What bloodwork should be ordered prior to starting treatment for an enlarged prostate?

Required Bloodwork Before Starting Treatment for Enlarged Prostate

Prior to starting treatment for benign prostatic hyperplasia (BPH), urinalysis and PSA testing should be performed in all patients, while additional tests like serum creatinine are not routinely recommended unless specific risk factors are present. 1

Essential Bloodwork and Testing

Required Tests:

• Urinalysis: Should be performed by dipstick testing or microscopic examination of sediment

  • Screens for hematuria and urinary tract infection (UTI)
  • Helps rule out bladder cancer, UTIs, urethral strictures, and bladder stones as causes of LUTS 1

• Prostate-Specific Antigen (PSA):

  • Recommended for patients with at least a 10-year life expectancy
  • Indicated when knowledge of prostate cancer would change management
  • Serves as a predictor of BPH natural history - higher PSA levels correlate with higher risk of prostate growth, symptom deterioration, and BPH-related complications 1

Optional Tests Based on Clinical Scenario:

• Serum Creatinine:

  • Not routinely recommended for initial BPH evaluation
  • Consider only if urinalysis, history, or physical examination suggests underlying renal disease or urinary retention
  • Baseline renal insufficiency appears no more common in men with BPH than age-matched controls 1

• Hemoglobin/Hematocrit:

  • Should be considered if planning testosterone therapy for concomitant hypogonadism
  • Elevated hematocrit (>50%) should be investigated before starting testosterone therapy 2

Additional Considerations

For Specific Treatment Modalities:

• If considering 5-alpha reductase inhibitors (finasteride, dutasteride):

  • Baseline PSA is particularly important as these medications reduce PSA levels by approximately 50%
  • PSA serves as a proxy for prostate size and predicts response to 5-alpha reductase inhibitors 1

• If considering surgical or minimally invasive therapies:

  • Uroflowmetry and post-void residual (PVR) measurement may be appropriate
  • These tests are not necessary prior to medical therapy but helpful in patients with complex medical history 1

For Patients with Specific Risk Factors:

• Urine cytology:
  • Consider in men with predominantly irritative symptoms
  • Particularly important with history of smoking or other bladder cancer risk factors 1

Common Pitfalls to Avoid

1. Overreliance on serum creatinine: Routine measurement is not indicated in initial BPH evaluation unless specific risk factors are present. In large BPH clinical trials, renal insufficiency was reported in less than 1% of patients 1

2. Neglecting PSA testing: PSA is valuable not only for cancer screening but also as a predictor of BPH progression and treatment response

3. Ordering unnecessary tests: Advanced imaging (CT, MRI) and urodynamic studies are not recommended for initial evaluation unless planning invasive therapy 1

4. Focusing solely on prostate size: While prostate volume can help select treatment, it is not reasonable to base treatment decisions on size alone. Patient bother from symptoms is more important than objective measures 3

By following these evidence-based recommendations for pre-treatment bloodwork and testing, you can appropriately evaluate patients with BPH while avoiding unnecessary testing and associated costs.