Dr Ho Siew Hong lectured to a group of Family Physicians on 22 Oct 08 as part of the Continous Medical Education Program

1. Approach to Lower Urinary Tract Symptoms (LUTS) in Males Dr Ho Siew Hong Consultant Urologist S H Ho Urology and Laparoscopy Centre Gleneagles Hospital

5. Anatomy of BPH Normal BPH Prostate Bladder Urethra Hypertrophied detrusor muscle Obstructed urinary flow

6. Epidemiology of BPH: histological prevalence around the world Adapted from Roehrborn CG, McConnell JD. Etiology, Pathophysiology, Epidemiology, and Natural History of BPH. In: Walsh P, editor. Campbell’s Urology. 8th ed. Philadelphia: WB Saunders Co. 2002. p. 1308 Prevalence (%) 100 80 60 40 20 0 20–29 30–39 40–49 50–59 60–69 70–79 80–89 Age (years) Average Linear average

7. Risk of AUR versus other diseases (60 year old male) 10-year cumulative risk (%) 20 15 10 5 0 AUR Hip fx Hip fx Diabetes Stroke MI (women) (men) Jacobsen S. Urology 2001;58(6A):5

8. IPSS / AUA Symptom Score

9. Estimate size of prostate, Exclude nodule Detect hematuria, pyuria Creatinine

15. Primary endpoint: Mean change in IPSS from baseline Roehrborn et al . J Urol (In Press) -7 -6 -5 -4 -3 -2 -1 0 0 3 6 9 12 15 18 21 24 Treatment month Adjusted mean change in IPSS from baseline (ITT, LOCF) p<0.001 combo vs . tam p<0.001 combo vs . dut Tamsulosin -4.8 -4.5 -4.4 -4.3 -4.5 -4.4 -4.7 -4.5 Dutasteride -2.8 -3.4 -4.0 -4.2 -4.8 -4.9 -5.0 -4.9 Combination -4.8 -4.8 -5.4 -5.6 -6.0 -6.0 -6.2 -6.2

16. Secondary endpoint: Mean change in Qmax from baseline Roehrborn et al . J Urol (In Press) 0.0 0.5 1.0 1.5 2.0 2.5 3.0 0 6 12 18 24 Treatment month Adjusted mean change in Qmax (mL/sec) from baseline (ITT, LOCF) p<0.001 combo vs . tam p<0.006 combo vs . dut 1.2 0.9 1.1 0.9 Tamsulosin Dutasteride 1.5 1.8 1.9 1.2 Combination 2.0 2.0 2.3 2.4

17. Drug-related adverse events Roehrborn et al . J Urol (In Press) 1.0% 1.2% 1.4% 1.6% 1.7% 1.8% 2.4% 3.4% 4.2% 7.4% Combination (n=1610) 1.0% 0.6% 1.8% 0.7% 1.3% 0.3% 0.5% 2.8% 0.6% 6.0% Dutasteride (n=1623) 0.3% Breast tenderness 0.3% Nipple pain 0.8% Breast enlargement 1.7% Dizziness 0.9% Loss of libido 0.8% Semen volume decreased 0.8% Ejaculation failure 1.7% Altered (decreased) libido 1.1% Retrograde ejaculation 3.8% Erectile dysfunction Tamsulosin (n=1611)

22. What about the storage symptoms? TRABECULATION FREQUENCY NOCTURIA

27. Thank you