Doctors Issue New Guidelines on Spotting, Treating Enlarged Prostate

Experts at the American Urological Association (AUA) have issued updated guidelines on diagnosing and treating enlarged prostate—a common condition formally know as benign prostatic hyperplasia (BPH).

BPH can lead to lower urinary tract symptoms such as incontinence and affect a man’s quality of life. The new guidelines, the first since 2003, include a detailed procedure on how to help doctors diagnose and treat those urinary tract problems. They also lower the age at which doctors should start to look for these issues in patients—- the “index patient age”—from 50 to 45.

“This document provides much-needed guidance to doctors who are already treating lower urinary tract symptoms, as well as those who will be in the future,” Dr. Kevin T. McVary, chair of the guidelines panel, said in an AUA news release.

When treating a patient with suspected lower urinary tract issues, a doctor should obtain a relevant medical history, assess symptoms using the AUA’s symptom index, and conduct a full physical examination, including a digital rectal exam, the new guidelines say.

Laboratory tests should include a prostate-specific antigen (PSA) blood test and a urine analysis. Urine frequency and volume charts may also prove useful in reaching a diagnosis.

The advisory also includes new recommendations about drug treatment for enlarged prostate and advises doctors to delay prescribing alpha-blocker drugs to treat an enlarged prostate if a patient is scheduled for eye cataract surgery.

Patients already taking alpha blockers should inform their eye doctor prior to cataract surgery. That’s because cataract surgery patients taking alpha blockers are at risk for a complication called intraoperative floppy iris syndrome, which can lead to increased pain, a longer recovery and less improvement in vision.

One urologist called the new guidelines “a welcomed update.”

“Since the last published guideline in 2003, many new medical and surgical therapies have emerged to help urologists treat men who suffer from lower urinary tract symptoms related to BPH. Incorporating these new treatments in the new 2011 guideline will help to standardize care for all men diagnosed with BPH,” said Dr. David Shin, assistant professor of urology at the medical school of the University of Medicine and Dentistry of New Jersey, and a clinician at Hackensack University Medical Center.

“Interestingly, the 2011 guideline also lowered the index patient age to 45 from 50,” he added. “It is not surprising that younger men are having lower urinary tract symptoms since enlargement of the prostate begins at age 45. With this new AUA guideline, physicians will be able to effectively treat both the younger and older male suffering from voiding dysfunction related to their enlarged prostate.”

The guideline is expected to be published in an upcoming issue of The Journal of Urology.

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– Robert Preidt

SOURCE: Dr. David Shin, MD, assistant professor, urology, the University of Medicine and Dentistry of New Jersey Medical School, and clinician, Hackensack University Medical Center, Hackensack, NJ; American Urological Association, news release, Feb. 3, 2011