December 24, 1997

A 73-Year-Old Man With Symptomatic Benign Prostatic Hyperplasia

Author Affiliations

Dr Barry is Chief, General Medicine Unit; Assistant Chief of Medicine-Residency Training; and Director, Health Services Research Program, Massachusetts General Hospital, Boston.

JAMA. 1997;278(24):2178-2184. doi:10.1001/jama.1997.03550240068036

Dr Parker:  Mr B is a 73-year-old man who has had "prostate trouble" for several years. A former government employee, he lives in a suburb of Boston with his wife and daughter, and is covered by Medicare. He sees Dr N at a primary care practice at the Beth Israel Deaconess Medical Center.On a routine physical examination in 1993, he was noted to have a "firm" large prostate with a possible right prostatic nodule. At that time, he had no urinary symptoms. A prostate-specific antigen (PSA) level was 1.4 ng/mL. By the time of his urologic evaluation in early 1994, Mr B was complaining of nocturia every hour. Six biopsy specimens of the prostate were negative for malignancy, and the results of an ultrasound of the prostate were normal. Postbiopsy prostatitis was treated with a 6-week course of ciprofloxacin. Doxazosin (1 mg at bed-time) was prescribed to help alleviate