From the Guidelines
No immediate referral to a urologist is necessary for the patient's mildly enlarged prostate found on CT scan, as the patient is currently asymptomatic and denies any urinary concerns. The patient's condition will be monitored, and if symptoms develop, such as frequency, nocturia, difficulty starting a stream, weak or interrupted urine stream, or feelings of incomplete bladder emptying, a referral to a urologist will be considered 1. According to the guidelines, if the initial evaluation demonstrates the presence of lower urinary tract symptoms (LUTS) only, with or without some degree of nonsuspicious prostate enlargement, and the symptoms are not significantly bothersome, no further evaluation is recommended 1.
The patient's current asymptomatic state suggests that watchful waiting is an appropriate approach, as prostate enlargement (benign prostatic hyperplasia) is common with aging and often doesn't require treatment unless it causes bothersome symptoms 1. Key points to consider in the patient's management plan include:
- Monitoring for the development of symptoms
- Referral to a urologist if symptoms become bothersome
- Discussion of treatment options, including watchful waiting, medical treatment, interventional therapy, surgical or nonsurgical treatment, if symptoms develop
- Assessment of treatment success or failure and possible adverse events if pharmacological treatment is initiated 1.
It is essential to note that the patient should be advised to report any new urinary symptoms promptly, so the management plan can be adjusted if needed 1.
From the Research
Enlarged Prostate Management
- The patient's CT scan of the abdomen and pelvis showed a mildly enlarged prostate, but the patient is currently asymptomatic and denies any urinary concerns 2, 3, 4.
- The decision to monitor the patient for now and consider referral to Urology if symptoms develop is a common approach for managing benign prostatic hyperplasia (BPH) in asymptomatic patients 5, 6.
Treatment Options for BPH
- Combination therapy using alpha-1-adrenergic antagonists and 5-alpha-reductase inhibitors has been shown to be effective in improving lower urinary tract symptoms (LUTS) and reducing the risk of disease progression in patients with BPH 2, 4.
- Tamsulosin, an alpha-1-adrenergic antagonist, has been shown to improve symptoms and peak urine flow relative to placebo in patients with BPH 3.
- 5-alpha-reductase inhibitors, such as finasteride, have been shown to reduce the risk of hospitalization for heart failure, myocardial infarction, stroke, and cardiovascular death in patients with BPH 6.