Prostate disease.

Re: Prostate disease.

Mark Hedberg — Wed, 26 Dec 2012 00:18:38 GMT

Hah, i lurked until boxing day! :p

Wait, no i didn't...

Re: Prostate disease.

Mark Holmes — Tue, 25 Dec 2012 20:49:21 GMT

I couldn't drink for on call reasons needed 5 mins from kids and wanted to see who was sad enough to be posting on Christmas Day, ironically immediately putting myself in that group. Oops did it again!

Re: Prostate disease.

Chris Geddes — Tue, 25 Dec 2012 20:18:14 GMT

Why were you?! I can't drink for medical reasons and needed a quiet 5 mins away from kids!

Re: Prostate disease.

Mark Holmes — Tue, 25 Dec 2012 13:49:46 GMT

[quote user="Chris Geddes"]Hi Sarah, Your head nurse must have been confused. A box of Ypozane is about £15 (depends on size of dog) and no requirement to buy more than one box. Chris

[/quote] Why are you on here and not drunk?

Re: Prostate disease.

Chris Geddes — Tue, 25 Dec 2012 13:10:31 GMT

Hi Sarah, Your head nurse must have been confused. A box of Ypozane is about £15 (depends on size of dog) and no requirement to buy more than one box. Chris

Re: Prostate disease.

Sarah Keir — Mon, 24 Dec 2012 18:09:55 GMT

When I got the head nurse to last look at getting some Ypozane in for a case, it was going to be near two hundred pounds as the owner would have to buy the full lot from the supplier as we don't stock it. Even if it was just the amount the owner needed the it was over a hundred pounds for 6months treatment whereas castration is only 50% more (you're right Chris, most practices have neutering as a loss leader to encourage more responsible dog ownership, get more footfall through door etc.).

Sarah

Re: Prostate disease.

James Laidlaw — Fri, 21 Dec 2012 21:32:31 GMT

Chris, you're a star! Hope Santa is good to you.

Re: Prostate disease.

Chris Geddes — Fri, 21 Dec 2012 20:30:37 GMT

Hi James,

Virbac are only closed for weekends and bank holidays but you are right - I am very grateful for no longer having to work unsociable hours! Our tech guys are always at the end of a phone 24/7 for emergencies though.

Ypozane is a 7 day course (not 10) and lasts up to 6 months, after which it is repeated q6mo. You could monitor with clinical signs / rectal / u/s / CPSE if you wanted but I would probably just repeat after 5-6 months. Of course, waiting for signs to reappear is leaving it too late!

As for off-label use, I'm afraid I'd have to refer you to tech services after Christmas!

Regarding discussion of pros/cons of Odelis CPSE - I absolutely agree that it is not always necessary when a PR is done in experienced hands in a dog where palpation is possible. However, in inexperienced hands, or in a small or large dog where palpation is impossible, or to detect a bit earlier, I like to think it has its place. As people have noted, it is specific to BPH - it doesn't rule in or out other prostate pathology. Some have said to me in the past "I know when it's time to treat as clinical signs are there" - the test is calibrated so that it only comes back positive for significant disease - but this is of course well before signs such as haematuria are present.

Re Ypozane versus castration - sometimes anaesthesia or surgery is contraindicated medically, owner doesn't want surgery, or perhaps the dog is a stud dog! Also, many people use both - i.e. give Ypozane before or after surgery, as it shrinks the prostate much more quickly (about 27% in a week and 38% in two weeks....takes longer for testosterone to decrease after surgery of course).

Re the comment that castration was cheaper than Ypozane - a week's course is about £30 cost to owner (4 presentations so varies obviously) - sounds like a loss-making castration!

Chris

Re: Prostate disease.

James Laidlaw — Fri, 21 Dec 2012 17:22:58 GMT

Virbac closed for the holidays (nice for some!!!)

Just wondering - how long is the 10 day course of ypozane supposed to be effective for (minimum?), and how frequently it could be repeated?

