Departmentof UROLOGY

DEPARTMENT of UROLOGY UPDATE New Treatments for Benign Prostatic Hyperplasia Expanded Choices Provide Relief for a Common Condition FALL 2008 Vol.19 | No.2 The symptoms of an enlarged prostate include a weak stream, trouble starting and gland, called benign prostatic hyper- stopping, the frequent feeling of needing to Clinical Update p. 4 plasia (BPH), are familiar to a substantial urinate, and the sense that the bladder isn’t Kidney Cancer Vaccine p. 5 proportion of men older than 50. empty after urination. About half of men in their 50s and 80-90 percent Erectile Dysfunction Research p. 5 “To some degree, BPH affects all men as they of those older than 80 have enlarged prostates, age,” says Allan Pantuck, MD, MS, associate Clinical Trials p. 6 caused by changes in hormone balance and cell professor and physician in the UCLA Integrative growth. As their prostate begins to squeeze or Profile: Oscar Rivera, LVN p. 8 Urology Program, which combines the best partially block the surrounding urethra — the of preventative approaches, medical counseling, Kudos p. 9 tube that carries the urine from the bladder out nutritional science, and complementary medical of the body — many of these men experience Donor Notes p. 9 approaches for patients interested in the bothersome urinary symptoms, which can prevention and treatment of urologic conditions. Profile: Arthur Schapiro p. 9 “The prostate forms a channel that the urine passes through as it comes out of the bladder. As the prostate enlarges, there is increased resistance to the bladder’s ability to empty. This tends to also lead to changes in the bladder, including a decreased ability to hold urine.” BPH can wreak havoc with quality of life — in addition to the discomfort, some men are forced to get up several times during the night. Pictured above: Dr. Christopher Saigal (left), Dr. Allan Pantuck (middle), and Dr. Robert Reiter (right) continued on page 2 Frank Clark Urology Center Cover Story And although BPH has nothing to do with hospitalization and catheterization for 48 hours cancer (as the “benign” in its title suggests), in the or more and it comes with risks associated most severe cases it can lead to urinary tract with anesthesia; bleeding during and after the infections, stones in the bladder or kidney, operation; and in rare cases, fluid absorption urinary retention or kidney damage. For reasons that can be life-threatening. An alternative of quality of life as well as for the potential of such has emerged in laser surgery. Like TURP, the complications, Dr. Pantuck notes, bothersome so-called GreenLight Laser Therapy offered at symptoms should not be ignored. UCLA aims to create a channel through the urethra through which men can urinate more freely — but the surgery is considerably less A Growing Number of Treatment Options invasive. Instead of cutting tissue out, the The case for seeking treatment has become even newer technique creates the channel by stronger in recent years. For those who need vaporizing the tissue using laser energy. surgery, lower-risk, less invasive alternatives Thus far, almost every study has shown that to transurethral resection of the prostate when done by experienced urologists, the laser (TURP), the traditional surgical approach, are surgery produces results that are equal to those now offered. And for patients with moderate with TURP, but without the severe side effects symptoms who are looking for more “natural’ and risks. “This is an outpatient procedure alternatives to BPH medications — either with minimal to no bleeding, no risk of fluid because the drugs’ side effects are intolerable absorption, and catheterization only overnight, or because they simply don’t like the idea of if at all,” says Robert Reiter, MD, MBA, being on medication — options such as herbal professor of urology, who was the first to perform treatments have become more widespread. the procedure at UCLA more than six years ago. TURP surgery, in which the obstructing portion An even less invasive option, thermotherapy of the enlarged prostate tissue is removed, delivers microwave energy through a catheter is an effective procedure. But it does require inserted into the bladder in an effort to shrink WWW.UCLAUROLOGY.COM UROLOGY APPOINTMENT LINE: (310) 794-7700 the inside of the prostate. The office-based as a result, the evidence on their efficacy is less Beta-sitosterol. Many different preparations of outpatient procedure takes an hour or less certain, and the contents of each product can this plant-based medicine have been used, with and requires only mild sedation, explains Dr. vary widely. the most common employing the extract of Pantuck, who performs both the GreenLight South African star grass. Several studies have Laser surgeries and the thermotherapy surgery. Some physicians have shied away from shown an improvement in urinary symptoms, The downside to the thermotherapy is that it recommending them, but at the UCLA but the evidence is still scant. takes 6-8 weeks for the impact