Medical Treatments for BPH Video Transcript

Participants

, Christophe Dixon MD, Paul J. Moniz , Robert Salant MD

Summary

Although prostate enlargement is a normal part of the aging process, benign prostatic hyperplasia -- BPH -- can sometimes lead to uncomfortable and even painful symptoms. Fortunately, there are a variety of medical treatments that can help. Join our panel of experts as they discuss the advantages and disadvantages of these treatment strategies.

Webcast Transcript

PAUL MONIZ: I'm Paul Moniz. Thanks for being with us. If you have an enlarged prostate, you know it can be miserably uncomfortable turning routine urination into a chore. While little can be done to prevent your prostate from enlarging, it is part of the aging process for most men, there are medical treatments available to alleviate symptoms of BPH, or Benign Prostatic Hyperplasia.

Here to tell us about those treatments are two urologists. We have Dr. Christopher Dixon. He is an Assistant Professor of Urology at the NYU School of Medicine. He is also the co-director of the Prostate Center at NYU. Dr. Dixon, thanks for being here.

We also have Dr. Robert Salant, a Clinical Associate Professor of Urology at the NYU School of Medicine. He is also affiliated with Beth Israel Medical Center, Cabrini Medical Center and Hospital for Joint Diseases, all in New York City.

Dr. Salant, even before surgery is considered, there are patients or even before medicines are considered, I should say, there are patients who don't even want to take that. What can be done before medicines are put into the line of therapy here?

ROBERT SALANT, MD: Once a diagnosis of a prostatic enlargement is made, basically your treatment will depend upon the level of symptoms. For men who have enlarged prostates with minimal to mild symptoms, you may treat them with what we euphemistically call "watchful waiting." This is basically just keeping an eye on their symptoms, having examinations on an annual basis, and seeing how the symptoms change over time.

We have here a symptom score sheet which is a seven-question questionnaire that is self-administered, that the patient fills out and gives the urologist subjective information on how the patient is urinating and how the symptoms are interfering with the patients lifestyle. Th last question is actually a question related to the quality of life. Here the patient will tell us how much his symptoms are bothering him.

You may have two patients with very similar symptoms, one of whom is quite comfortable with the symptoms, the other who absolutely needs to be treated.

PAUL MONIZ: From this you can determine a course of action in addition to diagnostic tests and digital rectal exam. You could do a digital rectal exam on someone, find an enlarged prostate but that person may not have any symptoms. Is that right?

ROBERT SALANT, MD: Correct. Size is just one factor that goes into the constellation of symptoms that can create problems for the patient. Having an enlarged prostate and having a very enlarged prostate does not necessarily correlate with the amount of blockage or obstruction that the patient will experience.

PAUL MONIZ: Now we should add that that digital rectal exam should begin at age 40 yearly for all men, right?

ROBERT SALANT, MD: Yes.

PAUL MONIZ: And generally, that is for prostate cancer screening.

ROBERT SALANT, MD: The rectal examination does a few things one of which is to screen for prostate cancer which is an absolute. That must be done once a year starting at the age of 40. The other thing it does is give the urologist a handle on the size of the prostate which can be followed over time. You can see if there has been a significant change. Certainly prostate cancer screening is the most important thing.

PAUL MONIZ: Dr. Dixon, at which point do you begin medical treatment and we should add that prostate enlargement has nothing to do with prostate cancer. Is that correct?

CHRISTOPHER DIXON, MD: The two conditions, cancer and BPH (benign prostatic hyperplasia) are really two separate processes that can occur in the same prostate for that matter. The decision to treat, I think, sort of steps back may be one or two steps.