Benign prostatic hyperplasia — CCE clinical encounter

CCE-style clinical encounter: a 64-year-old with two years of worsening urinary symptoms who fears cancer and wants 'the strongest tablet'. The candidate must score and stage his LUTS, stratify retention risk, negotiate a medical regimen with honest sexual side-effect counselling, and set a review plan.

clinical encounter with role-player (CCE format)2 min readVerification in progress

Prompt

A 64-year-old school principal attends with two years of slow stream, hesitancy and nocturia twice nightly. He has started planning lessons around toilet access. His brother had prostate cancer at 66. He says: 'I want the strongest tablet you have — I am not having an operation.' No haematuria, no pain, no weight loss.

Objectives

Separate the two agendas: fear of cancer and desire to avoid surgery — address both explicitly. ^[24]
Complete structured assessment: IPSS with bother question, DRE, urinalysis, post-void residual. ^[1] ^[24]
Stratify progression risk using volume and PSA data honestly quantified. ^[9]
Negotiate medical therapy with onset expectations and sexual side-effect counselling before prescribing. ^[17] ^[28]
Set explicit safety-netting and review interval; correct the cancer misattribution without dismissing his family history. ^[24]

References12Show

[24]Gratzke C, Bachmann A, Descazeaud A et al. EAU Guidelines on the Assessment of Non-neurogenic Male Lower Urinary Tract Symptoms including Benign Prostatic Obstruction. European urology, 2015.PMID 25613154
[1]Barry MJ, Fowler FJ Jr, O'Leary MP et al. The American Urological Association symptom index for benign prostatic hyperplasia. The Measurement Committee of the American Urological Association. The Journal of urology, 1992.PMID 1279218
[9]Marberger MJ, Andersen JT, Nickel JC et al. Prostate volume and serum prostate-specific antigen as predictors of acute urinary retention. Combined experience from three large multinational placebo-controlled trials. European urology, 2000.PMID 11096237
[17]Roehrborn CG Efficacy of alpha-Adrenergic Receptor Blockers in the Treatment of Male Lower Urinary Tract Symptoms. Reviews in urology, 2009.PMID 20126606
[14]McConnell JD, Roehrborn CG, Bautista OM et al. The long-term effect of doxazosin, finasteride, and combination therapy on the clinical progression of benign prostatic hyperplasia. The New England journal of medicine, 2003.PMID 14681504
[16]Roehrborn CG, Siami P, Barkin J et al. The effects of combination therapy with dutasteride and tamsulosin on clinical outcomes in men with symptomatic benign prostatic hyperplasia: 4-year results from the CombAT study. European urology, 2010.PMID 19825505
[28]Corona G, Tirabassi G, Santi D et al. Sexual dysfunction in subjects treated with inhibitors of 5alpha-reductase for benign prostatic hyperplasia: a comprehensive review and meta-analysis. Andrology, 2017.PMID 28453908
[8]McConnell JD, Bruskewitz R, Walsh P et al. The effect of finasteride on the risk of acute urinary retention and the need for surgical treatment among men with benign prostatic hyperplasia. Finasteride Long-Term Efficacy and Safety Study Group. The New England journal of medicine, 1998.PMID 9475762
[21]Roehrborn CG, Gange SN, Shore ND et al. The prostatic urethral lift for the treatment of lower urinary tract symptoms associated with prostate enlargement due to benign prostatic hyperplasia: the L.I.F.T. Study. The Journal of urology, 2013.PMID 23764081
[26]McVary KT, Gange SN, Gittelman MC et al. Minimally Invasive Prostate Convective Water Vapor Energy Ablation: A Multicenter, Randomized, Controlled Study for the Treatment of Lower Urinary Tract Symptoms Secondary to Benign Prostatic Hyperplasia. The Journal of urology, 2016.PMID 26614889
[32]McVary KT, Gittelman MC, Goldberg KA et al. Final 5-Year Outcomes of the Multicenter Randomized Sham-Controlled Trial of a Water Vapor Thermal Therapy for Treatment of Moderate to Severe Lower Urinary Tract Symptoms Secondary to Benign Prostatic Hyperplasia. The Journal of urology, 2021.PMID 33872051
[4]Wasson JH, Reda DJ, Bruskewitz RC et al. A comparison of transurethral surgery with watchful waiting for moderate symptoms of benign prostatic hyperplasia. The Veterans Affairs Cooperative Study Group on Transurethral Resection of the Prostate. The New England journal of medicine, 1995.PMID 7527493

