Benign Prostatic Hyperplasia and Lower Urinary Tract Symptoms Pathophysiology to Improved Patient Care
Jointly sponsored by Educational Review Systems, Inc., and Integritas Communications
This activity is supported by an educational grant from Lilly USA, LLC. For further information concerning Lilly grant funding visit www.lillygrantoffice.com.
Held in conjunction with the 2013 Pri-Med Regional Conference: Baltimore, Maryland
BPH iProfessor Workbook R1.indd 1
12/2/13 1:55 PM
BPH iProfessor Workbook R1.indd 2
12/2/13 1:55 PM
Benign Prostatic Hyperplasia and Lower Urinary Tract Symptoms
Pathophysiology to Improved Patient Care
3
FACULTY Matt T. Rosenberg, MD Prerecorded Medical Director MidMichigan Health Centers Chief, Department of Family Medicine Foote Health System Jackson, Michigan
Dr. Matt T. Rosenberg earned his medical degree at the University of California, Irvine, School of Medicine, where he trained in general surgery. He also trained in urologic surgery at Brigham and Women’s Hospital in Boston, Massachusetts, before changing fields to general practice. Dr. Rosenberg has a special interest in the medical management of urologic diseases and has authored or coauthored articles published in Urology, Journal of Urology, BJU International, International Journal of Clinical Practice, and other peer-reviewed journals. He practices in Jackson, Michigan, as Medical Director of Mid-Michigan Health Centers and on staff at Allegiance Health, where he served as Chief of the Department of Family Medicine from 2003 to 2006. Dr. Rosenberg is Section Editor of Urology for the International Journal of Clinical Practice and is Founder and Chairman of the Urologic Health Foundation, a nonprofit group dedicated to the education of primary care physicians in the field of genitourinary disease. In 2011, he was appointed by the American Urological Association’s Office of Education to be the Coordinator of Primary Care Education.
BPH iProfessor Workbook R1.indd 3
12/2/13 1:55 PM
4
INTENDED AUDIENCE This activity is intended for primary care providers (PCPs), including physicians, nurse practitioners, physician assistants, and other health care providers involved in the initial assessment, diagnosis, and ongoing management of patients with benign prostatic hyperplasia and lower urinary tract symptoms (BPH-LUTS). There are no prerequisites for this educational activity.
EDUCATIONAL OBJECTIVES At the conclusion of this educational activity, participants should be better prepared to: •
Assess the full symptom profiles of patients with BPH-LUTS, including severity, risk of disease progression, comorbidities, and deleterious effects on function and quality of life •
Evaluate the mechanisms of action and clinical effects of α-blockers, 5α-reductase inhibitors (5-ARIs), and phosphodiesterase-5 (PDE5) inhibitors in the treatment of BPH-LUTS
NEEDS ASSESSMENT AND LEARNER’S GAP Older men commonly present with LUTS associated with BPH.1-3 BPH is a histologic condition characterized by age-related increases in the number of prostatic cells, which often obstruct the bladder outlet and impinge on the urethra.4 Additionally, other factors, such as pelvic atherosclerosis and insulin resistance, can increase autonomic nerve activity, enhance prostatic smooth muscle contraction, and reduce urine flow.5 Traditionally addressed in urology practices, BPH-LUTS is increasingly being identified and managed in primary care.2 Indeed, PCPs are uniquely positioned to diagnose the disorder and treat affected patients as soon as symptoms become bothersome.6,7 The Interactive Professor™ will provide attendees with time-sensitive approaches to the assessment of urinary complaints and multimodal management strategies for BPH-LUTS with or without comorbid conditions, such as
BPH iProfessor Workbook R1.indd 4
12/2/13 1:55 PM
Benign Prostatic Hyperplasia and Lower Urinary Tract Symptoms
Pathophysiology to Improved Patient Care
5
erectile dysfunction.8,9 The program will also cover the mechanistic rationale and evidence base for various pharmacologic classes, including Îą-blockers, 5-ARIs, and PDE5 inhibitors.4,10
REFERENCES 1.
Emberton M, Marberger M, de la Rosette J. Understanding patient and physician perceptions of benign prostatic hyperplasia in Europe: The Prostate Research on Behaviour and Education (PROBE) Survey. Int J Clin Pract. 2008;62:18-26.
2.
Rosenberg MT, Staskin DR, Kaplan SA, MacDiarmid SA, Newman DK, Ohl DA. A practical guide to the evaluation and treatment of male lower urinary tract symptoms in the primary care setting. Int J Clin Pract. 2007;61:1535-1546.
