Synopsis
Assess suspected benign prostatic enlargement, quantify symptom burden and recognise progression risk, competing diagnoses and obstructive complications.
- Benign prostatic hyperplasia is histological, enlargement is anatomical, and obstruction is a functional diagnosis.
- A smooth enlarged prostate supports BPE but does not prove the cause of a weak stream.
- Separate symptom burden from complication risk: painless chronic retention can threaten renal function despite little bother.
Investigation priorities
Identify infection, haematuria, glycosuria or proteinuria that may alter the assessment.
Management branches
Symptoms are tolerable and no renal or obstructive complication is identified.
- Record symptom burden, examination, urine findings and the patient’s preferred outcome. Explain what enlargement can and cannot tell us about cancer or obstruction, and address the reason for the consultation.
- Agree practical changes to intake, evening habits and constipation where relevant. Keep a route back for worsening flow, infections, blood or inability to void rather than promising that benign symptoms cannot progress.
Key medicines
Tamsulosin prolonged-release capsule400 micrograms orally once daily after breakfast or the first meal; swallow the capsule whole. Review at 4–6 weeks; continuation depends on benefit.Avoid with a history of orthostatic hypotension or severe hepatic insufficiency. Use caution below creatinine clearance 10 ml/min. Starting this capsule before planned cataract or glaucoma surgery is not recommended; ensure the eye team knows about previous as well as current tamsulosin use.
Finasteride tablet5 mg orally once daily, with or without food; swallow whole. Allow at least six months to judge response and continue long term when beneficial.No routine renal dose adjustment is required; hepatic impairment is insufficiently studied. Discuss sexual and psychiatric effects, prompt review for mood changes, PSA suppression and avoidance of broken-tablet handling during pregnancy.