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LEARNING OBJECTIVES

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LEARNING OBJECTIVES

Upon completion of the chapter, the reader will be able to:

  1. Explain the pathophysiologic mechanisms underlying the symptoms and signs of benign prostatic hyperplasia (BPH).

  2. Recognize the symptoms and signs of BPH in individual patients.

  3. List the desired treatment outcomes for a patient with BPH.

  4. Identify factors that guide selection of a particular α-adrenergic antagonist for an individual patient.

  5. Compare and contrast α-adrenergic antagonists versus 5α-reductase inhibitors in terms of mechanism of action, treatment outcomes, adverse effects, and interactions when used for management of BPH.

  6. Describe the indications, advantages, and disadvantages of various combination drug regimens for BPH that include an α-adrenergic antagonist, 5α-reductase inhibitor, anticholinergic agent, tadalafil, or mirabegron.

  7. Describe the indications for surgical intervention of BPH.

  8. Formulate a monitoring plan for a patient on a given drug treatment regimen based on patient-specific information.

  9. Formulate appropriate counseling information for patients receiving drug treatment for BPH.

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INTRODUCTION

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The prostate is an organ, which is of the shape and size of a horse chestnut, that encircles the portion of the proximal posterior urethra that is located at the base of the urinary bladder. The prostate produces secretions, which are part of the ejaculate.

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Benign prostatic hyperplasia (BPH) is the most common benign neoplasm in males who are at least 40 years of age. BPH can produce lower urinary tract symptoms (LUTS) that are consistent with impaired emptying of urine from and defective storage of urine in the bladder. Medications are a common mode of treatment to reduce symptoms and/or delay complications of BPH. For this reason, clinicians should be knowledgeable about the medical management of this disease.

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EPIDEMIOLOGY AND ETIOLOGY

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BPH is present as histologic disease in many elderly males. The prevalence increases with advancing patient age. However, of patients with microscopic BPH disease, only about 50% of patients develop an enlarged prostate on digital palpation and 25% of patients exhibit clinical voiding symptoms.1,2 It is estimated that 8% of males 40 years of age, increasing to 35% of men 60 to 69 years of age, have voiding symptoms consistent with BPH, and 20% to 30% of all male patients who live to the age of 80 years will require a prostatectomy for severe voiding symptoms of BPH.2

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Two chief etiologic factors for BPH include advanced patient age and the stimulatory effect of androgens.

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  • Prior to 40 years of age, the prostate in the adult male stays the same size, approximately 15 to 20 g. However, in males who have reached 40 years of age, the prostate undergoes a growth spurt, which continues as the male advances in age. Enlargement of the prostate can result in clinically symptomatic BPH.

  • The testes and adrenal glands produce 90% and 10%, respectively, of circulating testosterone. Testosterone enters prostate cells, where predominantly Type ...

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