Guidelines for the Treatment of Benign Prostatic Hyperplasia

Yunuo Wu, PharmD; Michael H. Davidian, MD, MS; Edward M. DeSimone II, RPh, PhD, FAPhA


US Pharmacist. 2016;41(8):36-41. 

In This Article


Diagnosis of BPH often rules out other clinical manifestations that may present with similar symptoms. Examples include prostate cancer, prostatitis, bladder cancer, bladder stones, overactive bladder (OAB), interstitial cystitis, and urinary tract infections; all of which may also cause LUTS.[3] Although symptoms related to BPH are often not life-threatening, they can be debilitating and affect quality of life (QOL) significantly Thus, it is important to identify and correctly diagnose BPH in order to pursue an effective treatment strategy.

The American Urological Association (AUA) guideline panel made several recommendations for the diagnosis of BPH that were consistent with an article published by Abrams et al in 2009.[2,4] The recommendations state that a basic evaluation should be performed on patients who are experiencing negative changes in their QOL due to LUTS. This evaluation may include several components, which are summarized in Figure 1. If the initial evaluation shows the presence of LUTS associated with one or more of the digital rectal examination (DRE) findings suspicious of prostate cancer, hematuria, abnormal prostate-specific antigen (PSA), pain, recurrent infection (infection should be assessed before referral), palpable bladder, or neurologic disease, the patient should be referred to a urologist for additional evaluation before pursuing treatment.[4]

Figure 1.

Diagnosis of BPH
a In select patients, generally performed by urologist.
b In life expectancy >10 y, prostate cancer diagnosis can affect management plan. Enlarged is >1.5 ng/mL.
c Used when nocturia is primary symptom.
AUASI: American Urological Association Symptom Index; BPH: benign prostatic hyperplasia; BOO: bladder outlet obstruction; DRE: digital rectal examination; LUTS: lower urinary tract symptoms; I-PSS: International Prostate Symptom Score; QOL: quality of life; PSA: prostate-specific antigen.
Source: References 2, 4.