Open Access

ARTICLE

Management of benign prostatic hyperplasia by the primary care physician in the 21^st century: the new paradigm

Jack Barkin

Humber River Regional Hospital, University of Toronto, Toronto, Ontario, Canada
Address correspondence to Dr. Jack Barkin, Chief of Staff, Humber River Regional Hospital, 960 Lawrence Avenue West, Suite 404, Toronto, Ontario M6A 3B5 Canada

Canadian Journal of Urology 2008, 15(Suppl.4), 21-30.

Abstract

Benign prostatic hyperplasia (BPH) is one of the commonest causes of lower urinary tract symptoms (LUTS) in men over age 50. Fifty percent of men over age 50 will require some type of management for BPH/LUTS symptoms. Until about 15 years ago, the most common management for BPH was a transurethral resection of the prostate (TURP) operation. Initially, once a diagnosis of BPH has been made, most men are treated medically. One must fi rst rule out other serious causes of these symptoms, such as prostate cancer, bladder cancer, and other obstructions. For men with an enlarged prostate, there is a good chance that therapy with a 5-alpha-reductase inhibitor (5-ARI) can prevent disease progression and the need for surgery. There has been a lot of recent work on different combination therapies for the treatment of BPH/LUTS. If a patient’s serum prostate-specifi c antigen (PSA) level is greater than 1.5 ng/ml and his prostate volume is greater than 30 cc and he has signifi cant LUTS, then combination medical therapy of an alpha blocker with a 5-ARI is the most effective therapy. After a careful workup, it is quite reasonable and appropriate for the primary care physician to initiate this therapy for a patient with BPH/LUTS.

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