Managing enlarged prostate in primary care

Naslund, Michael J.; Costa, Frank J.; Miner, Martin

doi:10.1111/j.1742-1241.2006.01194.x

Cited by 8 publications

(10 citation statements)

References 61 publications

(77 reference statements)

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“…It is also important to assess a patient's risk factors for progression of BPH. They include increasing age; EP (30 mL or more and PSA of 1.4 ng/mL or higher); moderate to severe symptoms (AUASI score higher than 7); signs of negative impact on quality of life (bother); and weak urinary fl ow [ 11 ].…”

Section: Evaluating Bph In the Primary Care Settingmentioning

confidence: 99%

Primary care physician versus urologist: How does their medical management of LUTS associated with BPH differ?

Miner

2009

Curr Urol Rep

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Medical and surgical therapies for benign prostatic hyperplasia (BPH) are based largely on the results from adherence to the 2003 American Urological Association Guidelines. However, with the emergenceof medical therapies as first-line treatment and the expansion of medical therapy for lower urinary tract symptoms (LUTS) into the primary care office, the evaluation and management of men presenting with urinary symptoms can vary depending on provider type. This review explains the basis for BPH medical management in primary care with the review of three key studies. In addition, this review utilizes the data provided by the first longitudinal, observational BPH registry to evaluate patient outcomes and practice patterns in both urologist and primary care offices. From these data, we can conclude that men seeing urologists were more likely to be on medical therapy than men seeing primary care physicians (PCPs), who more often utilized watchful waiting. Urologists also were more likely to prescribe 5-alpha-reductase inhibitors (5ARIs), combination therapy with an alpha-blocker and 5ARI, and anticholinergic therapy. In contrast, the use of nonselective alpha-blockerswas appreciably greater among men seeing PCPs than men seeing urologists.

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Section: Evaluating Bph In the Primary Care Settingmentioning

confidence: 99%

Primary care physician versus urologist: How does their medical management of LUTS associated with BPH differ?

Miner

2009

Curr Urol Rep

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“…The most important is that the authors believe that this clinical path is the most practical for the PCP, as minimal testing is required. It also follows typical practice patterns (4,28). Furthermore, an enlarged prostate may be the cause leading to the OAB.…”

Section: Provisional Bph: Behavioural and Pharmacological Therapymentioning

confidence: 99%

A practical guide to the evaluation and treatment of male lower urinary tract symptoms in the primary care setting

Rosenberg¹,

Staskin

Kaplan

et al. 2007

International Journal of Clinical Practice

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Summary Aims: Lower urinary tract symptoms (LUTS) are common in both men and women, and are among the most prevalent patient complaints heard by primary care physicians (PCPs). This article aims to provide PCPs with a logical algorithm for the assessment and initiation of treatment for LUTS in the male patient. Results: Management of LUTS involves a focused history and physical, as well as the assessment of bother. In patients for whom treatment is warranted, a series of decisions regarding therapy should be considered. Male patients commonly suffer from storage and/or voiding symptoms. Treatment of male LUTS is commonly begun with agents that are aimed at remedying the outlet symptoms of benign prostatic hyperplasia (BPH). When this intervention is ineffective or when refractory symptoms persist, consideration should be given to treating the storage symptoms characteristic of overactive bladder (OAB). Discussion: This article is intended to provide the PCP with a logical guide to the treatment of male LUTS. Benign prostatic hyperplasia and OAB predominate among the causes of these symptoms, and the PCP should be comfortable treating each. Recent data detailing the safety of the use of these treatments in the male patient are reviewed and incorporated into the algorithm. Conclusion: Primary care physicians are in a unique position to successfully identify and treat male patients with LUTS. With this paper, they now have a tool to approach treatment logically and practically.

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“…That being said, many feel that a "shared care" approach to the diagnosis and treatment of BPH should be adopted. 3,8 Primary care physicians are better positioned to identify men with LUTS and those at risk for disease progression, and should consider treatment for those men with mild to moderate symptoms without evidence of prostate cancer. In contrast, men with more severe symptoms requiring urgent or emergent treatment (such as surgery) should be seen by a urologist.…”

Section: S92mentioning

confidence: 99%

“…As a consequence, the initial management of BPH has shifted from the urologist to the family practitioner and other primary care physicians. 3,4 Subsequently, because of the rapidly increasing understanding of BPH and expanding treatment options, the Canadian and American urological associations were prompted to publish more relevant guidelines in 2005 and 2003, respectively. 5,6 Recent studies have demonstrated that the initial management of BPH may vary between the urologist and the primary care physician.…”

mentioning

confidence: 99%

Diagnosis and management of benign prostatic hyperplasia in primary care

Tanguay

Awde

Brock

et al. 2013

CUAJ

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S92colleagues 7 showed that the percentage of men who pursue active treatment, as opposed to watchful waiting, was notably greater for those seen by a urologist regardless of LUTS severity. 4 Urologists and primary care physicians also differed in their choice of therapy. Urologists prescribed 5-alpha-reductase inhibitors (5-ARIs), combination therapy with an alpha-blocker and 5-ARI, and an anticholinergic therapy significantly more often than primary care physicians. 4 Primary care physicians, on the other hand, prescribed nonselective alpha-blockers more often than urologists. 4 It is not apparent why these differences exist, but it is possible that primary care physicians view LUTS mostly as a quality of life (QOL) issue and are less concerned with the progressive nature of the disease. 4 It could also be due to the fact that patients with similar symptoms but who are more bothered about them are referred along to a urology specialist for management. That being said, many feel that a "shared care" approach to the diagnosis and treatment of BPH should be adopted. 3,8 Primary care physicians are better positioned to identify men with LUTS and those at risk for disease progression, and should consider treatment for those men with mild to moderate symptoms without evidence of prostate cancer. In contrast, men with more severe symptoms requiring urgent or emergent treatment (such as surgery) should be seen by a urologist.3 Thus, educating primary care physicians regarding changes in the management of BPH and progression is very important. This article aims to assist physicians in the diagnosis and treatment of BPH in the primary care setting so as to: (1) facilitate access to needed care; (2) improve long-term outcomes of LUTS management and stop the progression of BPH; and (3) avoid surgical consultations in cases where primary care management is sufficient. Diagnosis and management of benign prostatic hyperplasia in primary care REVIEW AbstractBenign prostatic hyperplasia (BPH), and its clinical manifestation as lower urinary tract symptoms (LUTS), is a major health concern for aging men. There have been significant advances in the diagnosis and treatment of BPH in recent years. There has been a renewed interest in medical therapies and less invasive surgical techniques. As a consequence, the treatment needs of men with mild to moderate LUTS without evidence of prostate cancer can now be accomplished in a primary care setting. There are differences in the way urologists and primary care physicians approach the evaluation and management of LUTS due to BPH, which is not reflected in Canadian Urological Association (CUA) and American Urological Association (AUA) guidelines. A "shared care" approach involving urologists and primary care physicians represents a reasonable and viable model for the care of men suffering from LUTS. The essence of the model centres around educating and communicating effectively with the patient on BPH. This article provides primary care physicians with an overview of the diagnostic and m...

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Managing enlarged prostate in primary care

Cited by 8 publications

References 61 publications

Primary care physician versus urologist: How does their medical management of LUTS associated with BPH differ?

Primary care physician versus urologist: How does their medical management of LUTS associated with BPH differ?

A practical guide to the evaluation and treatment of male lower urinary tract symptoms in the primary care setting

Diagnosis and management of benign prostatic hyperplasia in primary care

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