From the Guidelines
Yes, you can use the diagnosis of BPH with LUTS to describe obstructive symptoms in a 78-year-old male with low-grade, low-volume prostate cancer. These conditions can coexist, and the obstructive urinary symptoms are often primarily due to the BPH component rather than the cancer. Treatment for the LUTS can proceed with standard approaches including alpha-blockers (tamsulosin 0.4mg daily, alfuzosin 10mg daily, or silodosin 8mg daily), 5-alpha reductase inhibitors (finasteride 5mg daily or dutasteride 0.5mg daily), or combination therapy depending on symptom severity and prostate size, as recommended by the AUA guideline on management of benign prostatic hyperplasia 1. Anticholinergics or beta-3 agonists may be added for storage symptoms, as suggested by the management of lower urinary tract symptoms attributed to benign prostatic hyperplasia: AUA guideline part I-initial work-up and medical management 1. It's essential to monitor both conditions separately, as the management strategies differ. The low-grade prostate cancer may be managed with active surveillance, while the BPH requires symptomatic treatment. The distinction is crucial because BPH is a benign enlargement of the transition zone of the prostate, while prostate cancer typically arises in the peripheral zone, and they represent distinct pathological processes even when present simultaneously. The use of 5-alpha reductase inhibitors, such as finasteride, can reduce the risk of acute urinary retention and the need for BPH-related surgery, as stated in the AUA guideline on management of benign prostatic hyperplasia (2003) 1. Combination therapy with an alpha blocker and a 5-alpha reductase inhibitor can be offered to patients with LUTS associated with demonstrable prostatic enlargement, as recommended by the AUA guideline 1. In patients with moderate to severe predominant storage LUTS, anticholinergic agents or beta-3 agonists may be offered as a treatment option, as suggested by the management of lower urinary tract symptoms attributed to benign prostatic hyperplasia: AUA guideline part I-initial work-up and medical management 1. The choice of treatment should be based on the patient's symptoms, prostate size, and overall health, and should be guided by the most recent and highest quality evidence, such as the AUA guideline on management of benign prostatic hyperplasia 1.
From the FDA Drug Label
- 1 Monotherapy Finasteride tablets 5 mg/day was initially evaluated in patients with symptoms of BPH and enlarged prostates by digital rectal examination in two 1-year, placebo-controlled, randomized, double-blind studies and their 5-year open extensions Effect on Symptom Score Symptoms were quantified using a score similar to the American Urological Association Symptom Score, which evaluated both obstructive symptoms (impairment of size and force of stream, sensation of incomplete bladder emptying, delayed or interrupted urination) and irritative symptoms (nocturia, daytime frequency, need to strain or push the flow of urine)
The patient's obstructive symptoms can still be described as BPH with LUTS, as the diagnosis of BPH is based on symptoms and not solely on the presence or absence of prostate cancer. The patient's age (78 years old) and symptoms are consistent with the patient population in the study 2. Low-grade low-volume prostate cancer does not preclude a diagnosis of BPH with LUTS, as these conditions can coexist. However, it is essential to consider the patient's overall clinical presentation and medical history when making a diagnosis.
- Key points:
- BPH diagnosis is based on symptoms, not solely on prostate cancer status
- Patient's age and symptoms are consistent with the study population 2
- Low-grade low-volume prostate cancer can coexist with BPH and LUTS
From the Research
Diagnosis of BPH with LUTS in a Patient with Low-Grade Low-Volume Prostate Cancer
- The patient's obstructive symptoms can be described as BPH with LUTS, as the symptoms are not exclusively related to the prostate cancer 3.
- Low-grade low-volume prostate cancer is often viewed as a non-life-threatening condition, and the management approach is similar to that of precancerous conditions, with a focus on monitoring and balancing the risks of overtreatment and disease progression 3.
- The use of 5-alpha-reductase inhibitors (5-ARIs) and alpha-blockers can be beneficial in managing BPH-related LUTS, and their combination has been shown to be effective in reducing symptoms and preventing disease progression 4, 5.
- However, it is essential to note that the patient's prostate cancer diagnosis should be taken into account when managing their LUTS, and the treatment approach should be individualized based on their specific needs and risk factors 6, 7.
- The evidence suggests that 5-ARIs can decrease the risk of overall prostate cancer, low-grade prostate cancer, and delayed prostate cancer pathologic progression, but their impact on high-grade prostate cancer, prostate cancer-specific mortality, and all-cause mortality is limited 7.