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In the meantime, you can enjoy access to all the latest news, events and resources for different therapy areas on our website.Updated guidelines for the management and treatment of
patients with benign prostatic hyperplasia
Benign prostatic hyperplasia (BPH) has an estimated prevalence of 50% for men aged over 60 years and 80% for men aged over 80 years.1Lower urinary tract symptoms (LUTS) such as frequency, urgency and nocturia are associated with BPH.1
BPH can significantly affect patients’ quality of life and sense of mental well-being, and if left untreated can lead to development of urinary retention, urinary tract infections (UTIs) and hydronephrosis.1
Researchers from Toronto, Canada, recently published a summary and review of BPH management and treatment with updated guidelines and recommendations.1
They recommended the following for BPH diagnosis:1
- A detailed clinical history including comorbid conditions, medication use, family history, and caffeine, fluid and alcohol intake
- The use of the International Prostate Symptom Score (IPSS) questionnaire to assess the impact of BPH on the patient’s quality of life
- Physical examination including digital rectal examination to assess prostate size and cancer risk, and facilitate treatment selection
- Prostate-specific antigen (PSA) testing for patients with a life expectancy ≥10 years to assess cancer risk and prostate volume (≥30 cc volume associated with a PSA level of 1.5 ng/mL)
- Urinalysis to rule out UTI.
Detailed medical history and physical exam are crucial for diagnosis of BPH.
The Canadian Urological Association recommended optional tests such as serum creatinine, voiding diary, urine cytology or bladder scan post-voiding. 1
In addition, the following recommendations were made for management and treatment of BPH: 1
- Patients with mild symptoms (determined by IPSS) should make lifestyle modifications e.g. reduction in daily fluid intake, reduction in diuretic beverages, timed voiding or pelvic floor exercises
- Patients not receiving therapy should be monitored to avoid worsening of symptoms
- α-blockers are recommended for patients with small prostates (<30 mL) as they can reduce symptoms by 30–40%
- 5α-reductase inhibitors (5ARI) can reduce prostate size and improve BPH symptoms; baseline PSA levels should be assessed, as PSA levels would normally decrease with 5ARI, while increased PSA could indicate cancer
- α-blocker and 5ARI combination treatment is recommended for patients with large prostates or those who have previously failed to respond to α-blocker monotherapy
- PDE-5 inhibitors can improve LUTS symptoms, although they do not reduce prostate size; they can also be used in combination with 5ARI.
The authors suggest BPH can often be managed by primary care physicians.
Nevertheless, patients should be referred to a urologist for the following conditions: 1
- Previous genito-urinary trauma or surgery
- Meatal stenosis
- Uncertain diagnosis
- Worsening or progression of symptoms e.g. urinary retention, UTI or increased PSA.
The authors recommended interventional therapies for patients with LUTS who experience continual infections or bothersome symptoms after medication, including:1
- Transurethral resection of the prostate (TURP) as a gold standard
- Laser GreenLight photovaporisation and holmium enucleation, which can improve outcomes of TURP such as reduction in blood loss and length of stay in hospital
- Prostatic urethral lift, a recently developed technique which is minimally invasive and uses sutures to anchor the lateral lobes of the prostate apart, which can reduce risk of operative and post-operative complications.1
The authors conclude that primary caregivers play a key role in diagnosis and initial treatment of BPH and LUTS. 1
