BPH

This patient has lower urinary tract symptoms (LUTS) (eg, urinary frequency, nocturia, hesitancy), most likely due to benign prostatic hyperplasia (BPH). However, LUTS are not specific for BPH and can occur in other disorders, such as prostate or bladder cancer. Rectal examination may help differentiate prostate cancer from BPH; nodules, induration, and asymmetry favor malignancy whereas BPH is characterized by smooth, symmetric enlargement of the prostate.

Patients with LUTS should have a urinalysis to evaluate for hematuria (eg, bladder cancer) and infection. Although routine screening for prostate cancer in asymptomatic individuals is not advised, a prostate-specific antigen (PSA) level is indicated for symptomatic patients unless predicted life expectancy is <10 years. A serum creatinine is not required in the evaluation of uncomplicated BPH but is recommended by some experts, especially for patients with more significant symptoms or additional risk factors (eg, hypertension, diabetes) for chronic kidney disease.

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