It’s Time to Advocate for Prostate Health

By Dr. Sal Giorgianni, Senior Science Advisor at Men’ Health Network; and Ana Tomsic, Vice President of Men’s Health Network.

Enlarged prostate, or benign prostatic hyperplasia (BPH), is a very common condition that affects an estimated 42 million American men.¹ BPH is unrelated to, and more common than, prostate cancer.^2,3

The prevalence of BPH increases with age. While more than 40% of men in their 50s have BPH, nearly 90% of men in their 80s suffer from the condition.³ If left untreated, BPH can lead to permanent bladder damage and in severe cases, the need for long-term use of catheterization.⁴

Common BPH symptoms⁵ may include:

• Urgency, hesitancy, straining or dribbling when urinating or attempting to urinate
• A sensation that the bladder is not empty after urinating
• Weak urine flow
• Getting up multiple times during the night to go to the bathroom

Racial Differences in BPH Treatment Raise Questions About Equal Access

In one study, Black men were 51% less likely than white men to be diagnosed with BPH, and 65% more likely than white men to have surgery to treat their condition.⁶

This disparity is notable because surgery is typically reserved for the most advanced cases of BPH.  It raises questions about equitable access to early, less invasive treatment options for Black patients – before their condition worsens and requires major surgery.

BPH Treatment: The Benefits of Less-Invasive Procedures

Many men with BPH start off by taking medications. However, medication can be inadequate and temporary in relieving BPH symptoms, and can come with side effects such as sexual dysfunction, dizziness and headaches.⁷ As a result, many patients discontinue using the drugs.⁷ A recent study found that commonly prescribed BPH medications are also linked to an increased risk of new instances of heart failure.⁸

Minimally invasive BPH procedures are a proven alternative to medications and major surgeries. A recent survey of men who are currently taking a BPH medication and who have never had a medical procedure or surgery to treat their condition found that over two-thirds (66.81%) are extremely, very or somewhat interested in a minimally invasive procedure (with no heating or cutting) that could help them reduce their bathroom visits.⁹

Several minimally invasive BPH procedures can be performed right in a doctor’s office. In fact, when given the choice, many patients would prefer to have minor procedures performed in their physician’s office, rather than having to go to a hospital or other treatment facility.¹⁰

Protecting Men’s Access to Less-Invasive Procedures for BPH

At Men’s Health Network, we believe BPH patients covered by Medicare should have access to minimally invasive procedures in the safe, convenient, and less expensive physician office setting. BPH treatment decisions should be determined by physicians and patients, together, based on each patient’s individual needs.

Unfortunately, in July 2021, as part of the 2022 Medicare Physician Fee Schedule (MPFS) Proposed Rule, the Centers for Medicare & Medicaid Services (CMS) proposed significant reimbursement reductions for a broad range of office-based procedures in a variety of surgical specialties. These proposed reductions may make minimally invasive treatments for BPH in the less expensive, convenient, and often preferred physician office setting less accessible to Medicare patients.

We believe it is critical that CMS understand and protect patient access to minimally invasive procedures for BPH in the physician office setting, so physicians across the country can continue to optimize treatment decisions based on what is best for their patients.

To that end, we are urging Congress to reassess these proposals and consider their impact on patient access to care in physicians’ offices. We ask that CMS continue to protect patient access to minimally invasive procedures for BPH in the office setting by sustaining reimbursement at 2021 levels while the full impact of the proposed changes is assessed and alternatives considered.

You can get involved, too! You can help make your voice heard by providing your comments to CMS before the comment period closes on Monday, September 13 at 5pm EST.

Here’s how you can help protect access to BPH care:

1. Sign this petition!
2. Share this petition with fellow BPH patients and men’s health advocates.
3. Visit gov to comment and express your concern. Full instructions for commenting can be found here.
   1. Search for “2022 Medicare Physician Fee Schedule.”
   2. Select the document “The Medicare Program: CY 2022 Payment Policies Under the Physician Fee Schedule and Other Changes to Part B Payment Policies; Medicare Shared Savings Program Requirements; Provider Enrollment Regulation Updates; Provider and Supplier Prepayment and Post-Payment Medical Review Requirements (CMS-1751-P).”
   3. Select the blue button on the upper left, marked “COMMENT.” Enter your comments, update the subject line to personalize and avoid spam filters, and complete the CAPTCHA to submit.

Most importantly, men should feel empowered to talk with their doctor about bathroom habits that are disrupting their lives. Symptoms of BPH often include interrupted sleep and urinary problems, which can cause loss of productivity, depression, and decreased quality of life.¹¹ BPH does not improve on its own, but minimally invasive treatment options are available that can provide meaningful symptom relief. Let’s work together to keep it that way!

References

1. NeoTract US Market Model estimates for 2020, data on file.
2. American Cancer Society Key Statistics for Prostate Cancer
3. Berry, J Urol 1984
4. Tubaro, Drugs Aging 2003
5. Rosenbert, Int J Clin Pract 2007; Vuichoud, Can J Urol 2017
6. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2692430/
7. AUA BPH Guidelines 2003, 2010, 2018
8. Lusty A, J Urol2021
9. Data on file at NeoTract
10. https://www.mckinsey.com/industries/healthcare-systems-and-services/our-insights/finding-the-future-of-care-provision-the-role-of-smart-hospitals
11. Speakman, BJUI 2014