When most men think about their prostate health, they think of prostate cancer, but there are many other conditions negatively affecting prostate and urinary health — and quality of life. For example, many men suffer from urethral strictures, a narrowing of the channel that urine flows through from the bladder. And about 14 million men in the United States are affected by benign prostatic hyperplasia (BPH) — often referred to as an enlarged prostate.
“People think that if your prostate is enlarged you have symptoms, and if your prostate is not enlarged you don’t,” notes Steven A. Kaplan, M.D., professor of urology at the Icahn School of Medicine at Mount Sinai and chair-elect of research at the American Urological Association. “But that’s really not true. If the bladder has to work harder, it gets thicker, it’s not as elastic — it doesn’t stretch. And if it doesn’t stretch, it doesn’t hold as much.”
Symptoms can include urgent urination, urinary incontinence, urinary retention, and even infections and bleeding.
Treatment downsides
Traditional treatments of both BPH and urethral strictures come with serious downsides. “A urethral stricture is scar tissue somewhere in the urethral channel,” explains Dr. Kaplan. “Treatment is usually to dilate it; if it can’t be dilated, it can be surgically cut or lasered. If the stricture is too long or too complicated, they sometimes need a reconstruction called a urethroplasty. The problem with cutting strictures and lasering them is they come back,” Kaplan notes. “Scar tissue doesn’t have good blood supply, so it doesn’t heal that well because it scars — a scar begets a scar, which limits the ability of urine to flow freely and exit the bladder.”
For BPH, the most frequently used minimally invasive therapy uses an implant to lift or hold the enlarged prostate tissue out of the way so it no longer blocks the urethra. “That leaves something behind in the patient’s body,” Kaplan says. “Another therapy heats or steams the prostate tissue which causes some damage to it. It heals with time, opening the channel.”
Cutting edge
Dr. Kaplan is working to make treating BPH and other conditions more effective, with fewer downsides. “One of the concerns that I’ve had is that we have not trained enough physician-scientists,” he says. “We are not having enough discovery come from the field of urology. I want to create an incubator for urologic research, a platform where all the players are in one room — more of a horizontal platform where everybody is communicating with each other.”
Optilume combines balloon dilation and drug delivery, and is well-tolerated by patients.
Dr. Kaplan is spearheading clinical prostate research. One promising investigational procedure is Urotronic’s Optilume drug coated balloon, used to treat urethral strictures which can often require major reconstructive surgery known as urethroplasty. “The Optilume product uses a balloon to stretch the stricture, and then uses a drug coating on the balloon to reduce the inflammation that would lead to scarring or re-narrowing of the urethral lumen so that it doesn’t happen again,” Kaplan notes. “The Optilume product has also been applied to the treatment of BPH with promising results. It may be something that’s a nice balance or compromise because you don’t cut anything, you don’t heat anything, you don’t damage anything, and you don’t leave anything behind.”
The challenge
Dr. Kaplan notes that advanced treatments won’t benefit men if they don’t take charge of their urinary and prostate health. “Men seek healthcare about 25 percent less than women do,” he says, noting that African Americans have a higher incidence of prostate cancer than Caucasians, which can be due to healthcare disparities or genetic predispositions. “The problem is men associate prostate problems with sexual problems. That’s a barrier. But it should be an empowerment — to seek health earlier to be able to preserve those functions.”
*Note: Optilume is under clinical investigation and not commercially available in the United States.