Also, anyone know if it would have any effect (or even be necessary) for a prostatic cyst without hyperplasia? Complicated international (no) history case! I wouldn't be treating prostatic cysts if uncomplicated, but think he may have had BPH.

Re: Prostate disease.

HMC — Fri, 25 Mar 2011 16:27:01 GMT

[quote user="robloxley"]

I get the impression it's a more sensitive test than palpation, however it won't pick up the carcinomas so I'd want to be feeling too.

[/quote]

That's the problem from what I've heard- it can diagnose BPH but it cannot exclude prostatitis or carcinoma, so what is the point? If you have concurrent BPH and prostatitis/carcinoma the result will be BPH?

Re: Prostate disease.

Kishor Mahind — Fri, 25 Mar 2011 14:58:31 GMT

I find ultrasound very useful and handy for prostrate diseases.

Re: Prostate disease.

Clive Ansell — Fri, 25 Mar 2011 14:02:44 GMT

[quote user="robloxley"]

Not quite sure what you mean by 'uncomplicated prostate disease': I'd assume BPH for which Ypozane or castration would be suitable, and I'd probably push for castration as a permanent cure rather than repeated medical treatment that they'll forget until it develops an abscess...; but if pyrexic or painful is it 'uncomplicated prostate disease'. Do these not need more workup to differentiate prostatitis, abscesses, cysts, neoplasia, and yes in the former nsaids and abs would be the treatment alongside Ypozane/neutering.

[/quote]

Sorry, I should have been more specific. I meant treatment for BPH or assumed prostatitis based on pain and/or pyrexia that could be deduced from clinical exam +/- urinalysis alone.

I always discuss/offer work up, but most clients in the practices I work decline on grounds of cost, so it has to be treatment based on exam findings only, then work up if no/poor response. Most do respond to castration/Ypozane and nsaid's/ab's as needed though.

Re: Prostate disease.

Clive Ansell — Fri, 25 Mar 2011 13:52:26 GMT

[quote user="Laurence Webb"]

As an aside, is anyone using the blood test for BPH? Personally I can't see any advantage of it over a finger up the bum which is cheaper and gives immediate results.

[/quote]

No, but I can see it could be useful at times. I had a case yesterday; 10 year old un neutered dog with haematuria, prostate seemed slighty enlarged on rectal exam but not 100 % sure. radiographs said otherwise and a nasty 1cm irregular sharp urolith was found in bladder, although prostate looked +++ big on rads too. Still not sure as to the source of the haematuria, a blood test may have been useful here perhaps, but owner elected for castration at the same time as the cystotomy in the end.

Re: Prostate disease.

Rob Loxley — Fri, 25 Mar 2011 13:49:33 GMT

[quote user="Laurence Webb"]I can't see any advantage of it over a finger up the bum which is cheaper and gives immediate results[/quote]

I get the impression it's a more sensitive test than palpation, however it won't pick up the carcinomas so I'd want to be feeling too.

Re: Prostate disease.

Rob Loxley — Fri, 25 Mar 2011 13:46:54 GMT

[quote user="Clive Ansell"]How do people manage uncomplicated prostate disease in dogs, and do many of you use Ypozane? I tend to still advise castration as the treatment of choice with nsaid's and ab's if pyrexic or painful.[/quote]

Re: Prostate disease.

Laurence Webb — Fri, 25 Mar 2011 13:41:25 GMT

I've had good responses with both Ypozane and Suprelorin (not at the same time) so I'd now consider it as a good long term treatment and a viable alternative to castration. Unless there are concerns about castration I'd generally recommend surgery as it's a permanant cure and cheaper than medication in the long run.

As an aside, is anyone using the blood test for BPH? Personally I can't see any advantage of it over a finger up the bum which is cheaper and gives immediate results.

Re: Prostate disease.

Kishor Mahind — Fri, 25 Mar 2011 13:01:02 GMT

Castration most of the times, unless unfit for GA or other concerns.