Benign Prostatic Hyperplasia

Question 1

A 70 year-old male presents with obstructive urinary symptoms. Provide a differential diagnosis.

Answer 1

Benign prostatic hyperplasia (especially if slow onset)

Prostatitis (normally present with fever, tender prostate)

Prostate cancer (nodular prostate)

UTI (fever, dysuria, SP pain often present)

Question 2

What are the management prinicples for benign prostatic hyperplasia?

Answer 2

• Improve voiding and storage symptoms
  
  • Mild disease - watchful waiting
  • Moderate disease
    
    • Alpha 1a blockers (terazosin)
    • PDE-5 inhbitors (sildenafil)
    • NSAIDs (celecoxib)
  • Severe disease
    
    • 5a-reductase inhibitors (finasteride)
    • Surgery (vaporisation > TURP)