A Primary Care Physician's Perspective on Benign Prostatic Hyperplasia

Primary care clinicians are generally the first point of contact for men who suffer troublesome symptoms of benign prostatic hyperplasia. Although a subset of these patients will ultimately require referral to a urologist for an invasive procedure to provide symptom control, the majority can be appropriately managed in the ambulatory setting. Most symptomatic men respond favorably to alpha-blockers, which provide prompt improvement in symptoms such as nocturia. Although alpha-blockers may control troublesome lower urinary tract symptoms, there is no suggestion that they forestall the need for surgery or reduce the likelihood of development of acute urinary retention. Therefore, clinicians need to become familiar with use of 5-alpha-reductase inhibitors, as this is the only class of pharmacotherapy that has been shown to have a diseasemodifying effect.