D. P. is a 63-year-old man who has been experiencing progressive difficulty with initiating the urinary stream and frequently needs to get up in the night three or more times to urinate. A prostate-specific antigen (PSA) is obtained and a prostate examination performed. The PSA is not significantly elevated. The prostate is enlarged.

Case Questions

What is the likely cause of DP's urinary problem?
What is the danger of leaving this untreated?
What further testing would be helpful in evaluating the degree of urinary obstruction?
How reliable is the PSA in distinguishing between benign and malignant enlargement of the prostate? Is further testing indicated
What are the treatment options for D. P.?

1. Benign Prostatic Hyperplasia

2. There can be serious complications including kidney and bladder stones, urinary tract infections, urinary retention and kidney damage.

3. Urinary tract CT scan,

   IV pyelography,

   Cystoscopy, and

   Renal radionucleotide

4. Not reliable

5. Yes, further testing is indicated

6. Lifestyle changes and watchful waiting

   Use of medications

   Surgery

Explanation:

D.P's problem is likely to be Benign Prostatic Hyperplasia, a condition that is also called prostate gland enlargement. It is a condition that is common in men as they get older. BPH can cause uncomfortable urinary symptoms ranging from such as kidney and bladder stones, urinary tract infections, urinary retention and kidney damage.

Urinary tract CT scan, IV pyelography, Cystoscopy, and Renal radionucleotide are scans that can be very useful in diagnosing BPH.

PSA testing, though very useful in helping to detect prostate cancer early enough, it doesn't mean that having an elevated PSA level means that a man has cancer (or that it is malignant). A benign condition in this case (BPH) can also raise PSA levels. Studies have shown that about 70% to 80% of men with high PSA levels did not have cancer. This is why it is recommended to undergo an ultrasound and prostate biopsy to be very certain.

If symptoms are relatively mild, it's advised to watch closely and see if the symptoms persist. Lifestyle changes like drinking less liquids before bedtime, avoiding some medications, drinking less caffeine and alcohol.  Medications are also a very good treatment option, so also is surgetry which comes as a last resort.