Mr Andersson's basic LUTS examination

Mr Anderson's IPSS (symptom score between 0-35) is 12 and he is affected by his symptoms. The voiding diary verifies his nocturia (x2) and daytime frequency (x4), but the volume of his urine output is normal. Abdominal palpation, the simple neurological examination and Mr Andersson's external genitals are normal. Through the digital (finger) rectal examination you detected a slightly enlarged prostate with a smooth surface but increased tone (i.e. hard) on the right side. Borders are OK. A bladder scan shows 35 mL residual urine after voiding.

The urinary dipstick test is perfectly normal and his PSA level is 6 (normal=<3).

 How would you proceed now?

Option a: I am happy that Mr Andersson’s results are very good and that he is quite satisfied with his situation. I would advise him to come back if any new/more problems arise.

Option b: As Mr Andersson’s results indicate that his LUTS problems arise from a benign prostatic hyperplasia,  I would prescribe him medicines for this.

Option c: As the investigation shows, this could be a very serious malignancy. I would advise to undergo further investigations for prostate malignancy.


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