BMJ  2008;336:232-233 (2 February), doi:10.1136/bmj.39471.690440.3A

Letters

Benign prostatic hyperplasia

You have to put your finger in

The first 100% of the full text of this article appears below.

I found Wilt and N’Dow’s article on diagnosing benign prostatic hyperplasia unhelpful from the point of view of a general prctitioner seeing a man presenting with lower urinary tract symptoms, who is worried about cancer.1 I don’t see how it would reassure him to know that he is no more likely to have cancer than someone without these symptoms. The point is that he has got symptoms and wants an explanation. How do I know he hasn’t got an invasive carcinoma?

Surely digital rectal examination (DRE) and prostate specific antigen (PSA) have a part to play here. The American Urological Association guidelines, which are cited in the next paragraph, specifically advise DRE and PSA in the routine workup of these patients.2 The use of PSA in asymptomatic men, as a population screening tool, is a different issue.

Jeremy L Menage, general practitioner

1 Nuneaton CV10 0PB

jeremy.menage@nhs.net

Competing interests: None declared.

  1. Wilt TJ, N’Dow J. Benign prostatic hyperplasia. Part 1—Diagnosis. BMJ 2008;336:146-9. (19 January.)[Free Full Text]
  2. American Urological Association. Guideline on the management of benign prostatic hyperplasia (BPH). www.auanet.org/guidelines/bph.cfm (updated 2006).

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Relevant Article

Benign prostatic hyperplasia. Part 1—Diagnosis
Timothy J Wilt and James N’Dow
BMJ 2008 336: 146-149. [Extract] [Full Text] [PDF]

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