1. BPH Patient Education Seminar
Learn about Enlarged Prostate Solutions
Presented by {Physician Name}

2. Understanding the Prostate
Bladder
Urethra
Pubic Bone
Testes
Penis
Rectum
Prostate

3. Common Symptoms of Prostate Disorders
Increased frequency of urination especially at night
Sudden or urgent need to urinate
Painful or difficult urination
Slow flow of urine and difficulty in stopping
Terminal dribbling or leaking
Incomplete emptying of the bladder

4. Protecting Your Prostate
High levels of stress, obesity cigarette smoking and inactivity have all been linked with increased risk of prostate disease1
Reduce stress
Eat healthy
Keep active
Quit smoking/tobacco use

5. Assessing Your Prostate Health
Begin regular prostate exams at age 50 (or sooner if you are experiencing symptoms or have high-risk factors)
Know your Urology numbers
AUASS is the American Urological Association Symptom Score demonstrates symptom severity of BPH
Prostate Specific Antigen (PSA) indicates issues with the prostate including cancer
Testosterone Level is central to a man’s sex drive, energy level, muscle strength and bone density

6. Common Disorders
Prostatitis - Swelling or infection of the prostate gland
Low Testosterone - decreased functional activity of the testes
Erectile Dysfunction – Inability to maintain an erection sufficient for satisfying sexual activity
Benign Prostatic Hyperplasia – Enlargement of the prostate gland
Prostate Cancer - Malignant (cancerous) cells form in the prostate tissue

7. Enlarged Prostate: Most Common Condition
BPH is in the top 10 of the most commonly diagnosed diseases in men over the age of 502
50%+ of men in their 50s experience BPH symptoms3
90% of men in their 70s and 80s experience BPH symptoms3

8. What is Benign Prostatic Hyperplasia(BPH)?
Prostate cells begin to increase in number
Compresses the urethra making it difficult to urinate
Not cancerous or life threatening
Can be very bothersome and impact quality of life
Can progress to more serious conditions
Very common in men over 50 and advances with age

9. Normal Male Anatomy
Bladder
Urethra
Prostate Gland

10. Male Anatomy with Enlarged Prostate
Bladder
Blocked Urethra
Enlarged Prostate Gland

11. BPH Signs and Symptoms Waking at night to urinate Frequent urination
Sudden, uncontrollable urges to urinate
Straining to start urinate
Weak urine flow
Dribbling after urination
Feeling bladder is not completely empty
Pain during urination

12. Potential Medical Consequences of BPH
Urinary retention
Urinary tract infections
Bladder stones
Blood in the urine
Incontinence
Decreased kidney function
Derived from Benign enlargement of prostate. ADAM Health Illustrated Encyclopedia. Accessed Oct. 21, 2010

13. Physician Evaluation Physical exam Symptom score rate Urinalysis
Serum PSA
Flow Rate
Post-Void Residual

14. Patient Assessment & Testing
AUA Guidelines
Patient Assessment & Testing
Mild Symptoms?
AUASS <= 7 Or Not Bothersome
Moderate/Severe Symptoms?
AUASS >= 9 or Bothersome
Watchful Waiting
Discuss Treatment Options
Medical Therapy
In-Office Therapy
Surgery

15. Treatment Options Watchful Waiting Medication In-Office Therapy
Surgery

16. Watchful Waiting Symptoms are fairly mild or not bothersome
Ongoing assessments once or twice a year
Monitor symptom progression
Check disease progression
Check for infection and kidney/bladder stones

17. Herbal Supplements
Not recommended by the American Urological Association4
No evidence of efficacy4
May increase your risk of bleeding or interfere with other medications you're taking4
Most popular supplements
Saw palmetto extract
Beta-sitosterol extracts
Pygeum
Ryegrass extract
Stinging nettle extract

18. Drug Therapy Common Options Drugs: Most Common Treatment Option
Alpha-blockers
(Cardura, Flomax)
5-ARIs
(Avodart, Proscar)
Combination Therapy
(Jalyn)
Drugs: Most Common Treatment Option
94% of patients are treated with prescription medications, but 48% of patients do not show clinically significant symptom improvement5

