Prostate Disorders

Question 1

What is BPH?

Answer 1

The overgrowth of prostate gland cells

Question 2

Where does the enlargement of the prostate occur?

Answer 2

In the transition cells between the bladder and the anus

Question 3

Where is the prostate located?

Answer 3

The prostate surrounds the urethra and when enlarged, affects urination due to the constriction caused by the overgrowth of cells not supposed to be present during that time.

Question 4

What hormonal change occurs that can cause the prostate to rise?

Answer 4

As men age testosterone levels lower and estrogen rises. Estrogen has been found to escalate BPH because it promotes cellular prostatic growth.

Question 5

Who has a lower chance of BPH?

Answer 5

Those males who have their testicles removed

Question 6

What hormone is derived from testosterone in the prostate?

Answer 6

DHT

Question 7

What does DHT do?

Answer 7

Encourages growth of prostatic cells

Question 8

What are some indications for medication use regarding BPH?

Answer 8

Decreased urination - incomplete emptying of the bladder
Urinary urgency or frequency - dribbling during urination
Decreased urinary stream
Pelvic pain and bladder distention
Increased UTI

Question 9

What can be done for BPH before medication therapy?

This is first-line therapy

Answer 9

Lifestyle modifications
Watch and wait approaches
No medical treatments
Limitations on fluids
Void frequently
Massage prostate after intercourse

Question 10

Second-Line therapy:

What medications are used for the treatment of BPH?

Answer 10

5-Alpha Reductase Inhibitor

Alpha Adrenergic Inhibitor

Question 11

How do 5-Alpha Reductase Inhibitors work?

Answer 11

5-Alpha Reductase inhibitors work by blocking the enzyme that activates testosterone in the prostate. Inhibiting the conversion of testosterone to DHT thus impairs the prostate growth and enlargement.

Question 12

What are 2 examples of 5-Alpha Reductase inhibitors?

Answer 12

Proscar (finasteride)

Avodart (dutasteride)

Question 13

How do Alpha Adrenergic inhibitors work?

Answer 13

Alph Adrenergic inhibitors work by relaxing smooth muscles of the prostate and the bladder.
They are considered functional antihypertensives due to its action
**These take up to 6 months to see improvements

Question 14

What are 3 examples of Alpha Adrenergic inhibitors?

Answer 14

Hytrin (terazosin)
Cardura (doxazosin)
Flomax (tamulosin)

Question 15

What is the third-line treatment for BPH?

Answer 15

Combination therapy (5 Alpha Reductase inhibitors and Alpha Adrenergic inhibitors)

Question 16

What is a consideration when taking Hytrin?

Answer 16

Take at night to avoid postural hypotension

Question 17

What is a consideration when taking Cardura (doxazosin)?

Answer 17

benefits for BPH and cardiac disease; caution in those with CHF, hepatic or renal impairment

Question 18

What is a consideration when taking Flomax (tamulosin)?

Answer 18

Higher dosages may cause erectile dysfunction

Question 19

What is a consideration when taking Proscar (finasteride)?

Answer 19

It may take up to 6 months to see improvement of symptoms

Question 20

What is a consideration when taking Avodart (Dutasteride)?

Answer 20

It may take up to 6 months to see improvement of symptoms

Question 21

What are some alternative therapies or lifestyle modifications that can be done to treat BPH?

Answer 21

Weight loss
Low-fat diet
Avoid fluid intake 1-2 hours before bed
Avoid use of caffeine, diuretics, alcohol, which can excite the bladder
High-fiber diet
Increase water intake to at least eight 8 OZ glasses

Question 22

What are some supplements or herbal treatments for BPH?

Answer 22

Saw Palmetto
Pygum 50-100 mg BID
Zinc: 150 mg/day for 2 months then reduce to 50-100 mg/day as a maintenance therapy

Question 23

What are the goals of therapy for BPH?

Answer 23

Improvement of urinary stream
Reduce urinary urgency and frequency
Improve quality of life as it relates to urinary health
control the hyperplasia and managing symptoms overall