Managing benign prostatic hyperplasia and prostate cancer – the challenges today

Abstract

Many men who reach average life expectancy will experience benign prostatic hyperplasia (BPH) or prostate cancer and together these conditions account for a considerable amount of ill-health and distress for men and their partners. Although there is considerable overlap across BPH and prostate cancer in symptom and risk profiles, management approaches are very different for each condition and appropriate diagnostic evaluation is therefore crucial to achieve the best possible outcome. The primary care physician should play a vital role in the diagnosis, management and appropriate referral of men with prostate disease with the ultimate goals being (1) early detection of prostate cancer and (2) effective treatment of benign prostate disease to manage symptoms and reduce the risk of progression. In prostate cancer, although there is debate over the implementation of systematic prostate-specific antigen (PSA) screening and appropriate thresholds, the use of PSA screening in conjunction with digital rectal examination (DRE) may aid earlier detection. The challenge is now to better determine which men are likely to develop aggressive disease so that overtreatment can be avoided. Results of large trials of systematic PSA screening are eagerly anticipated. In BPH, a major challenge is to identify men with bothersome lower urinary tract symptoms. Improved communication, education of patients, and the use of tools such as the International Prostate Symptom Score (IPSS) may help detect men who need treatment. Treatment selection should be driven by an understanding of the risks of disease progression, the impact of the disease on the patient's quality of life, and by the patient's own treatment preferences. Ultimately, we must empower our patients to make informed decisions about their diagnostic and treatment options through open dialogue and provision of appropriate information and education.