Diagnosis and management of benign prostatic hyperplasia in primary care

Abstract

Benign prostatic hyperplasia (BPH), and its clinical manifestation as lower urinarytract symptoms (LUTS), is a major health concern for aging men. There havebeen significant advances in the diagnosis and treatment of BPH in recentyears. There has been a renewed interest in medical therapies and less invasivesurgical techniques. As a consequence, the treatment needs of men withmild to moderate LUTS without evidence of prostate cancer can now be accomplishedin a primary care setting. There are differences in the way urologistsand primary care physicians approach the evaluation and management of LUTSdue to BPH, which is not reflected in Canadian Urological Association (CUA)and American Urological Association (AUA) guidelines. A “shared care” approachinvolving urologists and primary care physicians represents a reasonable andviable model for the care of men suffering from LUTS. The essence of the modelcentres around educating and communicating effectively with the patient onBPH. This article provides primary care physicians with an overview of the diagnosticand management strategies outlined in recent CUA and AUA guidelinesso that they may be better positioned to effectively deal with this patient population.It is now apparent that we must move away from the urologist as thefirst-line physician, and allow primary care physicians to accept a new role inthe diagnosis and management of BPH.