Medical Treatments for BPH

" I'm Paul -- is thanks for being with -- if you had an enlarged prostate you know it can be miserably uncomfortable turning routine -- and intellectual war. Little can be done to prevent -- from enlarging it is part of aging who wrote that. There are medical treatments available to alleviate symptoms of -- PDA to a -- nine out of hyper plays it. How about those treatments are to your Rogers we have doctor Christopher Dick and he isn't -- professor of neurology at the NYU school of medicine. He's also the co director of the Internet why don't -- thanks for being here. We -- I have doctor Roberts a lot a clinical associate professor of neurology at the end why you love that and he is also affiliated with Beth Israel Medical Center Cabrini Medical Center. And the hospital for joint diseases all in New York City. Doctors a lot even before surgery -- and they are and who or even before Americans are that it should say they're -- and who don't want that. What can be done before. Medicines -- put into the line."

" ones that right now a prosthetic enlargement may. Basically your treatment will depend upon the low level of them for men who have -- it -- that. Minimal in my -- symptoms you made it and look what we euphemistically call waiting but basically just keeping -- kind of symptoms. Having examinations. And an annual basis and being held -- and change over time we can't hear me. Symptoms course she would and his. -- stepping question -- and there. That is self administered at -- fills out and gives urologist. Subjective and committee on how to urinating. And with the symptoms are. Interfering with the patient's life. The last question is actually quite elated that the quality of life whether it will tell. How much is Clinton's boring. You may have to pay and -- very similar symptoms when a woman's quite comfortable with symptoms the other who absolutely need to be treated. And from there you can determine a course of action -- into into my -- tests. -- digital rectal and you could do digital rectal exam on someone. Find an enlarged prostate but that person mean having an outright correct I think that's one factor that goes into the constellation. Symptoms that can create. Problems with the patient. And having an in the launch date. And having him very much -- does -- correlate with -- the block to obstruction of character and we should add that back to record and begin at 840 -- for Allman. And generally that is war. Prostate cancer screening. Partly rectal examination those things one of which screen apart can't -- an absolute must be done while when you're starting -- forty. The other thing it says it urologist. A handle on me -- apart we can be followed a time. If -- significant change but certainly prostate cancer screening them. Died -- now what point you begin medical treatment and we should -- that -- enlargement has nothing to do with prostate cancer."

" in the two with a two conditions can't -- and EPA's and I impressed and heard from Asia. Are really two separate product that can occur in the same -- it for that matter. The decision to treat -- for us that spectrum in order to death and if the symptoms are clearly. Clearly have been diagnosed because from this process -- theory. And the next question which is really. Back with a patient hasn't worked. Here's how bad are those symptoms do those symptoms. Why do you want to daily things aren't ready for example the question are usually put them -- Haitians directly as. Do those symptoms you -- to consider taking a -- once that thing. Indefinitely. Assuming that the pills and obviously going to make those and to better. And not -- side effects. This is what sort of leads us down the road towards medical therapy. Which is really them or. At least usually the most appropriate therapy for the vast majority of patients that are. -- Beyond medical therapy or who present was a little more extreme. Conditions of VP you know urinary retention of the plant here -- terror. Some of these more severe. True medical problems with the vast majority 8590%. Of patients really. Are are seeking an evaluation because there aren't going to really on a day to day or night tonight."

" So doctors a lot what kinds of -- are available. In general there are two class of medication can be used to treat symptomatic and -- prospects. One -- known as the -- blockers. And -- of medications that don't actually shrink the past they relaxed the prime. And you -- to look at the what do prosecutors and eight about 40%. Is made -- smooth muscle and connected it. The -- these medications work. It's too relaxed to smooth smart and what that would do reduce the amount of her and anti Blatter has pushed with can get figuring out of the Blatter. Of these medications make the urinary process easier by reducing the recent and you're in luck. Here's another class of medications called. He tried out for re uptake inhibitors. Which. Are medications that actually do shrink the -- of the and these medications work slowly over time they can actually reduce the size of the plastic and hopefully improve the symptoms. You eat it while you have a diagram and show -- Lee -- top back in the go through how all of the shrinking and Medicaid might work and try to call this is a diagram of prostate and -- broken in two. -- Iraq -- it is quite normal -- it would look like -- the prostate. Surrounding the two quietly re threaten the cute that. Transports to guard from the -- on out with the body. When the -- they start to grow. From EPA. Not tools that you grow -- red -- her from within it's not a uniform enlargement of the prostate as one might expect. What. The medications. That -- apart and do but actually shrink the knuckles of tissue. Decreasing the size of the pro. He other medications the for blocker medications actually relaxed. In the smooth Michael component of the prospect. Taking the pressure -- would be richer and allowing for easier urine flow I don't know -- prescribe. In general and most commonly people start with an alpha blocker. And the reason that it is the alpha blockers have been shown to work in the majority of patients who have -- Regardless the size of the the medications that going to -- it worked better for men who had. Significantly large grant and as we mentioned before I just one actor and it. Creates the symptoms. I don't think -- so. Amid could have a price that's only minimally in law but yet have significant symptoms. Inattention like that drinking upon it probably won't do a lot of good because it's not sign that's contributing the most of the symptoms. The -- block therapies would have a more beneficial. Doctor -- what about a side effect of these drugs."

