Appropriately identify patients requiring prostate cancer screening.
In a patient suitable for prostate cancer screening, use and interpret tests (e.g., prostate-specific antigen testing, digital rectal examination [DRE], ultrasonography) in an individualized/sequential manner to identify potential cases.
In patients with prostate cancer, actively search out the psychological impact of the diagnosis and treatment modality.
In patients with prostate cancer, considering a specific treatment option (e.g., surgery, radiotherapy, chemotherapy, hormonal treatment, no treatment):
Advise about the risks and benefits of treatment.
Monitor patients for complications following treatment
In patients with prostate cancer, actively ask about symptoms of local recurrence or distant spread.
Given a suspicion of benign prostatic hypertrophy, diagnose it using appropriate history, physical examination, and investigations.
In patients presenting with specific or non-specific urinary symptoms:
No screening recommended for all ages as per Canadian Task Force
Urological associations suggest discussing risks and benefits of PSA screening with patients >50yo (or >40yo if fam hx or african american) with >15y life expectancy
Can consider PSA screening if patient concerned about prostate cancer, high risk factors, good health status, and patient not concerned about risks of urinary incontinence and sexual dysfunction
eg. Tamsulosin (Flomax) CR 0.4mg PO daily (avoid in sulfa allergy)
Side effects: Orthostatic hypotension, retrograde ejaculation (ejaculation failure)
For larger prostates (eg. DRE>25mL or PSA>1.5 ng/dL), combination therapy more effective with 5-alpha reductase inhibitors (onhibit conversion of testosterone to DHT, onset 4-6 months)
eg. Dutasteride (Avodart) 0.5mg PO daily , or Finasteride (Proscar)
Side effects: Decreased libido, erectile dysfunction
After 6-9 months of combination therapy, consider stopping alpha blocker
Consider addition of PDE-5 inhibitors for LUT symptoms, eg. Tadalafil (Cialis) 5mg PO daily
Consider addition of anticholinergics (eg. Tolterodine, Oxybutynin, Mirabegron) especially if component of OAB (storage symptoms), caution if PVR >250mL
Referral
Failure of symptom control despite combination therapy, for possible Surgery (TURP)