Differential diagnosis (for LUTS like symptoms)

  • Prostate Ca – weight loss, back pain, haematuria
  • Diabetes – polyuria, polydipsia
  • UTI – dysuria, cloudy urine
  • STI – penile discharge, risk factors
  • BPH


Data gathering

  • Red flags – weight loss, back pains, blood in urine
  • Others – caffeine, nocturia, frequency, dribbling, stream
  • Examine – abdominal exam, PR (CHAPERONE)


Clinical management

  • Investigations
    • Bloods – U+Es, PSA
    • Urine dip
    • Bladder diary
  • Explanation
    • prostate is a gland just below the bladder that makes fluid which protects sperm, the tube that carries urine from the bladder runs through the prostate, if the prostate gets bigger, the tube can narrow hence the symptoms
  • Treatment
    • Lifestyle – reduce caffeine and alcohol, double voiding, stop smoking, bladder training
    • Medications – can relax muscle of prostate or reduce chemical involved with enlarging prostate
      • tamsulosin (a-blocker) – se dizziness, low BP, ED dysfunction
      • finasteride  – reduce libido, ED dysfunction, breast enlargement (can take 6/12 to see effect)
    • Surgery – TURP, prostatectomy
  • Follow-up / Safety net – return if symptoms not improving after 6months