" they are they're very well studied both alpha blockers and and -- right now and the days fairly clear there. The blockers are thinking of very. Sat side effect profile. Science -- in general -- not very sincere. And not terribly common although. If you look at -- Charles -- fifteen or Oprah and we'll withdraw because of a scientific and it's not something that you can ignore. Gospel record typically if they have side effects at all will be things like. Fatigue perhaps a little light handedness dizziness. These are artifacts. Now in the case of ironically doctor inhibitors that an asteroid. Then there is reduced in size they typically work through -- and -- type mechanism. There's -- Also required rare. Both or both class reversible. -- asking -- to continuation of the drugs in the case there finance right current therapies. Usually the I think you'll see if they -- really sexual function things aren't. Diminished -- perhaps diminished directions. And perhaps a -- you. Fluid volumes. Things like this Vladimir significant side effect they had some. Certainly for some -- doesn't. Certainly to withdraw that there. But it it's a relatively low incidence perhaps 5% of so it. I don't think I should refrain from using -- appropriate. Just because -- ran to -- it. A side effect that completely reversible if you just continued."

" how about the long term safety of these drugs because taking these types of medications and both as an indefinite proposition. In the Arab -- not o'clock news. So. Before initiating therapy you really need to discuss that issue with the patient. And there are and who really do not want to take medication that they would either have no treatment or seek an alternative treatment. In terms that there are long long term safety. And the have been studied instead of the world over. Block them to well over ten years. There's really no. Significant long term. Down and then a question about and -- for those in our audience may have heard fourth and writers or use another drug called the five times. Weaker than the prime time in the in the now ready for -- even so what are the qualities -- someone is taking. And asked right for a pair law. -- weaker. Strongly and is there any benefit perhaps our long term as a prevent for the price in order concentration so weak that it it would now. It shouldn't actually being studied right now and nobody has definitive and and certainly the scene. One milligram dose which is 15 of the doubt that it that is often used to getting it may have an effect on the prostate itself. What we do know is that -- Lowered those found in cooking here as blessed are being cited in terms of difficulty with corrections and difficulty where volume of the jacket. No way you don't know if that would be truly effective and argument I write these Medicare have not been studied it and move out. He whether or not can prevent it growth. Doctors wouldn't personally anecdotal evidence you have to talk from your patience and easy all the time they come and they take the medication how. Radically altered and there urinary -- speak."

" I think equality rights can be McCain and drastically improved and I think you have to put the medical -- isn't -- active. In terms of treatments that are available generally speaking. There's three of four therapies that one would think of watchful waiting. Medical therapy used. Minimally invasive approaches. And then standard surgical approaches. I think the expectations. From a -- Should not be confused with the expectations of and you have a standard surgical procedure. Which is generally considered as the most. An official in terms of therapeutic. Therapeutic. Improvement. I'm never -- you're sitting there with a pension as we do on a daily basis and these are well. Would you rather trying to kill the improve your incomes and seeing if this gives you personally I'm not symptomatic relief. To make your quality of life. What you would like it to be but you're gonna take a pure gold trying to operation. That is it's a very easy answer for patients and -- Collecting in the film obviously always comes out on top -- a very rational. A very rational approach many Haitians. Symptoms are not gruesome enough to go towards surgical intervention. Particularly dramatic release an improvement in quality of life. With mild moderate or severe symptoms. Without a blocker which will typically work very quickly in the matter as a few days in some cases. At at the very least and -- longest two to four weeks probably American or even seen an actual benefit. You know -- right then there. I think the -- authorities are probably have much less impressive that way. And this has been I think fairly well established a unilateral -- depressed and -- 20/20 -- percent after a month or so. That was not necessarily correlate or translate into a patient with a better quality of life this this -- did compare and has been talking you know very well controlled well designed trials. And and pretty clear intent for symptom improvement which is what drives people. Alpha -- really think lead the way."

" Does not worry about drug interactions in the content and that affects men who have traditionally older they may already be on other medications for different conditions. Do his medications and make OK with other medications that they might have taken generally. Well you're right. Many of the man who suffer from symptoms of them -- Are in the older population and it's and to have other medical conditions including -- blood pressure heart disease diabetes. And lung diseases. As being out of blockers. And a side effect of lowering blood pressure which accounts some of -- I'd expect that tucked in there and spoke about earlier. The interaction of the alpha -- with other anti hypertensive medications. Can be problematic. And in this case has been used the medications judiciously. Start with very relative to this and literally -- crate or increased the dose level to -- therapeutic level. He's an asteroid Medicare and add significantly fewer interactions with other men and they work more early in the alpha blockers to. And are very well tolerated okay thank you very much doctor Robert alive and why you. And also doctor Chris protects an event when he was well -- and if you are experiencing urinary symptoms that you should -- you. There's you Rogers who may prescribe -- that that are available are Bologna thanks for being."