Benign Prostate Hyperplasia (BPH) Flashcards
What is the function of the prostate?
Contributes for about 25% of ejaculate
What does the prostate contribute to the ejaculate?
Citric acid
G proteolytic enzymes - eg. prostate specific antigen (PSA)
G seminal plasmin
What is citric acid used for?
Provides sperm with energy
What is PSA used for?
Help facilitate sperm motility via liquefaction of seminal fluid
Dissolving cervical mucus
What is G seminal plasmin used for?
Sperm motility
Potent antimicrobial activity
What is PSA?
Glycoprotein enzyme secreted by epithelial membranes of prostate cells
What happens to PSA with age?
Increases
Also increases with size of prostate
Why does the prostate tend to get bigger with age?
Age
Tissue remodelling
Hormonal effects
Metabolic effects
Inflammation
What happens with age?
Larger prostate + lower flow of rates of urine
How does tissue remodelling increase the prostate?
The balance between cell growth + apoptosis is disrupted
How does hormonal effects increase the prostate?
Androgen is the main regulator in stimulating proliferation + inhibiting apoptosis
How does inflammation increase the prostate?
Inflammation within prostate triggers cytokine release + resultant healing responses = proliferative environment dominant
What are the symptoms?
Lower tract urinary symptoms (LUTS)
Voiding symptoms
Storage symptoms
Acute/chronic urinary retention
What are voiding symptoms?
Hesitancy associated with resistance to urinary flow
Poor urinary flow = increased time to urinate
Incomplete bladder emptying = increased times at toilet
What are storage symptoms?
Urgency
Polyuria during day + night
What can cause an acute/chronic urinary retention to develop?
Bladder outflow obstruction
Very painful
= chronic UTI
How do you diagnose?
International prostate symptom score (IPSS)
Medical + drug history
Physical examination = bladder + rectal
Urine dipstick test
Complete urine frequency chart
Assessment of serum creatine if renal impairment suspected
What are the scores for IPSS?
0-7 = mild
8-19 = moderate
20-35 = severe
What is the focus of treatment?
Control LUTS
Minimise impact on QoL
Reduce other issues - eg. hospital admission + recurrent UTI
What can be lifestyle issues?
Not adequate fluid intake
Drinking large amounts of fluids
Medication on symptoms
Food + drinks containing active substances
What is the pharmacological management?
Reduce smooth muscle tone
Alter size of prostate
What are the first drugs used?
Alpha blockers
Where does alpha-1 + alpha-2 receptors exist?
Both in bladder
Alpha-2 in CVS
What are examples of alpha blockers?
Tamsulosin
Doxazosin
Alfuzosin
Terazosin
What does alpha blockers do?
Improve IPSS = improve urinary flow
BUT do NOT alter prostate size
What is the problem with alpha blockers?
Older agents cause more cardiovascular problems = first dose hypotension = taken at night
What are the adverse effects of alpha blockers?
Postural hypotension
Headache
Dizziness
Drowsiness
Sweating
What are some adverse effects of alpha blockers caused by?
Initial doses
= first doses taken bedtime = patient lying down
Who is Tamsulosin OTC licensed for?
Men aged 45-75 years
What is the dose of Tamsulosin OTC?
400 microgram dosage units
How long can Tamsulosin OTC be taken for?
6 weeks before clinical assessment by doctor
When should a patient see a doctor when using Tamsulosin OTC?
After 14 days if symptoms have not improved
What is the second drug?
5-alpha reductase inhibitors (5ARIs)
What does 5ARIs do?
Stop the conversion of testosterone to dihydrotestosterone (DHT)
How does 5ARIs benefit?
Improve IPSS
Reduce PSA
Reduce likelihood of requiring surgery
Reduce prostate volume
What does Dutasteride inhibit?
5ARI
I + II
What does Finasteride inhibit?
II
What are the adverse effects of 5ARIs?
Loss of libido
Impotence
Ejaculatory dysfunction
Breast tenderness
What is the problem with 5ARIs?
Drug is present in sperm + women of child bearing age should NOT be exposed to it
Either through intercourse or handling broken tablets
Why combine the treatment?
Reduce progression
Improve symptom score
Improve LUTS
Improve prostate size
Who is the combined treatment for?
Men with worsening LUTS + large prostates
Estimated over 30g
What are the surgical interventions?
Transurethral resection of prostate (TURP)
Transurethral incision of prostate (TUIP)
Laser prostatectomy
