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Quick Reference

Benign Prostatic Hyperplasia - Quick Reference

Examining the patient

Drug therapy

  • 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.

Indications for referral to a urologist

Follow-up

  • 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.