This document provides an overview of prostate health and benign prostatic hyperplasia (BPH). It discusses the anatomy and function of the prostate gland. BPH is defined as non-cancerous enlargement of the prostate and its symptoms include frequent urination and weak urine flow. Risk factors include age and lack of exercise. Treatment options for BPH include watchful waiting, medications that shrink the prostate, minimally invasive procedures like microwave therapy, and surgeries such as transurethral resection of the prostate (TURP) and GreenLight laser therapy. GreenLight laser therapy uses a laser to vaporize prostate tissue and has benefits over TURP such as shorter hospital stays and catheterization time.

1. Understanding Prostate Health

2. Neil Baum, M.D.
Urology
Neil Baum Urology
• 3525 Prytania St., Ste. 614, New Orleans, LA 70115
• 504-891-8454
Affiliations
• Touro Hospital
Specializes In:
• General Urology

3. Prostate Overview

4. Overview of the Prostate
• Walnut sized gland at base of
the male bladder
• Surrounds the urethra
• Produces fluid that transports
sperm during ejaculation
• Prostate grows to its normal
adult size in a man’s early 20s;
it begins to grow again during
the mid-40s

5. Prostate Conditions2
• Enlarged Prostate or Benign Prostatic Hyperplasia (BPH)
• Prostatitis
• Prostate Cancer
Each condition affects the prostate differently.

6. What is BPH?
• Commonly known as enlarged prostate, BPH means the prostate gland
has grown larger than normal
• Normal adult size = approximately 1.5 inches in diameter
• Benign prostatic hyperplasia/enlargement can lead to bladder outlet
obstruction which can cause lower urinary tract symptoms
BPH
Benign
=
Non-
cancerous
Prostatic
=
Relating to the
prostate gland
Hyperplasia
=
More cells
than normal3

7. What is BPH?
BPH’s Relation to Prostate Cancer
• BPH is not prostate cancer
• BPH does not cause prostate cancer
• BPH symptoms are similar to those of cancer
• BPH may co-exist with prostate cancer1
• Prostate-Specific Antigen (PSA) levels alone do not distinguish
BPH from prostate cancer. Both BPH and prostate cancer can
cause elevated PSA levels.

8. Normal vs. Enlarged Prostate
• As the prostate enlarges, pressure can be put
on the urethra causing urinary problems
• Prostate size does not correlate with degree of
obstruction or severity of symptoms.
Normal Prostate
Enlarged Prostate

9. Recognizing the Symptoms of BPH
• Frequent urination during day and/or night
• Sudden urge to urinate
• Burning, painful urination
• Weak urine flow
• Sensation the bladder is not empty after urination
• Inability to urinate
• Trouble stopping and starting of flow

10. BPH Affects Quality of Life
Many men who suffer from BPH
may experience a reduction in quality of life.
• Up to 95% of men with moderate symptoms are unhappy and don’t
want to spend the rest of their life with these symptoms.
• 51% of men say BPH interferes with one aspect of their normal life
• Studies show almost 50% of men experience sexual problems
• BPH also affects men’s partners quality of life, daily routines and
relationships

11. BPH Affects Quality of Life

12. BPH – Who is at Risk?
• BPH affects more than 27 million men
over 50 each year in the United States
• Affects 40-50% of men ages 51-60
• Affects 80%+ men over age 80
• Obesity, higher body mass index (BMI) and lack of exercise may
increase the risk of BPH

13. How is an Enlarged Prostate Diagnosed?
• Medical History
• Physical Exam
–Prostate exam
•Digital rectal exam (DRE)
–Urinary Output Testing
•Peak urinary flow (QMAX) testing
•Post-void urine volume testing

14. Treatment Options

15. Treatment Options
Treatment Options for Enlarged Prostate
• Watchful Waiting
• Medication
• Minimally Invasive Therapy
– Heat/Microwave (TUMT)
• Surgical Therapy
– TURP (Transurethral Resection of the Prostate)
– GreenLight™ Laser Therapy
A variety of different treatments options are available and are
appropriate for different patients.

16. Treatment Options
Watchful Waiting
Characteristics
• Best for men with mild symptoms
• Consists of yearly exams and no active intervention
• No surgery
• No drugs
• May involve lifestyle modification such as adjusting diet, evening
fluid intake, medication use and exercise patterns
Side Effects
• Symptoms may worsen or remain unchanged without lifestyle
modification1

17. Treatment Options
Characteristics
• Intended for men with demonstrable prostatic
enlargement
• Avodart® inhibits prostate enlargement by 85-
90% after 2 weeks and 94% average after 2
years.
• Proscar® inhibits prostate enlargement by
70% after 4 years.
• No surgery required
• No drug interactions with other medications
Side Effects
• Erectile dysfunction (ED)/Impotence
• Lowered sexual drive/libido
• Ejaculation disorders
• Lowers Prostate Specific Antigen
(PSA) levels up to 50%; can
interfere with prostate cancer
detection
Medication
5-Alpha Reductase Inhibitors (e.g. Avodart® and Proscar®)1