3.
Parsons JK, Bergstrom J, Silberstein J, Barrett-Connor E. Prevalence and characteristics of lower urinary tract symptoms in men aged > or = 80 years. Urology. 2008;72:318-321.
4.
Lepor H. Pathophysiology of benign prostatic hyperplasia: insights from medical therapy for the disease. Rev Urol. 2009;11(suppl 1):S9-S13.
5.
McVary K. Lower urinary tract symptoms and sexual dysfunction: epidemiology and pathophysiology. BJU Int. 2006;97(suppl 2):23-28.
6.
Tanguay S, Awde M, Brock G, et al. Diagnosis and management of benign prostatic hyperplasia in primary care. Can Urol Assoc J. 2009;3(3 suppl 2):S92-S100.
7.
Seftel AD, Rosen RC, Rosenberg MT, Sadovsky R. Benign prostatic hyperplasia evaluation, treatment and association with sexual dysfunction: practice patterns according to physician specialty. Int J Clin Pract. 2008;62:614-622.
8.
Gacci M, Eardley I, Giuliano F, et al. Critical analysis of the relationship between sexual dysfunctions and lower urinary tract symptoms due to benign prostatic hyperplasia. Eur Urol. 2011;60:809-825.
9.
McVary KT. BPH: epidemiology and comorbidities. Am J Manag Care. 2006;12(5 suppl):S122-S128.
10. Gacci M, Corona G, Salvi M, et al. A systematic review and meta-analysis on the use of phosphodiesterase 5 inhibitors alone or in combination with alpha-blockers for lower urinary tract symptoms due to benign prostatic hyperplasia. Eur Urol. 2012;61:994-1003.
ACCREDITATION STATEMENT This activity has been planned and implemented in accordance with the Essential Areas and Policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of Educational Review Systems, Inc., and Integritas Communications.
BPH iProfessor Workbook R1.indd 5
12/2/13 1:55 PM
6
CREDIT DESIGNATION This program has been reviewed and is acceptable for up to 0.25 Prescribed credit hour by The American Academy of Family Physicians. AAFP Prescribed credit is accepted by the AMA as equivalent to AMA PRA Category 1 Credit™ for the American Medical Association (AMA) Physician’s Recognition Award (PRA). When applying for the AMA PRA, Prescribed hours earned must be reported as Prescribed hours, not as Category 1. (This statement applies to all Physicians, not just Family Physicians.)
CONFLICT OF INTEREST STATEMENT The Conflict of Interest Disclosure Policy of Educational Review Systems, Inc., requires that faculty participating in any CME activity disclose to the audience any relationship(s) with a pharmaceutical, product, or device company. Any presenter whose disclosed relationships prove to create a conflict of interest with regard to his/her contribution to the activity will not be permitted to present. Educational Review Systems, Inc., also requires that faculty participating in any CME activity and anyone in a position to influence content disclose to the audience when discussing any unlabeled or investigational use of any commercial product, or device, not yet approved for use in the United States.
FACULTY AND PLANNING COMMITTEE DISCLOSURES Matt T. Rosenberg, MD Astellas Pharma US, Inc. (Consultant, Speakers Bureau); Eli Lilly and Company (Consultant); Ferring Pharmaceuticals, Inc. (Consultant); Forest Laboratories, Inc. (Speakers Bureau); Horizon Pharma, Inc. (Consultant, Speakers Bureau); Ortho-McNeil-Janssen Pharmaceuticals, Inc. (Speakers Bureau); Pfizer Inc. (Consultant, Speakers Bureau) Jim Kappler, PhD, of Integritas Communications, has no relevant financial relationships to disclose.
