What are the treatment options for benign prostatic hyperplasia (BPH) or prostate cancer?

Prostacor: Clarification Needed

The term "prostacor" does not correspond to any recognized FDA-approved medication, established medical treatment, or standard diagnostic test for prostate conditions. If you are asking about treatment options for benign prostatic hyperplasia (BPH) or prostate cancer, the following evidence-based approaches are recommended:

Initial Evaluation for Prostate-Related Symptoms

All men over 50 presenting with lower urinary tract symptoms (LUTS) should undergo a focused initial assessment 1:

• History and physical examination including digital rectal examination (DRE) to exclude locally advanced prostate cancer and assess prostate size 1
• Focused neurologic examination assessing mental status, ambulatory status, lower extremity neuromuscular function, and anal sphincter tone 1
• Urinalysis by dipstick or microscopic examination to screen for hematuria and urinary tract infection 1
• AUA Symptom Index (identical to IPSS) to quantify symptom severity: mild (0-7), moderate (8-19), or severe (20-35) 1

PSA Testing Recommendations

Serum PSA measurement should be offered to patients with at least 10-year life expectancy for whom knowledge of prostate cancer would change management, or when PSA may change management of voiding symptoms 1. PSA predicts BPH natural history including prostate growth, symptom deterioration, acute urinary retention risk, and need for surgery 1.

Tests NOT Routinely Recommended

• Serum creatinine is not indicated unless urinalysis or examination suggests renal disease or urinary retention (renal insufficiency occurs in <1% of BPH patients) 1
• Cystoscopy is not routinely necessary prior to watchful waiting or medical therapy 2

Treatment Options for BPH

Watchful Waiting

Watchful waiting is the preferred strategy for patients with mild symptoms 1. It is also appropriate for men with moderate-to-severe symptoms who have not developed BPH complications (renal insufficiency, urinary retention, recurrent infection) 1.

• Patients are monitored yearly with repeat initial evaluation 1
• Simple measures include decreasing bedtime fluid intake and reducing caffeine/alcohol consumption 1

Medical Therapy

5-Alpha Reductase Inhibitors

Finasteride is FDA-approved for BPH treatment to improve symptoms, reduce acute urinary retention risk, and reduce need for surgery including TURP 3. Finasteride can be combined with alpha-blocker doxazosin to reduce symptomatic BPH progression risk 3.

Dutasteride is FDA-approved for BPH treatment with similar indications 4. Dutasteride can be combined with tamsulosin for symptomatic BPH in men with enlarged prostates 4.

• Both medications reduce prostatic vascularity and decrease bleeding probability 5
• Prostate size (measured by ultrasound or estimated by PSA) predicts response to 5-alpha reductase inhibitor therapy 1
• Neither finasteride nor dutasteride is approved for prostate cancer prevention 3, 4

Alpha-Adrenergic Blockers

The AUA guidelines identify alpha-adrenergic blockers as a medical therapy option for BPH 1. These can be used as monotherapy or in combination with 5-alpha reductase inhibitors 3, 4.

Surgical and Minimally Invasive Options

Transurethral resection of the prostate (TURP) remains the benchmark therapy for BPH 1. Alternatives include:

• Transurethral incision of the prostate (TUIP) for select patients based on prostate size and anatomy 1
• Minimally invasive therapies such as transurethral microwave thermotherapy (TUMT) and transurethral needle ablation (TUNA) 1
• Open prostatectomy for very large prostates 1

When to Consider Surgery

Surgery is appropriate for patients with:

• Recurrent urinary retention 1
• Recurrent urinary tract infections due to BPH 1
• Renal insufficiency due to BPH 1
• Bladder stones due to BPH 1
• Recurrent gross hematuria clearly due to BPH refractory to medical therapy 5

Optional Diagnostic Tests Before Invasive Therapy

Transrectal or transabdominal ultrasound may be appropriate when minimally invasive or surgical interventions are chosen 1, 2. Prostate size and anatomical features (such as intravesical lobes) impact therapy selection between TUIP versus TURP and eligibility for minimally invasive options 1, 2.

Important Clinical Caveats

• Symptom scores alone do not determine need for intervention—patient bother is equally important 1
• DRE tends to underestimate true prostate size; if the prostate feels large by DRE, it is usually enlarged by ultrasound 1
• Approximately 25% of men with BPH have PSA >4 ng/ml, creating overlap with prostate cancer values 1
• Cystoscopic appearance does not predict response to BPH therapy 2

If "prostacor" refers to a specific peptide preparation or alternative therapy not recognized in Western medical literature, please clarify so appropriate guidance can be provided.