Benign Prostatic Hyperplasia: Diagnosis and Treatment

Diagnosis

• The evaluation will begin with a medical history and a physical examination. During the examination, a digital rectal exam will typically detect prostate enlargement.
  
• Blood testing to measure prostate–specific antigen levels is usually performed.
  
• Prostate biopsy and/or ultrasound may be recommended to help rule out cancer and confirm a diagnosis of BPH.

Treatment

The purpose of BPH treatment is to improve the patient’s quality of life.

• Observation alone (“watchful waiting”) is appropriate if symptoms are mild.
• Medical treatment includes use of alpha–blockers (e.g., prazosin, terazosin and doxazosin) and 5–alpha–reductase inhibitors (e.g., finasteride). A combination of an alpha–blocker and finasteride appears to work best.
• Plant extracts from saw palmetto (Serenoa repens), the American dwarf palm, and Pygeum africanum (an African plum tree) have been shown to be effective in treating symptoms, although their mechanisms of action are not yet clear.
• Surgery may be recommended to treat severe symptoms.