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

Understanding the Prostate Bladder Urethra Pubic Bone Testes Penis Rectum Prostate

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

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

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

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

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

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

Normal Male Anatomy Bladder Urethra Prostate Gland

Male Anatomy with Enlarged Prostate Bladder Blocked Urethra Enlarged Prostate Gland

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

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. www.healthline.com/adamcontent/enlarged-prostate. Accessed Oct. 21, 2010

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

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

Treatment Options Watchful Waiting Medication In-Office Therapy Surgery

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

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

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

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.

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

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

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 15-20 minutes and will include post treatment instructions

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 24-48 hours8,9 Symptom improvement generally seen within 8 to 10 weeks of the treatment8,9 Lasting and significant relief from your symptoms6,7 .

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

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.

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

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

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.

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.

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?

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References http://www.umm.edu/patiented/articles/what_causes_cell_growth_leading_benign_prostatic_hyperplasia_000071_3.ht m#ixzz2R79HHR4H 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. 07-3012. June 2006. http://www.mayoclinic.com/health/prostate-gland-enlargement/DS00027/DSECTION=alternative-medicine 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):1804-1810 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):2336-2340 Data derived from the CTC Advance® Instructions for Use, 250348 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 2010 American Medical System Inc. website: http://www.greenlightforbph.com/ MC1654 Rev D 08/14