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A 60 year old M: had to wait before the urinary stream starts, strain to…

- - - - •Patient age, prostate volume, digital rectal examination findings, family history, and patient race must all be considered. A PSA level substantially above normal for a certain age may be an indication for biopsy.
        •A change from prior values (more than 0.35 ng/mL/year for a PSA of <4.0 or 0.75 ng/mL if the PSA is >4.0) should be considered suspicious
    - - can occur in the setting of cystitis, urethritis, or other urogenital tract infections. Patients are typically acutely ill, with spiking fever, chills, malaise, myalgia, dysuria, irritative urinary symptoms (frequency, urgency, urge incontinence). On exam, the prostate is often warm, firm, edematous, and exquisitely tender.
    - - gradually over a period of years.
        – persistent gross hematuria
        – bladder stones
        – recurrent UTIs
        – renal insufficiency
        ●Men <45 years old ●Abnormality on prostate examination ●Presence of hematuria in the absence of infection ●Failure to respond to initial treatment for LUTS ●Men who desire surgical treatment ●Men with incontinence ●Men with severe symptoms ●PVRs >300 to 400 mL that are increasing
        
        digital rectal examination, PSA, high serum creatinine may be due to bladder outlet obstruction or to underlying renal or prerenal disease
        
        Alpha adrenergic-receptor antagonists (relax sm)
        5-alpha reductase inhibitors (prevent conversion to DHT)
  - - - Hematuria, pain, nausea, vomiting, dysuria, and urgency