Benign Prostatic Hyperplasia (BPH)

Question 1

What is the function of the prostate?

Answer 1

• Sits right below the bladder and secretes fluid to help with making seminal fluid for sperm

Question 2

What is the way that testosterone is metabolized?

Answer 2

• By 5 alpha reductase into dihydrotestosterone (DHT)

DHT helps with normal and hyperplastic growth (responsible for BPH)

Question 3

What are the symptoms and complications of BPH?

Answer 3

• Hesitancy, intermittent unrine flowm, straining or a weak stream
• Urinary urgency and leaking or dribbling
• Increased frequency (especially at night)

Question 4

What are some natural products that could help with BPH?

Answer 4

• NO natural products for the treatment of BPH but…
• Saw Palmetto has been used (so has pygeum, pumpkin seeds, rye pollen)
• Lycopene is used for prostate cancer prevention

Question 5

What are some of the medication treatment options that are used for BPH?

Answer 5

• Alpha blockers (1st line)
• +/- 5 alpha reductase inhibitors
• +/- Peripherally acting anticholinergics (tolterodine)
• +/- Beta 3 Receptor agonist (mirabegron)
• PDE-5i +/- finasteride (good with BPH & ED)

Question 6

What is the MOA of the alpha-blockers used for BPH?

Answer 6

• inhibit alpha-1 receptors causing relaxation of smooth muscle in the prostate = reduction of bladder obsturction and improves urinary flow

Question 7

Where are alpha receptors normally found within the body?

Answer 7

• Alpha-1A = prostate & iris
• Alpha-1B & 1D = Heart & Arteries

Why the NON-selective alpha blockers (terazosin, doxazosin) have more side effects than the selective Alpha 1A blockers (tamsulosin, alfuzosin, silodosin)

Question 8

What is intraoperative floppy iris syndrome and what should be done to prevent this?

Answer 8

• Alpha receptors are found in the iris; using 5a-reductase & cataract surgery increase risk of iris to be floppy
• If cataracts surgery is planned, the alpha blocker MUST be stopped before

Question 9

What are the nonselective alpha 1A blcokers that are used for BPH?

Answer 9

• Doxazosin (Cardura) bedtime dosing
• Terasozin bedtime dosing

Question 10

What are the selective alpha 1A blockers that are used for BPH?

Answer 10

• Tamsulosin (flomax) + Dutasteride (Jalyn)
• Alfuzozin (Uroxatral)
• Silodosin (Rapaflo)

Question 11

What are some warnings for Alpha Blockers used for BPH?

Answer 11

• Orthostatic hypotension/fainting with 1st dose, therapy is interrupted, dose increased too much or if taing PDE-5i
• Floppy Iris (IFIS) with cataracts surgery

Question 12

What are some side effects for alpha blockers used for BPH?

Answer 12

• Dizziness, fatigue, headache, abnormal ejaculation

Question 13

What are some additional notes for alpha blockers used for BPH?

Answer 13

• Non-selectives: given at bedtime (minimize the orthostasis/dizziness)
• DO NOT shrinky dink prostate or change PSA levels (LUTS may take ~4-6w to dissappear)
• Silodosin can cause retrograde ejactuation

Question 14

What is the MOA for the 5 alpha reductase inhibitors used foBPH?

Answer 14

• inhibit 5 alpha reductase, which blocks the conversion of testosterone to dihydrotestosterone

Question 15

What is important to know about the combination of the 5 alpha reductase inhibitors with other BPH medications?

Answer 15

• Combo with alpha blockers to improve symptoms, decrease risk of urinary retention and decrease need for surgery

Prostatectomy

Question 16

What are the 5 alpha reductase inhibitors that are used for BPH?

Answer 16

• Finasteride (proscar) [Propecia - alpecia]
• Dutasteride (avodart) + tamsulosin (jalyn)

Question 17

What are some contraidications for 5 alpha reductase inhibitors used for BPH?

Answer 17

• Women of childbearing potential
• Pregnancy

Question 18

What are some side effects for 5 alpha reductase inhibitors used for BPH?

Answer 18

• Impotence, decrease libido, ejaculation disturbances, breast enlargment and tenderness

Question 19

What are some additional notes for 5 alpha reductase inhibitors used for BPH?

Answer 19

• Pregnant women should not take or handle
• Treatment of 6 months to see max efficacy
• WILL shrinky dink the prostate and PSA levels

Question 20

What are the PDE-5 inhibitors that are used for BPH?

Answer 20

• Tadalafin (Cialis)
• SHOULD NOT be used with an alpha blocker (increased risk of Hypotension)

Question 21

What are some contraindication for Tadalafil used for BPH?

Answer 21

• DO NOT use with Nitrates

Question 22

What are some warnings for Tadalafil used for BPH?

Answer 22

• Impaired cooor discrimination (basically color blindness)
• Hearing loss, vision loss, hypotension
• Priapism (erection lasting < 4H)
• Chest pain = medical help asap

Question 23

What are some side effects for Tadalafil used for BPH?

Answer 23

• headache, flushing, dizziness, dyspepsia
• Back pain with tadalafil