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<strong>Prostate</strong> Health<br />

Hani Rashid, MD<br />

Assistant Professor of Urology and Oncology


<strong>Prostate</strong> Health<br />

Overview<br />

• Screening<br />

• <strong>Prostate</strong> Role<br />

• <strong>Prostate</strong> <strong>Cancer</strong><br />

• Enlarged <strong>Prostate</strong><br />

• Questions?<br />

2


Men Live Sicker and Die Younger<br />

• Lower rates of Health coverage<br />

• Higher prevalence and death rates<br />

of 10 leading causes of death<br />

• Less health maintenance visits<br />

3


The Weaker Sex<br />

• 115 males conceived for every 100<br />

females<br />

• By age 36, males=females<br />

• By age 100, 8 females to every 1<br />

male<br />

4


<strong>Prostate</strong> Screening<br />

• <strong>Prostate</strong> <strong>Cancer</strong> #1 diagnosed cancer in<br />

men<br />

• BPH most common benign growth in<br />

men<br />

• <strong>Cancer</strong> and enlargement can lead to<br />

serious medical issues if left untreated in<br />

some patients.<br />

5


<strong>Prostate</strong> Anatomy<br />

6


<strong>Prostate</strong> Anatomy<br />

7


<strong>Prostate</strong>: Role<br />

• Secretory gland<br />

• Helps sperm<br />

• Prevents retrograde ejaculation<br />

• Helps continence<br />

•Issues with age<br />

8


<strong>Prostate</strong> <strong>Cancer</strong><br />

• 192,280 new cases this year<br />

• 23,360 deaths<br />

• 10% of all cancer deaths<br />

• 1 in 6 lifetime diagnosis<br />

• USUALLY NO SYMPTOMS<br />

• 2 million prostate cancer patients<br />

alive in US<br />

9


<strong>Prostate</strong> <strong>Cancer</strong>: Risk Factors<br />

• Age<br />

• Race/ethnicity<br />

• Family History<br />

• Nationality<br />

• Diet<br />

• Obesity<br />

• Exercise<br />

• Inflammation<br />

10


<strong>Prostate</strong> <strong>Cancer</strong>:<br />

Prevention<br />

• Screening:<br />

• General: PSA/DRE<br />

Age 50-75<br />

• Family History:<br />

Age 40-45<br />

• PSA controversy<br />

• Diet<br />

• Medication<br />

11


<strong>Prostate</strong> <strong>Cancer</strong>: Treatments<br />

• Active Surveillance<br />

• Cryotherapy<br />

• Radioactive Seed Implantation<br />

• External Radiation<br />

• Robotic Surgery<br />

• Testosterone blockade<br />

• Chemotherapy<br />

12


<strong>Prostate</strong> <strong>Cancer</strong> Prevention:<br />

Why and How?<br />

• Early diagnosis = cure<br />

• Late diagnosis=containment<br />

• PCP<br />

• Urologist<br />

13


Benign Prostatic Hyperplasia


<strong>Prostate</strong> <strong>Cancer</strong> Prevention:<br />

Why and How?<br />

• Early diagnosis = cure<br />

• Late diagnosis=containment<br />

• PCP<br />

• Urologist<br />

15


Negative Impact of BPH on Daily<br />

QOL Increases With Symptom<br />

Severity<br />

16


Potential Complications of BPH<br />

• Urinary retention<br />

• Renal impairment<br />

• Urinary tract infection<br />

• Gross hematuria<br />

• Bladder stones<br />

• Bladder decompensation<br />

• Overflow incontinence as a result of<br />

retention<br />

Jensen JV, et al. Urol Clin North Am. 1988;25:545-554.<br />

17


Potential Complications of BPH<br />

LUTS 1,2<br />

Bothersome<br />

Interference with daily<br />

activities and sexual<br />

function<br />

BPH<br />

(Benign Prostatic<br />

Hyperplasia)<br />

BOO 3<br />

(Bladder Outlet<br />

Obstruction)<br />

AUR<br />

Surgery<br />

Nonfunctioning bladder<br />

UTI<br />

Stones<br />

Renal failure<br />

1. AUA Practice Guidelines Committee. J Urol. 2003;170:530-547.<br />

2. Rosen R et al. Eur Urol. 2003;44:637-649.<br />

3. Lepor H, Lowe FC. In: Walsh PC et al, eds. Campbell’s s Urology. . 8th ed. Philadelphia, Pa: Saunders; 2002:1337-1377.<br />

18


AUA Symptom<br />

Index (AUA-SI)<br />

• Incomplete bladder emptying<br />

• Frequency<br />

• Intermittency<br />

• Urgency<br />

• Weak stream<br />

• Straining<br />

• Nocturia<br />

AUA Practice Guidelines Committee. J Urol. 2003;170(2 pt 1):530−537.<br />

Barry MJ et al. J Urol. 1992;148:1549−1557.<br />

19


Goals of Therapy for BPH<br />

Successful treatment of BPH results in:<br />

• Relieving Urinating Symptoms<br />

• Decreasing Bladder Outlet Obstruction<br />

• Improving bladder emptying<br />

• Ameliorating detrusor instability<br />

• Preventing progressive renal damage<br />

• Preventing further episodes of gross<br />

hematuria, UTI, and Retention<br />

Lepor H, Lowe FC. In: Walsh PC et al, eds. Campbell’s Urology. 8th ed. Philadelphia, Pa:<br />

Saunders; 2002:1337-1377.<br />

20


Treatment options for BPH<br />

21


Treatments for LUTS, BPH, BOO<br />

• Watchful waiting<br />

• Behavioral Changes<br />

– Diet<br />

– Weight loss<br />

– Exercise<br />

– Reduced Caffeine<br />

• Medical therapy<br />

– Phytotherapy<br />

– 5α-reductase inhibitors<br />

– α-blockers<br />

– Combination therapy<br />

• Office-based treatment<br />

– Microwave<br />

– Laser or radiofrequency<br />

• Hospital-based<br />

treatment<br />

– TURP<br />

– Laser surgery<br />

– Robotic surgery<br />

– Open surgery<br />

22


Summary<br />

• Men die earlier than women<br />

• One issue is lack of screening and<br />

health maintenance<br />

• <strong>Prostate</strong> cancer and enlargement very<br />

common<br />

• Early diagnosis can prevent future<br />

morbidity and mortality<br />

• See your doctor or urologist regularly<br />

23


Questions?<br />

24

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