CASE LEARNING OBJECTIVES
Recognize the symptoms and signs of benign prostatic hyperplasia (BPH) in individual patients
List the desired treatment outcomes for a patient with BPH
Identify the factors that guide selection of a particular α-adrenergic antagonist for an individual patient
Compare and contrast the α-adrenergic antagonists versus 5-α-reductase inhibitors in terms of mechanism of action, treatment outcomes, adverse effects, and interactions when used for management of BPH
Describe the indications, advantages and disadvantages of single versus combination drug treatment of BPH
Describe the indications for surgical treatment of BPH
Formulate a monitoring plan for a patient on a given drug treatment regimen based on patient-specific information and formulate appropriate counseling information for patients receiving drug treatment for BPH
"I'm taking 2 drugs for my big prostate, but my urine flow is still too slow. I have urinary frequency day and night. I feel like I can't empty my bladder. Sometimes I can't get to the bathroom on time and I leak on myself."
History of Present Illness
George Gold is a 73-year-old male with long-standing lower urinary tract symptoms (LUTS) who is referred to the urology service after failing maximal medication therapy for BPH. He has been taking terazosin 20 mg orally daily and finasteride 5 mg orally daily for 9 months. His current complaints include urgency with urge incontinence, nocturia 2–3 times a night, a weak urinary stream, and small-volume voids. He denies hematuria, dysuria, suprapubic or flank pain. He has no fever, chills, nausea, or vomiting. His American Urological Association (AUA) symptom score is 30.
Hyperlipidemia × 10 years
OA with chronic lower back pain × 5 years
History of a bleeding ulcer secondary to aspirin overuse
S/p transurethral incision of the prostate (TUIP) in 2005
Father died of a stroke. Mother died of breast cancer. Sister, alive, has breast cancer.
Married for 45 years; has 2 children: a son and a daughter, both alive and healthy.
Allergies/Intolerances/Adverse Drug Events
Sulfonamides; develops hives and shortness of breath when exposed. Cannot use Bactrim or Septra (trimethoprim/sulfamethoxazole)
Finasteride 5 mg PO daily
Furosemide 40 mg PO daily
Lisinopril 40 mg PO daily
Metoprolol 50 mg PO twice a day
Nifedipine 60 mg extended release 2 tablets PO daily