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© The Canadian Journal of Urology™; 18(Supplement 1); April 2011
5-ARI for at least 6 months, whereas there is no impact
on PSA if a patient is taking an alpha blocker.
29
Conclusion
Significant LUTS is very common in men over age 50.
After ruling out causes of LUTS other than BPH, it is
necessary and fairly easy for the primary care physician
to perform the patient workup to confirm that BPH
is causing the LUTS. The primary care physician can
manage the patient by following a patient-assessment
algorithm. If the primary care physician determines
that the patient has moderate symptoms (IPSS
≥
8),
moderate “bother” (
≥
3 on IPSS on the “bothersome
index” question), and an enlarged (> 30 cc) prostate,
then the most effective, recommended treatment is
combination therapy with an alpha blocker and 5-ARI
from the outset
. This combination therapy will provide
the most dramatic, early symptom response (decline
in IPSS), the most sustained symptom response, and
the most durable prevention of the long term sequelae
of BPH progression -- acute urinary retention or the
need for surgery. If the patient complies with taking
the combination medical therapy, his PSA levels are
expected to decline by 50%, and his symptom response
is expected to persist. If a patient’s PSA levels does
not decline by 50%, or if his symptom score does not
improve, then he should be referred to a urologist.
Disclosure
Dr. Jack Barkin is an active urologist and Chief of Staff
at the Humber River Regional Hospital in Toronto.
He sits on the medical advisory board for Abbott,
AstraZeneca, Bayer, Boehringer-Ingelheim, Eli Lilly,
GlaxoSmithKline, Merck Frosst, Paladin, Pfizer,
sanofi-aventis and Solvay. He has done the clinical
research on Androgel, Avodart, Casodex, Cialis,
Detrol, Flomax, Hytrin, Levitra, Xatral, Proscar and
Viagra. He has spoken all over the world for all of
the companies outlined.
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BARKIN