drugs work to shrink the physical size of the prostate in doing so they alone can prevent further enlargement and worsening of the condition or all both
Types of prostate medications are effective at improving symptoms and they are generally well tolerated a summary of the medical management options for urinary symptoms secondary to bph is shown here this slide lists some of the many resources available where you can find more information but the medical treatment of bph these current references were used to assist
In the preparation of this module all of these are available through your local medical library or the internet if you are interested in more detailed reading on this subject these additional references were also used to assist in the preparation of this module thank you again for viewing this presentation talk to your doctor if you would like to learn more about your condition
Transcribed from video
Medical Treatment fro Benign Prostatic Hyperplasia (BPH)/Lower Urinary Tract Symptoms (LUTS) By mdconversation