BPH iProfessor Workbook R1.indd 6
12/2/13 1:55 PM
Benign Prostatic Hyperplasia and Lower Urinary Tract Symptoms
Pathophysiology to Improved Patient Care
BPH iProfessor Workbook R1.indd 7
7
12/2/13 1:55 PM
8
BPH iProfessor Workbook R1.indd 8
12/2/13 1:55 PM
Benign Prostatic Hyperplasia and Lower Urinary Tract Symptoms
Pathophysiology to Improved Patient Care
BPH iProfessor Workbook R1.indd 9
9
12/2/13 1:55 PM
10
BPH iProfessor Workbook R1.indd 10
12/2/13 1:55 PM
Benign Prostatic Hyperplasia and Lower Urinary Tract Symptoms
Pathophysiology to Improved Patient Care
BPH iProfessor Workbook R1.indd 11
11
12/2/13 1:55 PM
12
BPH iProfessor Workbook R1.indd 12
12/2/13 1:55 PM
Benign Prostatic Hyperplasia and Lower Urinary Tract Symptoms
Pathophysiology to Improved Patient Care
BPH iProfessor Workbook R1.indd 13
13
12/2/13 1:55 PM
14
BPH iProfessor Workbook R1.indd 14
12/2/13 1:55 PM
Benign Prostatic Hyperplasia and Lower Urinary Tract Symptoms
Pathophysiology to Improved Patient Care
BPH iProfessor Workbook R1.indd 15
15
12/2/13 1:55 PM
16
BPH iProfessor Workbook R1.indd 16
12/2/13 1:55 PM
Benign Prostatic Hyperplasia and Lower Urinary Tract Symptoms
Pathophysiology to Improved Patient Care
BPH iProfessor Workbook R1.indd 17
17
12/2/13 1:55 PM
18
BPH iProfessor Workbook R1.indd 18
12/2/13 1:55 PM
Benign Prostatic Hyperplasia and Lower Urinary Tract Symptoms
Pathophysiology to Improved Patient Care
BPH iProfessor Workbook R1.indd 19
19
12/2/13 1:55 PM
20
BPH iProfessor Workbook R1.indd 20
12/2/13 1:55 PM
Benign Prostatic Hyperplasia and Lower Urinary Tract Symptoms
Pathophysiology to Improved Patient Care
21
TOOLS American Urological Association Symptom Index Questionnaire The American Urological Association Symptom Index is used to evaluate the severity of symptoms associated with lower urinary tract symptoms. Urinary symptom scores of 1-7 suggest mild symptoms, 8-19 indicate moderate symptoms, and 20-35 denote severe symptoms. Barry M, et al. J Urol. 1992;148:1549-1557.
GUIDELINES Update on AUA Guideline on the Management of Benign Prostatic Hyperplasia Guideline statements graded as a standard of care, a recommendation, or an option address studies published before February 2008. McVary KT, et al. J Urol. 2011;185:1793-1803.
EAU Guidelines on the Treatment and Follow-up of Non-neurogenic Male Lower Urinary Tract Symptoms Including Benign Prostatic Obstruction 2013 version of the European Association of Urology guidelines on the treatment and follow-up of male lower urinary tract symptoms. Oelke M, et al. Eur Urol. 2013;64:118-140.
SUGGESTED READING Baseline Factors as Predictors of Clinical Progression of Benign Prostatic Hyperplasia in Men Treated With Placebo Crawford ED, et al. J Urol. 2006;175:1422-1426.
The Correlation Between Metabolic Syndrome and Prostatic Diseases De Nunzio C, et al. Eur Urol. 2012;61:560-570.
BPH iProfessor Workbook R1.indd 21
12/2/13 1:55 PM
22
A Systematic Review and Meta-analysis on the Use of Phosphodiesterase 5 Inhibitors Alone or in Combination with α-Blockers for Lower Urinary Tract Symptoms Due to Benign Prostatic Hyperplasia Gacci M, et al. Eur Urol. 2012;61:994-1003.
The Mechanism of Action of Phosphodiesterase Type 5 Inhibitors in the Treatment of Lower Urinary Tract Symptoms Related to Benign Prostatic Hyperplasia Giuliano F, et al. Eur Urol. 2013;63:506-516.
Medical Management of Lower Urinary Tract Symptoms Laborde EE, McVary KT. Rev Urol. 2009;11(suppl 1):S19-S25.
Efficacy of α-Adrenergic Receptor Blockers in the Treatment of Male Lower Urinary Tract Symptoms Roehrborn CG. Rev Urol. 2009;11(suppl 1):S1-S8.
The Effect of Benign Lower Urinary Tract Symptoms on Subsequent Prostate Cancer Testing and Diagnosis Weight CJ, et al. Eur Urol. 2013;63:1021-1027.
A Practical Guide to the Evaluation and Treatment of Male Lower Urinary Tract Symptoms in the Primary Care Setting Rosenberg MT, et al. Int J Clin Pract. 2007;61:1535-1546.
BPH iProfessor Workbook R1.indd 22
12/2/13 1:55 PM
BPH iProfessor Workbook R1.indd 23
12/2/13 1:55 PM
Copyright Š 2013 Educational Review Systems, Inc., and Integritas Communications. All rights reserved. No part of this syllabus may be used or reproduced in any manner whatsoever without written permission except in the case of brief quotations embedded in articles or reviews.
BPH iProfessor Workbook R1.indd 24
12/2/13 1:55 PM