From the Guidelines
Ultrasound is not routinely necessary for the initial evaluation of patients with benign prostatic hyperplasia (BPH) but can be an optional test when minimally invasive or surgical interventions are chosen as therapy. According to the AUA guideline on management of BPH 1, transrectal or transabdominal prostate ultrasound may be appropriate when selecting patients for transurethral microwave heat treatment, TUNA, and other minimally invasive therapies, as well as for the selection of TUIP versus TURP. The size and shape of the prostate, as measured by ultrasound, are important in guiding treatment decisions and predicting the response to therapy with 5 alpha-reductase inhibitors. Some key points to consider when using ultrasound in BPH diagnosis and treatment include:
- Ultrasound can assess prostate size, shape, and volume, helping to confirm BPH and rule out other conditions 1
- Prostate size, as measured by ultrasound, is predictive of the natural history of BPH and the response to therapy with 5 alpha-reductase inhibitors 1
- Anatomical features, such as intravesical lobes, may impact the choice of therapy 1
- Ultrasound is not recommended for the initial evaluation of patients without risk factors or solely to determine the “need for treatment” 1
- The procedure is non-invasive, painless, and provides immediate results, making it a valuable diagnostic tool in the standard BPH management pathway. For most patients with BPH, treatment typically begins with medications such as alpha-blockers or 5-alpha reductase inhibitors, followed by surgical interventions like TURP if medications fail 1.
From the Research
Ultrasound for BPH
- Ultrasound can be used to demonstrate the gross anatomy and natural history of BPH, and its role in diagnosis and treatment strategies 2
- Transrectal ultrasound is a useful tool in the diagnosis and treatment of BPH, and can be used to classify the condition based on gross anatomic classification 2
- High intensity focused ultrasound is a minimally invasive procedure that can be used to treat BPH, and is associated with fewer adverse effects than traditional surgical procedures 3
Treatment Options for BPH
- Medical therapy, including alpha-blockers and 5-alpha-reductase inhibitors, is a common treatment option for BPH 3, 4
- Combination therapy with 5-alpha-reductase inhibitors and alpha-blockers can be considered a gold standard intervention for medical management of LUTS/BPH 5
- Finasteride, a 5-alpha-reductase inhibitor, can be used as monotherapy for BPH, and has been shown to be effective in reducing prostate volume and improving symptoms 5
Adverse Effects of BPH Treatment
- Pharmacological therapy of BPH can have adverse effects on male sexual function, including changes in sexual desire, erectile, ejaculatory, and orgasmic function 6
- The main adverse effect on sexual function in men is the deterioration in ejaculation or the absence thereof, with combined therapy and tamsulosin having the most significant effects 6