Benign Prostatic Hyperplasia - Quick Reference

This is a Quick Reference article. See also the main article Benign prostatic hyperplasia Benign Prostatic Hyperplasia.

Examining the patient

If the patient has difficulty passing urine, feeling of poor bladder emptying, or nocturia at least twice a night, ask him to fill in the IPSS questionnaire International Prostate Symptom Score (IPSS).
DRE (digital rectal examination)
Test for dipstick chemical urinalysis, creatinine, PSA.
Determine residual urine volume and prostatic size by ultrasonography, if available (video Residual Urine Volume (Ultrasonography); pictures Prostatic Hyperplasia (Longitudinal Ultrasonographic Picture) Prostatic Hyperplasia (Transverse Ultrasonographic Picture)).

Watchul waiting is sufficient, if the symptoms are mild (IPSS < 8).
If the prostate size is < 30 ml and PSA is < 1.5 µg/l, first choice is an alpha-1 blocker: tamsulosin, alfuzosin, doxazosin or terazosin.
If the prostate is clearly enlarged or PSA is > 1.5 µg/l, a 5-alpha-reductase inhibitor (finasteride or dutasteride) or an alpha-1 blocker can be used.
The combination of an alpha blocker and a 5-alpha-reductase inhibitor relieves symptoms more efficiently than either drug alone.
Phosphodiesterase 5 inhibitors are particularly suitable for patients suffering from mild to moderate urinary symptoms and who concomitantly are in need of treatment for erectile dysfunction.

Age under 50 years
Suspicious finding at palpation of the prostate (nodularity or a hard area)
The following abnormalities in PSA concentrations:
- PSA > 10 µg/l, or > 3 µg/l in patients under 65 years of age
- PSA increase > 0.75 µg/l/year
- Total PSA in the range 4-10 µg/l and free PSA fraction < 15 % of total PSA
Urinary retention (first aid: suprapubic cystostomy [video Suprapubic Cystostomy] or catheterization), overflow incontinence, or residual urine exceeding 400 ml despite drug therapy
Pain associated with difficulty in urination
Haematuria

Inform the patient that he should contact the doctor if the symptoms get worse.
Test for creatinine, PSA and (if indicated) residual urine at 6-12-month intervals.
PSA concentration should decrease during finasteride treatment.