BPH Flashcards
What are my chances of needing surgery for BPH?
Ball study: 2% AUR, 10% require surgery
Olmstead country study: 3% in 4 yrs
What did the PLESS STUDY REVIEW?
(PROSCAR - LT Efficiency & Safety Study (Proscar=Finasteride)
Multi centre RCT 1998
3000 men randomised finasteride or placebo for 4 yrs
Aim to examine LT benefit of finasteide in men with symptomatic BPH
What were the findings of the PLESS study?
Reduction in Prostate volume in finastide -18% vs Placebo +14%
Prostate volume reached nadir at 1yr
Symptom score and flow rate in finasteride showed improvement vs placebo
Finasteride - 57% reduciton in risk of AUR
55% reduction in progression to surgery
BAseline PSA predicted disease progression in men (PSA >7ng/ml)
What did the MTOPS study look at?
MTOPS - Medical therapy of Prostate Symptoms
Diuble blind placebo trialed assessing impact of medical therapy on BPH progression
Progression of >4pt rise in IPSS
Development of AUR
Need ofr surgery
INcontinence
Recurrent UTI
renal failure
4.5yr FU
3000 nen - mean vol 36 cc
(Placebo, doxazocin, finasteride, combined doxazocin and finasteride)
Waht did MTOPS find?
Combination therapy provided benefits compared to monotherapy
MTOPS: most important risk factors for clinical progression?
Prostate vol >30 cc
PSA > 1.5
ALSO - identified both treatment and placebo pts with stable PVR had lower risk of AUR than those rising after 4.5 yr FU
ComBAT study findings?
First time that 5ARI superior to alpha blocker in lowering IPSS and QMAx
Combonation superior to monotherapy
What is Benign prostatic hyperplasia?
Histological diagnosis characterised by increased NUMBER of prostate cells causing benign enlargement of prostate gland
What was the risk reduction in MTOPs study eith combined treatment (doxasosin & finasteride?
RR of 66%
According to the PLESS study, what was the reliable predictor for BPH progression?
PSA
What are the three storage symptoms on IPSS score?
Frequency, nocturia, urgency
(F.N.U.)
What are the 4 voiding symptoms on IPSS score?
Feelign of incomplete emptying, intermittancy, straining and weak stream
I.I.S.W
What did the Combat study reveal about the most common drug related side effect ?
In combined therapy - most common reported event was ED 9%
Other:
Retrograte ejaculation 4%
Dec libido 4%
Ejac fail 3%
Which alpha blocker subtype does tamsulosin block?
Alpha -1a
What are the main late complications of TURP?
62%-78% retrograde ejaculation
Stricture 4%
BN contracture 2%
REDO 2% per year
REDO 10% at 5yr
REDO 20% at 10 yr
