Chapter 091. Benign and Malignant
Diseases of the Prostate
(Part 11)

Benign Disease
Symptoms
Benign proliferative disease may produce hesitancy, intermittent voiding, a
diminished stream, incomplete emptying, and postvoid leakage. The severity of
these symptoms can be quantitated with the self-administered American
Urological Association Symptom Index (Table 91-2), although the degree of
symptoms does not always relate to gland size. Resistance to urine flow reduces
bladder compliance, leading to nocturia, urgency, and, ultimately, urinary
retention. An episode of urinary retention may be precipitated by infection,
tranquilizing drugs, antihistamines, and alcohol. Prostatitis often produces pain or
induration. Typically, the symptoms remain stable over time and obstruction does
not occur.
Table 91-2 AUA Symptom Index

AUA Symptom Score (Circle 1 Number on Each Line)
Questi
ons to Be
Answered
Not
at All
Le
ss than 1
Time in
5
Le
ss than
Half the

less than 2 h
after you
finished
urinating?
0 1 2 3 4 5
Over
the past
month, how
often have
you found you
stopped and
0 1 2 3 4 5
started again
several times
when you
urinated?
Over
the past
month, how
often have
you found it
difficult to
postpone
urination?
0 1 2 3 4 5
Over
the past
month, how
often have


times)
(3
times)
(4
times)
(5
times)
the morning?
Sum of
7 circled
numbers
(AUA
Symptom
Score): ____ Note: AUA, American Urological Association.
Source: Barry MJ et al: J Urol 148:1549, 1992. Used with permission.
Diagnostic Procedures and Treatment
Asymptomatic patients do not require treatment regardless of the size of the
gland, while those with an inability to urinate, gross hematuria, recurrent infection,
or bladder stones may require surgery. In patients with symptoms, uroflowmetry
can identify those with normal flow rates who are unlikely to benefit from surgery
and those with high postvoid residuals who may need other interventions.
Pressure-flow studies detect primary bladder dysfunction. Cystoscopy is
recommended if hematuria is documented and to assess the urinary outflow tract
before surgery. Imaging of the upper tracts is advised for patients with hematuria,
a history of calculi, or prior urinary tract problems.
Medical therapies for BPH include 5α-reductase inhibitors and α-adrenergic
blockers. Finasteride (10 mg/d PO) and other 5α-reductase inhibitors that block

Thorpe A, Neal D: Benign prostatic hyperplasia. Lancet 366:1359, 2003
Yao SL, DiPaola RS: Evidence-based approach to prostate cancer follow-
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