BPH

Source: JAPPA, uptodate
Benign prostatic hyperplasia
Epidemiology: 50% of men by 50, 90% by 80
Cause: increase in DHT, Age related hormonal changes, cytokines (inflammation)
Risk Factors: Age, black, DM, family hx, obesity. Lifestyle may influence progression
– sx caused by compression of urethra due to enlargement of prostate
Symptoms: frequency, urgency, nocturia, incontinence, difficulty intiating, dribbling, slow flow
Diagnosis:  of exclusion: take good history, use questionnaires (IPSS or AUASI), Digital rectal exam (DRE) -> asses for size, shape, consistency, PSA of 1.5 or so (very variable), UA (exclude other causes), postvoid residual volume measure, U/S
TREATMENT -> based on severity, goal to improve quality of life and reduce complications
  1. watchful waiting
  2. Alpha-adrenergic receptor antagonist = 1st line medication,
    1. mechanism smooth muscle relaxation
    2. side effect ->hypotension, dizziness, fatigue, HA, dry mouth/eye, ED
    3. Tamsulosin (Flomax) = selective -> 0.4 mg daily, can increase to 0.8 after 2 -4 weeks
    4. terazosin = nonselective ->treat pt with BPH and hypertension
      1. 1 mg at bedtime, titrate up over weeks to 10mg
    5. don’t prescribe if pt planning on cataract surgery
  3. 5-alpha-reductase inhibitors = blocks conversion of testosterone to DHT
  1. finaseride (Proscar for BPH, Propecia for hair loss) 5 mg daily (1mg for baldness)
  • Cialis (Tadalafil ->phosphodiesterase-5 inhibitor)  -> 5mg daily
  1. for ED dose is 10 – 20mg for as needed and 2.5mg for daily use
  • Anticholinergic = Add on to alpha-adrenergic if needed
    1. example = Oxybutynin -> 5 to 10mg daily extended release
  • Saw Palmetto -> herbal  – mixed data on efficacy