This week we narrow in on the enlarging prostate and decipher the common issue of benign prostatic hyperplasia with Adam C. Reese MD, Associate Professor of Urology at the Lewis Katz School of Medicine at Temple University and Chief of Urologic Oncology at Temple University Hospital. Learn how to interpret the symptom profile for patients presenting with common urinary issues, what to feel for in the digital rectal exam, how to treat BPH, and when to refer. ACP members can visit https://acponline.org/curbsiders to claim free CME-MOC credit for this episode and show notes (goes live 0900 EST). See you at SGIM 2019! Find us in our red Curbsider’s t-shirts handing out Curbsiders and Kashlak stickers/patches at SGIM 2019 in Washington DC! We’ll be recording full length shows and daily recaps! Credits Written and produced by: Paul Williams MD Hosts: Paul Williams MD, Matthew Watto MD Images and infographics: Elena Gibson, Beth Garbitelli Show Notes: Elena Gibson, Beth Garbitelli Edited by: Matthew Watto MD, Chris Chiu MD Guest: Adam Reese MD Time Stamps 00:00 SGIM announcement 00:30 Disclaimer, intro and guest bio 03:20 Guest one liner, book recommendation, favorite failure and surgical M&M 10:56 Case of benign prostatic hyperplasia, defining terms and obstructive/voiding versus storage/irritative symptoms 16:11 IPSS score and evaluating symptoms 22:10 Digital rectal exam. Will this give any useful information? 26:55 Taking a history about BPH and some lifestyle modifications 29:20 Lab studies for urinary tract symptoms and interpreting PSA and free PSA 36:20 Initial therapy for BPH and managing patient expectations, alpha blocker side effects 39:25 Choice of agent and monitoring symptoms on therapy 42:25 Nonpharmacologic management of bladder complaints 45:10 Who and when to refer to urology 47:33 Counseling about use of 5 alpha reductase inhibitors, their side effects and is there a risk for high grade cancer? 52:35 Phosphodiesterase inhibitors for BPH symptoms 53:50 Urethral milking. NOT prostate milking 54:55 Desmopressin for nocturia 56:20 Take home points 59:03 Prostate volume and PSA 61:10 Outro Full show notes available at http://thecurbsiders.com/episode-list. Join our mailing list and receive a PDF copy of our show notes every Monday. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com.