18. Treatment Options
Characteristics
• Intended for men with mild to severe
symptoms
• Clinical studies measuring symptom
scores for Flomax® and Uroxatra
showed a reduction in symptom
severity
• No surgery required
• Work almost immediately
Side Effects
• Sudden drop in blood pressure can occur
• Headache
• Dizziness and/or fainting
• Weakness or Fatigue
• Congestion
• Painful erection or abnormal ejaculation16
• Can have drug interactions with other
medications
Medication
Alpha-Blockers (e.g. Flomax, Rapaflo

19. Minimally Invasive Therapy
Transurethral Microwave Therapy (TUMT)
Characteristics
• Intended for men with moderate
to severe symptoms
• Non-surgical procedure
• Outpatient capability
• Lack of sexual side-effects
• Can be performed without anesthesia
Side Effects
• Average catheterization time = 2 weeks
• Urinary retention
• Urinary Tract Infections
• Variable levels of short and long term
functional improvements
• Retreatment rates: 32-39%
Treatment Options

20. Treatment Options
Surgical Therapy
TURP
Uses electricity to superheat a thin metal band that cuts the prostate tissue into
small chunks
Characteristics
• Intended for men with moderate
to severe symptoms
• Most common type of BPH surgery
• Post-void residual
• Improved Quality of Life scores
• Provides symptom relief
• Demonstrated improved QMAX
(volume of urine per sec)
• Demonstrated improved prostate volume
Side Effects
• TUR Syndrome
• Bleeding requiring transfusion
• Retrograde ejaculation rates: 53-75%
• Erectile Dysfunction (ED): 6.3%18
• Activities after surgery restricted for about 6 weeks

21. Surgical Therapy
GreenLight™ Laser Therapy
Uses a laser to vaporize away the prostate tissue
Side Effects
• The side effects and complications of laser therapy are similar to TURP
• Retrograde ejaculation
• 36% for GreenLight Procedure
• Urgency/frequency
• Dysuria
• Hematuria/blood in the urine
• Bleeding and transfusion events happen less often than TURP, but GreenLight has a
slightly higher risk of retreatment in 5 years (based on earlier technology)
Treatment Options

22. Surgical Therapy
GreenLight™ Laser Therapy
Uses a laser to vaporize away the prostate tissue
Characteristics
• Intended for men with moderate to severe symptoms25
• Over 500,000 patients treated worldwide21
• Done in an outpatient setting
• Provides long-lasting symptom relief
• Significant, immediate urine flow improvement after the procedure
• Safe and effective for use in men in urinary retention, with large prostates or on anticoagulant therapy
Treatment Options

23. Clinical Comparison
GreenLight TURP
Length of Hospital Stay 1.1 days 3.4 days
Length of Catheterization 12.2 hours 44.5 hours

24. GreenLight Pre and Post-Op
Pre-Op Immediate Post-Op 3 Months Post-Op

25. Effect on Erectile Function
• Does NOT affect erectile function
• There is no difference between pre-
operative and post-operative erectile
function after treatment for men with
either mild or no erectile dysfunction
pre-operatively.

26. Insurance Coverage
• TURP and GreenLight
are covered by Medicare
and most private
insurance companies.

27. Am I Eligible For This Treatment?
• Consultation with your Urologist is required to
determine if GreenLight is the best treatment
option for you.
• Potential candidates may include men who are:
– Not satisfied with medication therapy
• Medication ineffectiveness, costs, side effects
• Don’t want to take medications
• Want better symptom relief than medications provide19
– On anti-coagulation therapy
– Mildly to severely symptomatic2

28. In Summary
• What is the prostate and how does it work?
• Enlarged prostate = BPH
• Treatment Options
– Watchful Waiting
– Medication
– Minimally Invasive Therapy
• Heat Therapy
– Surgical Therapy
• TURP
• GreenLight Laser Therapy

29. Brief Summary
Brief Summary – Risk Information for GreenLight™
The GreenLight™ laser system is intended for incision/excision, vaporization, ablation,
hemostasis and coagulation of soft tissue, including photoselective vaporization of the
prostate for benign prostatic hyperplasia (BPH). The laser system is contraindicated for
patients who: are contraindicated for surgery, have calcified tissue, require hemostasis in
>2mm vessels, have uncontrolled bleeding disorders, have prostate cancer, have acute
urinary tract infection (UTI) or severe urethral stricture. Possible adverse events include,
but are not limited to, irritative symptoms (dysuria, urgency, frequency), retrograde
ejaculation, hematuria, urinary incontinence, erectile dysfunction, hematuria - gross, UTI,
bladder neck contracture/outlet obstruct, urinary retention, perforation - prostate, urethral
stricture.
Prior to using these devices, please review the Operator’s Manual and any
accompanying instructions for use for a complete listing of indications, contraindications,
warnings, precautions and potential adverse events.
Rx Only

30. Questions?