of the treatment Integrative Urology Program, Drs. Saigal and to be realized, and although the risks are Pantuck take a different approach. “We meet “None of these is likely to be as effective as relatively minimal, the results are not comparable with patients, review their goals and will the FDA-approved drugs,” says Dr. Pantuck. to those of TURP or laser surgery. “There are pros discuss complementary strategies that can help “But for some men with mild symptoms, the and cons to all of the treatments; it’s a matter of them,” Dr. Saigal explains. “We will direct them improvement that they find with the alternative determining what’s appropriate for the individual toward natural products that are supported by approaches is sufficient so that they don’t need patient,” Dr. Pantuck says. some evidence, and help them find appropriate a stronger medicine, at least for that particular time in their life.” With all of these newer therapies added to “ Too many men assume that BPH is just part of getting older, what was already an effective arsenal of BPH and they let the problem slowly creep up on them without treatments, Dr. Saigal notes, men should never be content to simply live with the discomfort. doing anything about it.” – Dr. Christopher Saigal “Too many men assume that BPH is just part of getting older, and they let the problem slowly creep up on them without doing anything about The Pros and Cons of suppliers. These products can also work in it,” he says. “It’s important for them to realize Alternative Medications concert with pharmaceuticals for people who that we now have many effective options that can Overall, the medications that are available to are interested in both approaches.” eliminate or significantly reduce their symptoms.” treat BPH can be very effective. These include The most common herbal medicines for For more information on the UCLA Integrative drugs that take aim at BPH symptoms — BPH include: Urology Program or to make an appointment, see so-called alpha blockers that relax the www.uclaurology.com/integrativeurology.htm or call bladder muscle to help improve urine flow; Saw palmetto. Derived from the berry of (310) 395-4542. and those that attack the problem directly by the plant Serenoa repens, saw palmetto has shrinking the prostate and slowing its rate of been extensively studied — including a recent growth, known as 5-alpha-reductase inhibitors randomized placebo-control clinical trial in (finasteride, or Proscar; and dutasteride, or Shanghai, China on which Dr. Pantuck was Avodart). While some patients experience an author — and has been shown to decrease side effects, they tend to be mild, ranging from symptoms and improve urinary flow rates, dizziness and decreases in blood pressure to although some studies have failed to show decreased libido and occasional problems with a benefit. The therapy is currently being erection or ejaculation. investigated in a Phase II trial sponsored by the U.S. Food and Drug Administration. “These drugs improve symptoms in most people and are safe,” says Christopher Saigal, Pygeum africanum. Another commonly used MD, MPH, associate professor and UCLA herbal therapy, pygeum africanum is an extract Integrative Urology Program physician. from an African plum tree. In randomized “Although there are known side effects, they trials it has been shown to provide moderate occur right away, and are reversible once the improvement of urinary symptoms compared person stops taking the drug.” to a placebo, but most of the studies have been short — only a few months — and a year’s worth Still, Dr. Saigal notes, herbal supplements for of data is typically required to demonstrate that BPH are gaining in popularity — an estimated an agent is effective, Dr. Saigal notes. one-third of men with the condition have tried them. When used appropriately, herbal Stinging nettle. This plant-based therapy medicines tend to have few side effects. In has proved popular in Europe (where herbal Europe, they are a frontline therapy for BPH. therapies are widely prescribed as front-line However, Dr. Saigal points out, in the United treatment for BPH), and small studies have States supplements do not undergo the same shown symptom improvements. rigorous testing and regulation as medications; WWW.UCLAUROLOGY.COM UROLOGY APPOINTMENT LINE: (310) 794-7700 3 UCLA Department of Urology Update Fall 2008 Vol.19 Clinical Update Phase III Trial Launched for Prostate Cancer Drug An experimental drug that has shown dramatic system, which is faster than the first and able to results in patients with chemotherapy-resistant provide high-definition images, will allow the advanced prostate cancer has moved to a Phase department to at least double its volume of III clinical trial at UCLA. robotic surgeries. Robotic prostatectomies offer the advantages of short hospital stays and Abiraterone, manufactured by Cougar recovery times and less blood loss and Biotechnology, takes advantage of basic scarring.

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