MAC00031-01 Rev G Financial support for this seminar has been provided by NeoTract, Inc., the manufacturer of the UroLift® System.

The Enlarged Prostate Symptoms, Diagnosis and Treatment

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Today’s Agenda

• What is BPH

• How it is diagnosed

• What are the treatment options

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Overview of the Prostate

• Walnut sized gland at base of the male bladder

• Surrounds the urethra

• Produces fluid that transports sperm during ejaculation

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BLADDER

PROSTATE

URETHRA

Anatomy of a Prostate Over Time

The prostate grows to a normal size in teenage years and then begins to grow again around the age of 50

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PRO

STAT

E SI

ZE

Age 1 Age 15 Age 50 Ag 75 Age 5 Age 10 Age 25 Age 35

Prostate Conditions

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Prostatitis • Swelling/Inflammation of the prostate

Prostate Cancer

• Very common cancer among men • Typically a slow growing cancer

Enlarged Prostate • Enlargement of the prostate gland

Each condition affects the prostate differently Having one condition does not mean

you will have another

Aging and the Prostate

• Affects nearly 40 million men each year in the United States

• By age 60, 70% of all men have an enlarged prostate • Affects nearly 90% of men by age 80

Berry, et al., J Urol 1984 Roehrborn, et al., Prostate Cancer and Prostatic Diseases 2006; 2015 U.S. Census population estimates

40 60

Age 50

70

30

Age 60

90

10

Age 80

% of Men with BPH

% of Men without BPH

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What is BPH?

• Benign Prostatic Hyperplasia (BPH) is the clinical term for enlarged prostate

• Non-cancerous enlargement of the prostate gland – BPH is not an indication or a predictor of cancer

– PSA rises with both BPH and prostate cancer, so PSA alone cannot tell you which is the issue

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Normal vs. Enlarged Prostate

• As the prostate enlarges, pressure can be put on the urethra • Causes urinary problems • In general, the size of the prostate does not correlate to

severity of symptoms

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Normal Prostate Anatomy Enlarged Prostate (BPH) Anatomy

HYPERTROPHIED DETRUSOR

MUSCLE

OBSTRUCTED URINARY FLOW

PROSTATE

BLADDER

URETHRA

Roehrborn CG, McConnell JD. In: Walsh PC et al, eds. Campbell’s Urology. 8th ed. Philadelphia, Pa: Saunders; 2002:1297-1336.

What Happens if BPH is Not Treated?

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Not treating enlarged prostate can lead to bladder deterioration

BPH Disease Progression

10 Images courtesy Dr. Steven Gange

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

11 Abrams, et al., Neurourology and Urodynamics 2002; Maximilian, et al., BJU Intl 2012

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

12 Abrams, et al., Neurourology and Urodynamics 2002; Maximilian, et al., BJU Intl 2012

For nearly half of men in the U.S. with BPH, their symptoms are severe enough to disrupt

their lifestyle and cause them to seek treatment

How is an Enlarged Prostate Diagnosed?

• Medical history • Physical exam

– Bladder scan (Ultrasound) • residual urine assessment

– Digital Rectal Exam (DRE) • approximate prostate size • texture and symmetry

• Symptoms – AUA Symptom Score • How much of a bother is it to you?

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How is an Enlarged Prostate Diagnosed?

Optional Studies • Uroflow • Pressure flow studies • Transrectal Ultrasound (TRUS)

– With or without biopsy

• Cystoscopy

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International Prostate Symptom Score (IPSS)

Symptoms • Incomplete bladder

emptying • Frequency • Intermittency • Urgency • Weak stream • Straining • Nocturia

15 Abrams P et al. The standardisation of terminology of lower urinary tract function. Report from the International Continence Society. Am J . Obstet. Gynecol 2002 187: 116-126.

0-7 | Mild

8-19 | Moderate

20-35 | Severe

Regardless of the score, if your symptoms are bothersome you

should notify your doctor

How is the IPSS scored?

0-6

How is Quality of Life scored?

Treatment Options for Enlarged Prostate

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Different treatments are appropriate for different patients

Advantages • No surgery • Cheaper than drugs • No side effects

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Watchful Waiting

Disadvantages • May not have

symptom improvement • Risk that symptoms

will worsen

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Medication Flomax, Avodart, Duodart, Cialis

Medications/Herbal Remedies

Herbal Remedies

AUA Guidelines 2010, 2003 *Side effects may vary depending on medication type.

Advantages • No surgery • May provide enough symptom relief

Disadvantages • Must be taken daily, from now on • Potential side effects*

– Lowered sexual drive, erection problems, ejaculation problems, dizziness, lack of energy

• High out-of-pocket cost • Over time may stop working

Advantages • No surgery • No drugs • No side effects

Disadvantages • May not have symptom improvement –

none have shown benefit in clinical trials • Risk that symptoms will worsen • Potential down stream issues

– Bladder stones; bladder health, kidney function

• Future treatments may be less effective

Roehrborn Urology Clinics 2016 McVary et al. J Sex Med 2013 Shore et al. Can J Urology 2014

Advantages • In-office procedure • Preserves sexual function

– No new and lasting problem with erections or ejaculation

• Rapid, durable relief – Typically return to

normal within 5-9 days • Typically no catheter

Disadvantages • Some discomfort • Potential for blood in urine • Increased urgency

after procedure

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Prostatic Urethral Lift (PUL) The UroLift® System

How PUL Works

The delivery device is placed through the urethra to access the enlarged prostate.

The delivery device is removed, leaving a more open urethra.

Implants are placed through a needle that comes out of the delivery device to hold the enlarged prostate tissue out of the way.

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AUA Guidelines 2010, 2003 21

Heat & Steam-Based Therapies TUMT – Microwave; TUNA – Radiofrequency; Rezum

Advantages • In-Office procedure • Oral sedative • Paid by most insurers • Fewer side effects

than surgery

Disadvantages • Catheter for days

after treatment • 4-6 weeks until symptom relief • Potential for sexual dysfunction

How Heat & Steam Based Therapies Work

http://www.prostatetreatmentindore.in/treatment-of-prostate-cancer.php 22

Advantages • Maximizes flow and symptom relief • Removes prostate tissue • Durable • Low retreatment rate

AUA Guidelines 2010, 2003

Major Surgery TURP – Resection; Greenlight – Laser Vaporization

Disadvantages • Hospital procedure with general or

regional anesthesia • TURP requires hospitalization

– Laser shows less bleeding and typically no overnight hospital stay

• Catheter for 1-5 days • 6 weeks restricted activity • 10% have erectile problems • 40%-65% lose ejaculation • 3% incontinence • 7% strictures

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How TURP & Laser Based Therapies Work

24 https://www.indiamart.com/thechennai-speciality-klinic/endourology.html

What Next?

• Pay attention to your symptoms before your appointment – Each solution has unique risks, benefits, and costs – Let’s find the right solution for YOU!

We are here to help improve your quality of life!

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Questions?

MAC00031-01 Rev G Financial support for this seminar has been provided by NeoTract, Inc., the manufacturer of the UroLift® System.