19. Medication – Possible Side Effects
Alpha-Blockers
5 ARIs
Reduced blood pressure
Headache
Nasal congestion
Pounding heartbeat
Nausea
Weakness
Weight gain
Floppy iris syndrome (IFIS)
Erectile dysfunction
Lowered sexual drive (libido)
Decrease in semen released during ejaculation
Decrease PSA levels
As with most medical procedures, there may be some side effects associated with in-office BPH therapies. This list is not a complete list, but represents the most commonly reported side effects that were experienced during the clinical studies that were used to approve these procedures. It is important to note that in most cases these side effects were temporary or mild and required minimal or no medical intervention. If you decide to pursue in-office BPH therapy, we can discuss your specific medical condition including benefits and risks when you come to my office.
Note: This list represents the most commonly reported side effects. Please discuss any questions you may have with your physician. Your physician can also provide you with a comprehensive list of all potential side effects.

20. Drug Therapy Advantages
Simple to use
Fast symptom relief (Alpha-blockers)
Does not require surgery, anesthesia or a hospital stay (or associated side effects)
Low rate of side effects
Covered by Medicare and many private insurance companies

21. In-Office BPH Therapy Common Options:
Transurethral Microwave Therapy (TUMT) (Cooled ThermoTherapy)
Targeted heat to reduce excess prostate tissue in large glands8
Transurethral Needle Ablation (TUNA) (Prostiva RF Therapy)
Precisely targeted low-level RF energy for small glands or atypical prostates9

22. During the Treatment Pre-procedure preparation 15-20 minutes
Medications given for relaxation and comfort
Comfort levels are generally tolerable and reported between a 2-3 on a 10 point pain scale6
New prostatic blocks being performed that may eliminate discomfort completely
Procedure time usually less than 30 minutes
Recovery time generally minutes and will include post treatment instructions

23. After Treatment Go home shortly after treatment
Urinary catheter or temporary stent may be required for a few days7,8
Return to normal activities within hours8,9
Symptom improvement generally seen within 8 to 10 weeks of the treatment8,9
Lasting and significant relief from your symptoms6,7 .

24. In-Office Therapy Advantages
Very effective at relieving symptoms6,7
Proven long-lasting results6,7
Can eliminate need for chronic medication
Lower risk than invasive surgical procedures
Completed in urologist office in less than an hour - no hospitalization, general anesthesia or long recovery time
Quick return to normal activities
Low rate of side effects8,9
Covered by Medicare and many private insurance companies

25. In-Office Therapy – Possible Side Effects
TUMT
TUNA
Hematuria
Dysuria
Blood in urine
Clots in urine
Painful or difficult urination
Rectal irritation
Temporary inability to control urination
Inability to discharge semen in orgasm
Brief inability to achieve or maintain an erection
Obstruction (blockage)
Bleeding
Blood in Urine
Pain/Discomfort
Urgency to Urinate
Increase Urinary Frequency
Urinary Tract Infection
As with most medical procedures, there may be some side effects associated with in-office BPH therapies. This list is not a complete list, but represents the most commonly reported side effects that were experienced during the clinical studies that were used to approve these procedures. It is important to note that in most cases these side effects were temporary or mild and required minimal or no medical intervention. If you decide to pursue in-office BPH therapy, we can discuss your specific medical condition including benefits and risks when you come to my office.
Note: This list represents the most commonly reported side effects. Most of these side effects were temporary or mild and required minimal or no medical intervention.
Please discuss any questions you may have with your physician. Your physician can also provide you with a comprehensive list of all potential side effects.

