BPH Management

[doc0610]

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So far what i understood is,

you do UA and creatine first
UA to rule out infection

do we do a PSA for all the patients?

also, if cath and suprapubic cath are the options when do you choose each?

in short, does anyone have an outline for the management and treatment for BPH?

 

[Keto]

Hi Doc0610

Benign prostatic hyperplasia (BPH) is due to hyperplasia of stroma and epithelium in the prostatic transition zone (smooth muscle cells might also play a role). It is extremly common in old guys (50% of 50yr olds) and about 1/4 will require treatment.

Workup of BPH

• Asses impact on quality of Life (different scores available: IPSS Score [0])
• Urine analysis
• Creatinine
• PSA
  • conflicting evidence (see USPSTF recommendations [1])
  • but PSA is recommended for man with >10 life-expectancy + one of the following
    • suspicious finding on digital rectal exam
    • moderate/severe lower urinary tract symptoms (as we usually have with BPH)
    • if investigating for a carcinoma of unknown origin or suspect postata carcinoma as primarius

Hope this helps!
Keto

[0] https://en.wikipedia.org/wiki/International_Prostate_Symptom_Score
[1] http://www.uspreventiveservicestask...ommendation-summary/prostate-cancer-screening

 

[doc0610]

Hi Doc0610



Benign prostatic hyperplasia (BPH) is due to hyperplasia of stroma and epithelium in the prostatic transition zone (smooth muscle cells might also play a role). It is extremly common in old guys (50% of 50yr olds) and about 1/4 will require treatment.

Workup of BPH

• Asses impat on quality of Life (different scores available: IPSS Score [0])
• Urine Analysis
• Creatinine
• PSA
  • conflicting evidence here as everyone knows (see USPSTF against recommendation for the whole populaton [1])
  • but PSA is recommended for man with >10 life-expectancy + one of the following
    • suspicious finding on DER
    • moderate/severe lower urinary tract symptoms (as we have here with BPH)
    • if investigantinf for a Carcinoma of unknown origin or suspect postata carcinoma as primarius

Hope this helps!
Keto

[0] https://en.wikipedia.org/wiki/International_Prostate_Symptom_Score
[1] http://www.uspreventiveservicestask...ommendation-summary/prostate-cancer-screening

So, I was wondering, if creatinine is high, we do a USG to rule out other causes?

Also, i read somewhere that if a person comes for the first time with BPH you do a PSA anyways. IT's better to be safe than sorry?!

 

[Keto]

Hi
you're completely correct.

If you have a high creatinine on your exam or real life, you'll shift your focus on kidney and hydronephrosis (secondary to BPH). This helps you also decide your treatment.

PSA is a controversial topic. But generally, you do a PSA in BPH because you have findings of lower urinary tract symptoms in BPH or a positive DRE, which are all criteria for doing a PSA. You do PSA in a patient with an expected life expectancy greater than ~10 years and after discussing the possible positive result with the patient (you only screen, if you are also willing to treat).

Have a good day,
Keto

 

[doc0610]

Hi
you're completely correct.

If you have a high creatinine on your exam or real life, you'll shift your focus on kidney and hydronephrosis (secondary to BPH). This helps you also decide your treatment.

PSA is a controversial topic. But generally, you do a PSA in BPH because you have findings of lower urinary tract symptoms in BPH or a positive DRE, which are all criteria for doing a PSA. You do PSA in a patient with an expected life expectancy greater than ~10 years and after discussing the possible positive result with the patient (you only screen, if you are also willing to treat).

Have a good day,
Keto

Thank you so much

also, have you done the nbme clinical mastery series yet?