Annals of Long Term Care

**sub**Benign Prostate Diseases **endsub**
Tomas Griebling, MD, Assistant Professor of Urology and Assistant Scientist for the Center on Aging at the University of Kansas, Lawrence, KS, spoke about prostate disorders. He reviewed benign conditions of the prostate that affect older adults, including benign prostatic hyperplasia (BPH) and prostatitis.

Benign Prostatic Hyperplasia
Benign prostatic hyperplasia affects almost all men over the age of 40 in the U.S. Symptoms most commonly consist of urinary urgency, frequency, a decreased force in the urinary stream, nocturia, a feeling of incomplete emptying, and a sense of postvoid dribbling. The diagnosis is most commonly made using uroflowmetry, checking postvoid residual and elevated prostate-specific antigen (PSA) blood levels, and conducting a rectal examination. Dr. Griebling cautioned that the size of the prostate gland itself does not correlate with symptomatology, as men can have significant obstructive BPH with a relatively small prostate gland.

Treatment for BPH usually begins with a type of alpha-blocker therapy, followed by finasteride, a 5-alpha reductase inhibitor that shrinks the prostate gland. Finasteride is most effective in men who are symptomatic and who have a large prostate, but it has a much slower onset of action (4-6 months) than the alpha-blockers. Furthermore, this medication, because of its effects on testosterone, will also alter PSA. The use of such drugs as finasteride as long-term, potential preventive medications for BPH is being examined.

Surgical therapy for BPH includes transurethral resection of the prostate (TURP), a very safe procedure performed under general or regional anesthesia. Open prostatectomy, through a suprapubic or retropubic approach, is usually reserved for men who have very large glands (over 100 grams in size). The prostate is left intact, as opposed to radical prostatectomy, where it is removed. There are minimally invasive surgical techniques now available that involve applying some type of energy to the prostate, such as radiation, microwave thermotherapy, or prostatic stents, to decrease resistance in the bladder. Overall, most invasive techniques have shown to be promising, but none have had the overall success rate of transurethral resection, explained the speaker.

Prostatitis
Prostatitis is a common problem seen in both younger and older men. The two forms of prostatitis are acute and chronic prostatitis. Acute prostatitis is triggered by a bacterial infection and causes a prostatic loculated abscess, which is treated by TURP. Symptoms include dysuria, burning with urination, frequency, urgency, and pelvic pain. Diagnosis of prostatitis is made primarily by examination and a urinalysis. An elevated white cell count calls for a complete blood count. Diagnosis may also require obtaining prostatic secretions for examination, a post-prostate examination, a urine culture, or ultrasound.

Treatment of prostatitis may be symptomatic, including warm sitz baths, dietary modification (eliminating foods rich in potassium, acids, or caffeine that can worsen symptoms), and developing a bowel regimen to eliminate constipation and pelvic discomfort. Short-term (about 2 weeks) antibiotic therapy is used for acute bacterial prostatitis, and long-term antibiotics may be considered with chronic prostatitis. Typical antibiotic choices include a fluoroquinolone, such as levofloxacin, ciprofloxacin, or doxycycline. Patients with an elevated PSA should be started on chronic antibiotics for 1-2 months. If the PSA level lowers, if is probably related to prostatitis, but if the level has not lowered or has elevated, the concern is for a prostate cancer.

Summary
Benign prostate diseases are very common in older men. The impacts of these disorders can be quite significant on patients, affecting clinical comorbidities, functional status, and quality of life.