Benign prostatic hyperplasia — CCE clinical encounter

clinical encounter with role-player (CCE format)2 min readVerification in progress

Objectives

Separate the two agendas: fear of cancer and desire to avoid surgery — address both explicitly. ^[24]

Complete structured assessment: IPSS with bother question, DRE, urinalysis, post-void residual. ^[1] ^[24]

Stratify progression risk using volume and PSA data honestly quantified. ^[9]

Negotiate medical therapy with onset expectations and sexual side-effect counselling before prescribing. ^[17] ^[28]

Set explicit safety-netting and review interval; correct the cancer misattribution without dismissing his family history. ^[24]

References12Show

[24]Gratzke C, Bachmann A, Descazeaud A et al. EAU Guidelines on the Assessment of Non-neurogenic Male Lower Urinary Tract Symptoms including Benign Prostatic Obstruction. European urology, 2015.PMID 25613154
[1]Barry MJ, Fowler FJ Jr, O'Leary MP et al. The American Urological Association symptom index for benign prostatic hyperplasia. The Measurement Committee of the American Urological Association. The Journal of urology, 1992.PMID 1279218
[9]Marberger MJ, Andersen JT, Nickel JC et al. Prostate volume and serum prostate-specific antigen as predictors of acute urinary retention. Combined experience from three large multinational placebo-controlled trials. European urology, 2000.PMID 11096237
[17]Roehrborn CG Efficacy of alpha-Adrenergic Receptor Blockers in the Treatment of Male Lower Urinary Tract Symptoms. Reviews in urology, 2009.PMID 20126606
[14]McConnell JD, Roehrborn CG, Bautista OM et al. The long-term effect of doxazosin, finasteride, and combination therapy on the clinical progression of benign prostatic hyperplasia. The New England journal of medicine, 2003.PMID 14681504
[16]Roehrborn CG, Siami P, Barkin J et al. The effects of combination therapy with dutasteride and tamsulosin on clinical outcomes in men with symptomatic benign prostatic hyperplasia: 4-year results from the CombAT study. European urology, 2010.PMID 19825505
[28]Corona G, Tirabassi G, Santi D et al. Sexual dysfunction in subjects treated with inhibitors of 5alpha-reductase for benign prostatic hyperplasia: a comprehensive review and meta-analysis. Andrology, 2017.PMID 28453908
[8]McConnell JD, Bruskewitz R, Walsh P et al. The effect of finasteride on the risk of acute urinary retention and the need for surgical treatment among men with benign prostatic hyperplasia. Finasteride Long-Term Efficacy and Safety Study Group. The New England journal of medicine, 1998.PMID 9475762
[21]Roehrborn CG, Gange SN, Shore ND et al. The prostatic urethral lift for the treatment of lower urinary tract symptoms associated with prostate enlargement due to benign prostatic hyperplasia: the L.I.F.T. Study. The Journal of urology, 2013.PMID 23764081
[26]McVary KT, Gange SN, Gittelman MC et al. Minimally Invasive Prostate Convective Water Vapor Energy Ablation: A Multicenter, Randomized, Controlled Study for the Treatment of Lower Urinary Tract Symptoms Secondary to Benign Prostatic Hyperplasia. The Journal of urology, 2016.PMID 26614889
[32]McVary KT, Gittelman MC, Goldberg KA et al. Final 5-Year Outcomes of the Multicenter Randomized Sham-Controlled Trial of a Water Vapor Thermal Therapy for Treatment of Moderate to Severe Lower Urinary Tract Symptoms Secondary to Benign Prostatic Hyperplasia. The Journal of urology, 2021.PMID 33872051
[4]Wasson JH, Reda DJ, Bruskewitz RC et al. A comparison of transurethral surgery with watchful waiting for moderate symptoms of benign prostatic hyperplasia. The Veterans Affairs Cooperative Study Group on Transurethral Resection of the Prostate. The New England journal of medicine, 1995.PMID 7527493