A clinical guide to managing prostate disease

9 min

Prostate disease includes benign prostatic hyperplasia (BPH) and prostatitis. 

GPs are typically the first point of contact for men with these conditions. This article provides information on managing BPH and prostatitis, including clinical assessment, treatment, referral and follow-up.

Benign prostatic hyperplasia 

BPH is the non-cancerous enlargement of the prostate gland1. While not normally life-threatening, BPH can have a considerable impact on quality of life2.

Diagnosing benign prostatic hyperplasia

To diagnose BPH, review medical history for lower urinary tract symptoms (LUTS) and conduct a physical examination. You may also need to undertake additional tests. 

Medical history

BPH has several urinary symptoms. However, some men with BPH may not present with many or any symptoms of the disease.

Urinary symptoms of BPH

Physical examination


Prostate-specific antigen (PSA) levels

Routine PSA screening is not necessary for patients with BPH. Patients with LUTS are not at increased risk of having prostate cancer.

Other PSA tests

Other PSA tests include creatinine levels, post-void residual urine (ultrasound) and PSA velocity (or doubling time). 

The Prostate Health Index (PHI) is not covered by the MBS. PHI is thought to be more specific for diagnosing prostate cancer than PSA level alone. But quality evidence is lacking, and it’s not recommended in Australian prostate cancer testing guidelines.

Investigations by a urologist

Managing benign prostatic hyperplasia

Managing BPH depends on the type and severity of symptoms.

Observation and review

  • This course of action is appropriate for mild or low-impact symptoms. .Optimise through reassurance, education, periodic monitoring and lifestyle modifications Consider adjusting medication e.g. timing of diuretic.

Medical therapy

5α-reductase-inhibitors (5ARIs) 

These include dutasteride and finasteride. 5ARIs are rarely used as monotherapy.

Combination therapy

Combining dutasteride and tamsulosin is better for patients with large prostates (greater than 30 ml). However, 5ARI can affect sexual function so consider it carefully in sexually active men. 

5ARI may be associated with prostate cancer risk so PSA surveillance is recommended. If PSA increases while the patient is on 5ARI, refer them to a urologist to exclude prostate cancer.

Other drugs

Bladder-directed medications are most commonly used for overactive bladder symptoms. 
They include:


Mirabegron, a beta-3 adrenergic agonist, which requires blood pressure monitoring within the first week.

Anticholinergics like oxybutynin, solifenacin, and darifenacin

Urologist referral


Indications for surgery are similar to the indications for referral to a urologist. Surgery can be considered when medications are no longer suitable. Stopping medication therapy usually results in the recurrence of symptoms.

Long-term catheterisation is a last resort for patients unfit or unwilling for surgery but with complications e.g. urinary retention. In these cases, a supra-pubic catheter is preferred to an indwelling urethral catheter. GPs should also consider intermittent self-catheterisation.


It is appropriate for a GP to monitor and follow up with a patient, regardless of their treatment modality. However, if the patient is not responding to medical treatment, refer them to a urologist.


Prostatitis is an inflammation of the prostate gland from bacterial or non-bacterial infection. Acute bacterial prostatitis is the least common form but can be serious if the infection is left untreated. 

Like BPH, prostatitis is rarely life-threatening, but quality of life can be severely affected.

Diagnosing prostatitis

Medical history


Managing prostatitis

There are several therapeutic options for prostatitis. There is limited evidence for benefits of these treatments; however, they may be trialled with the patient.

Bacterial prostatitis (acute and chronic) can be treated using antibiotics. Once diagnosed, rapid treatment is essential to avoid further complications.

For chronic nonbacterial prostatitis (chronic prostate pain syndrome), treatment is difficult, and cure is often not possible. Treatment focuses on symptom management to improve
quality of life. Non-medical therapy is recommended as the initial treatment.

Treatment options


Surgery has a very limited role and requires an additional, specific indication e.g. prostate 
obstruction, prostate calcification. 



  • The need for urologist follow-up depends on the patient’s progress. Most urologists will refer back to the GP to monitor the progress of the patient. The urologist will seek re-referral if the patient’s progress is not satisfactory. A GP can re-refer if they do not feel comfortable managing a relapse

Free clinical resource

Download the clinical summary guide as a print-ready PDF:
Prostate Disease


Health practitioners
Prostate cancer
Prostate health

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