Expert discusses what is needed to treat earlier in BPH setting

Commentary
Video

“We're always so focused on the prostate. That's the million-dollar question: are we getting to bladders too late?” says Kevin C. Zorn, MD, FRCSC, FACS.

In this video, Kevin C. Zorn, MD, FRCSC, FACS, discusses what is needed to treat patients earlier in the benign prostatic hyperplasia (BPH) setting, which was discussed at the 2024 Society of Benign Prostate Disease (SoBPD) Annual Meeting in Dallas, Texas. Zorn is a urologist and the founder of BPH Canada in Montreal.

Video Transcript:

That's the million-dollar question. At the SoBPD meeting we were looking at do we build algorithms? Dr. Claus Roehrborn was looking at some of the data from Dr. Stavros Gravas, looking at predictors of how do we pick the guy who is heading in the wrong direction? Looking at some of the work with Dr. Wayne Kuang, he's looking at preservation in the bladder, defenders of the detrusor. He was one of our speakers and spoke very passionately about getting involved earlier and preserving bladders. We're always so focused on the prostate. That's the million-dollar question: are we getting to bladders too late? Are we waiting for people to have those Hiroshima moments where they've got a catheter in place, they go to the emergency room and there’s false passage, they have renal failure, they have stones. We failed those patients; we didn't get to them soon enough. The question is what are the biomarkers or urinary assays, outside of having these technologies perhaps administered with some of these points of care ultrasounds?

In my practice, I use the Clarius ultrasound. With regards to the follow-up of patients, how great would it be to have the ultrasound devices that we have in our office. This is a second gen; there's a third generation Clarius system where this links up to your phone. So, you not only can tell the size of your prostates really quickly, you can see what's leftover or you press a button it does an AI bladder scan for you. You can do this periodically, once a year. Why can't primary care [have these]? Why can't these be in drugstores or in patient’s access? They can do this non-radiation, simple procedure [where]–like when you watch your kid go through puberty–you see the changes, and you can get in there earlier. The problem is patients aren't feeling their own prostates, not all primary care is doing digital rectal exams. This is not a great tool for measuring prostate size. We need to know our numbers. Patients can get to know their numbers better, be it through technology on Soundable devices, ultrasound.

That, to me, is going to be the greatest, most easy, keep it simple technologies that will get us there earlier until we get biomarkers that are going to be able to help us predict who genetically is going to be a grower. Then to really get to the essence that questions all urologists, [which] is "why does this happen, doctor?" We know we give them 5 ARIs and medications to shrink or relax or prostate, but the essence and we touched a bit on the work of Dr. Brian Helfand as well as some of the work with Dr. Claus Roehrborn and his team, some of the genomics and growth factors perhaps responsible, and its association with metabolic syndrome. So, losing weight, exercising may also have some role in this. That's a big picture of overall health, men's health, and our future that we still are still young at, and there's a lot more work to go.

This transcription has been edited for clarity.

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