Article

Benign prostatic hyperplasia: treat or wait?

Division of General Internal Medicine, Mayo Clinic, Rochester, MN 55905, USA.
The Journal of family practice (Impact Factor: 0.74). 08/2008; 57(7):454-63.
Source: PubMed

ABSTRACT Talk to every male patient over the age of 50 about urinary function. Utilize questionnaires, such as the International Prostate Symptom Score to evaluate the patient's perception of symptom severity and quality of life. Rule out potential causes of lower urinary tract symptoms with a thorough medical history, focused physical exam (including digital rectal examination and neurological assessments), and appropriate laboratory evaluations. When choosing treatment for benign prostatic hyperplasia, remember that quality of life is generally more important than symptom severity.

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    ABSTRACT: Benign prostatic hyperplasia (BPH), and its clinical manifestation as lower urinary tract symptoms (LUTS), is a major health concern for aging men. There have been significant advances in the diagnosis and treatment of BPH in recent years. There has been a renewed interest in medical therapies and less invasive surgical techniques. As a consequence, the treatment needs of men with mild to moderate LUTS without evidence of prostate cancer can now be accomplished in a primary care setting. There are differences in the way urologists and primary care physicians approach the evaluation and management of LUTS due to BPH, which is not reflected in Canadian Urological Association (CUA) and American Urological Association (AUA) guidelines. A "shared care" approach involving urologists and primary care physicians represents a reasonable and viable model for the care of men suffering from LUTS. The essence of the model centres around educating and communicating effectively with the patient on BPH. This article provides primary care physicians with an overview of the diagnostic and management strategies outlined in recent CUA and AUA guidelines so that they may be better positioned to effectively deal with this patient population. It is now apparent that we must move away from the urologist as the first-line physician, and allow primary care physicians to accept a new role in the diagnosis and management of BPH.
    Canadian Urological Association journal = Journal de l'Association des urologues du Canada 07/2009; 3(3 Suppl 2):S92-S100. · 1.92 Impact Factor
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    ABSTRACT: We propose a simple and practical approach to the identification, evaluation and treatment of lower urinary tract symptoms (LUTS) resulting from an enlarging and obstructive prostate. The proposed Simplified Treatment for Enlarged Prostate (STEP) plan is a logical guide to patient management by the primary care provider (PCP). Symptoms of enlarged prostate (EP) are common and may frequently progress into a condition with profound adverse effects on quality of life. Despite the high prevalence, EP is underdiagnosed and undertreated. This situation may result from patient- and provider-related issues. Assessment of symptoms of EP should be initiated with a discussion of LUTS. Evaluation includes a focused history, physical examination and selected laboratory tests. Certain factors put the symptomatic patient at risk for disease progression; however, not all factors can be readily evaluated in the PCP setting. The serum prostate-specific antigen (PSA) level acts both as an indicator of prostatic size and a screening tool for prostatic cancer, and thereby provides an important tool for PCPs. The STEP plan is a logical guide to patient management. Step 1, watchful waiting, is appropriate in patients with symptoms that are not bothersome. If symptoms cause bother, the initiation of an alpha-blocker (AB) in step 2, provides relatively rapid symptom improvement. Patients with bothersome symptoms and a PSA > or = 1.5 ng/ml are at risk for progression and consideration should be given to combination treatment with an AB and a 5alpha-reductase inhibitor (step 3). Patients with refractory symptoms should be referred to a urologist (step 4). Identification, evaluation and management of EP are within the domain of the primary care setting. The STEP approach provides a simple and practical framework for PCPs to manage most men with symptoms of EP.
    International Journal of Clinical Practice 03/2010; 64(4):488-96. DOI:10.1111/j.1742-1241.2009.02304.x · 2.54 Impact Factor

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