Elevated PSA, BPH, prostate health

Question 1

Men with PSA>7 OR abnormal DRE need

Answer 1

referral to urologist for possible biopsy

Question 2

Men with PSA between 3-7 should get

Answer 2

retested in a few weeks and if PSA remains above 3 needs urology referral

Question 3

If PSA<3 in a man

Answer 3

can get normal screening.

Question 4

Management of PSA that is elevated

Answer 4

Question 5

benign prostatic hyperplasia can have worsening nocturia without increased daytime frequency from worsening CHF and so what to do?

Answer 5

fluid retention and worsening heart failure and so this can seem like his BPH is getting worse. In this case treat their CHF and control volume status

Question 6

BPH with CHF pts

Question 7

Treatment of BPH

Answer 7

with mild symptoms start behavioral interventions

• shifting fluid intake to earlier in the day, decreasing caffeine and ETOH intake, and double voiding to thoroughly empty the bladder

Severe symptoms or obstructive symptoms: bladder infections, bladder stones or renal impairment may need pharmacology right away or invasive interventions.

if symptoms persist, start alpha 1 adrenergic antagonist (tamsulosin) and if that is not working needs a 5 alpha reductase inhibitor

Question 8

evaluation of lower urinary tract symptoms

Answer 8

Question 9

what often causes urinary frequency

Answer 9

HCTZ and so consider stopping and putting on a different antihypertensive medication.

If not on it, need UA, BMP and blood glucose and serum PSA if there’s also prostate enlargement.

Question 10

1st line therapy for BPH is

Answer 10

alpha adrenergic receptor blocker doxazosin (or Cadura)

if these do not improve then finasteride (proscar) is added

Meds should only be aded after careful hx of bladder storage and obstructive symptoms and digital rectal exam, lab studies nad (UA and PSA) are done.

Question 11

what causes bladder storage issues in men?

Answer 11

prostatitis and UTI’s

would also see suprapubic tenderness, dysuria nad fever.

Question 12

initial evaluation of BPH and management

Answer 12

• get a physical prostate exam.
• get urinalysis to rule out hematuria from bladder cancer and infection

get BMP to see if there’s obstructive AKI and some say get a PSA

Question 13

symptoms of BPH

Answer 13

nocturia, hesitancy, urinary frequency and decreased force with stream

see prostate enlargement on exam but symptoms don’t correlat to prostate size

Question 14

when to use urethrocystoscopy

Answer 14

routine evaluation of BPH and it’s used for suspected calculi, urethral strictures, or bladder cancer. or can be done as surgical planning.

Question 17

first line medication to treat someone who has both BPH and ED?

Answer 17

sildalafil

not tamsulosin because it can cause hypotension and orthostasis and sexual dysfunction.