26. Surgery Common Options Transurethral Resection of the Prostate (TURP)
Surgical removal of part of an enlarged prostate gland
Button TURP
Prostate tissue removed through vaporization
Laser
Photoselective Vaporization (PVP or GreenLight)
Holmium Laser Prostatectomy (HoLAP)
A laser (concentrated light) is used to generate intense heat to shrink or remove excess tissue

27. Surgery Advantages Immediate symptom relief10,11
Long history of success (TURP)
Can eliminate need for chronic medication
Covered by Medicare and many private insurance companies

28. Surgery Possible Risks/Side Effects
TURP10
LASER11
Anesthesia issues
Intracapsular perforation
TUR Syndrome
Transfusions
Post-op pain/discomfort
Infection
Retrograde ejaculation
Erection problems
Painful Urination
Temporary difficulty urinating
Urinary tract infection
Narrowing of the urethra
Retrograde Ejaculation
Erectile Dysfunction
Please discuss any questions you may have with your physician. Your physician can also provide you with a comprehensive list of all potential side effects.

29. A Winning Solution Urinary symptoms are a normal part of aging
There are treatment options that can help you restore your quality of life
If you are dissatisfied with your current therapy, please speak with your physician about what other therapies might be suited for you
That’s in-office procedure advantage.
Imagine life without the bother and frustration of BPH symptoms thanks to a safe, proven, non surgical treatment . . .
That provides lasting relief without the side effects or high cost of medication.
Therapies are performed in the comfort of my office . . .
Without invasive surgery or the added risk of general anesthesia.
The result is a happier you, able to do all the things you love to do without worrying about BPH symptoms – or the problems caused by chronic BPH medications.

30. Common Questions How comfortable will I be during the procedure?
Are the results long-lasting?
Are the procedures covered by my insurance?
Before I take your questions. I thought I’d answer a few questions that many men like you have asked.
The first question many men ask is whether the procedure is comfortable.
While individual responses vary, in my experience most patients do feel a heating sensation and often experience the need to urinate during the procedure.
Based on your feedback during the procedure, I have options to help minimize discomfort.
I may also administer oral medications or a local anesthesia before the procedure to help keep you comfortable during the procedure.
Another questions I get is are the results long-lasting.
Cooled ThermoTherapy and Prostiva RF Therapy have been proven to provide high quality, long lasting results based on lower symptom scores, higher urinary flow rates, and improved quality of life.1,2
Studies show a significant and lasting improvement through 5 years following treatment with recent data showing only 9% or 14%, respectively, of patients needing any further procedures for their enlarged prostate1,2.
Sometimes people are worried about the expense of in-office procedures and whether or not insurance will cover the procedures.
Cooled ThermoTherapy and Prostiva RF Therapy are one-time procedures that can eliminate the need to take chronic BPH meds forever. As some of you already know, chronic BPH medications must be taken daily and may cost hundreds of dollars annually.
Medicare and many commercial insurance plans provide coverage.
My office will assist you in providing the information your insurance plan may require.
Are there any questions that you have about enlarged prostate that I can answer for you?

31. REMINDER: Complete and turn in the response cards!
For the Physician’s Office
For Urologix

32. Thank you!

33. References
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Fenter TC, Naslund MJ, Shah MB, et al. The cost of treating the 10 most prevalent diseases in men 50 years of age or older. Am J Manag Care. 2006;12(4 suppl):S90-S98.
National Institute of Diabetes and Digestive and Kidney Diseases. Prostate enlargement: benign prostatic hyperplasia. NIH Publication No June 2006.
Wei, et al. High Rates for Continued BPH Medical Therapy among Non responders, AUA2010 Abstract 498
Mynderse, L., et al. 5 year Results of a Multi-Center Trial of a New Generation Cooled TUMT for BPH, J Urol. 2011; 185(5):
Hill, B., et al. Transurethral Needle Ablation vs TURP for the Treatment of Symptomatic BPH: 5 Year Results of a Prospective, Randomized, Multicenter Clinical Trial, J Urol. 2004;171(6 Pt 1):
Data derived from the CTC Advance® Instructions for Use, Rev D 08/10
Data derived from the Prostiva® RF Therapy System User Guide 8930 CRMRef_R06
American Urological Association Guideline: Management of Benign Prostatic Hyperplasia (BPH), McVary et al. Revised
American Medical System Inc. website:
MC1654 Rev D 08/14