A LARGE PROSTATE IS NOT ALWAYS A TUMOR

Introduction: Benign Prostate Hyperplasia (BPH) increases its incidence with age. Related symptoms (LUTS) may harm quality of life. Wait and see strategy should be avoided if symptom severity occurs. Patient can pressure for surgery. Diagnosis, monitoring and treatment of this disease demand evaluation in family medicine. Case description: Men, 64 years old, married, nuclear family, Duvall VIII, no family risk, retired (gas worker). Active problems: hypertension, obesity, dyslipidemia, moderate ethanolic habits. Medication: ibersartan and simvastatin. begins In the first appointment with family physician complains of weight gain, insomnia. Diagnosed OASS, begins C-PAP and motivation to life style changes March 2012: refers nocturia. Evaluation of LUTS: IPSS 4 very satisfied with life quality. Prostatic ultrasound and PSA evaluation, wait and see strategy. December 2012: prostate volume of 70 without significant residual urine. Tansulosin and Urology referral. March 2013: His son’s divorce, 18 LUTS, very unsatisfied with quality of life. September 2014 Undergoes surgery. February 2015 – depressed, no ejaculation, erectile dysfunction May 2015 – coping, regretting surgery Comment This case illustrates BPH natural history of multipathology patient. Initial diagnosis of relevant pathologies should not distract approach to BPH´s symptoms. Any change in patient personal status or life cycle plays a psychosocial risk and contributes to quality of life impairment. Natural history and progression of BPH can be impaired by: age, LUTS, PSA, prostate volume. However evaluation isn’t linear: patient can undervalue or hide symptoms. Family doctor involvement is mandatory as surgery follow up is many times transferred to him.