Benign prostatic hyperplasia

what does hyperplasia mean

increased number of cells

what does hypertrophy mean

increased cell size

does BPH raise the risk of prostate cancer?

no

T/F BPH is the most common cause of lower urinary tract symptoms in men 50+

T

what are some risk factors for BPH

increasing age, race, genetics, bladder cancer

what occurs most in the inner prostate and outer prostate

inner = BPH, outer = malignancies

T/F “All men will have an enlarged prostate if they live long enough”

T

explain the pathophysiology of BPH

testosterone converted by 5-alpha reductase to dihydrotestosterone (5x potency of testosterone) = stimulates hormone growth factors = influences cell number + less commonly cell size = enlarged prostate

how are obese men impacted further

estrogens can further tip the scale in favour of cell proliferation. estrogens are present in adipose tissue.

How does BPH cause LUTS

enlargement of the prostate compresses urethra in addition to increased adrenergic tone causes outlet obstruction

what are the 2 main symptoms of BPH

failure to store urine, failure to empty the bladder

what lab testing can help you exclude cancer

prostate specific antigen (PSA)

severity of symptoms ____ (IS/IS NOT) related to prostate size

is not

which is more effective: surgical intervention or drug tx

surgical

what is the gold standard for surgical tx for BPH

TURP- transurethral resection of the prostate

what are some minimially invasive surgical techniques

TUMT- transurethral microwave thermotherapy, TUNA- transurethral needle ablation

what are some pros for using alpha blockers in treatment

sx improvement in 48hrs, effective regardless of prostate size, improve urinary flow

which one is more selective, prazosin or alfuzosin

alfuzosin

why do we slowly titrate prazosin

due to effects on BP

_____ has the highest rate of causing ejaculatory abnormalities

silodosin

what are the 5a reductase inhibitors, what can they help with

dutasteride, finasteride, help with prostate size, rates of urinary retention, urinary flow

how long does it take for 5a reductase blockers to work

6 months

what is the difference is half life of dutasteride and finasteride

dutasteride = 3-5weeks, finasteride = 6hrs

why does teratogenic matter for dutasteride/finasteride

female staff that handle the medication

when would you use tadalafil

erectile dysfunction + BPH

list some CAMS that can be used for BPH

beta-sitosterol, pygeum (african plum tree)

what are some non-pharmacological approaches to BPH

avoid cold temperatures, relax when urinating, restrict fluid intake at bedtime, stress reduction, no smoking, reduce coffee, avoid OTC antihistamines