Version July 2025
5ARI: 5-alpha reductase inhibitors; CT: computed tomography; DRE: digital rectal exam; LUTS: lower urinary tract symptoms; MRI: magnetic resonance imaging; PSA: prostate-specific antigen; TRUS: transrectal ultrasonography.
* A PSA of ≥4 ng/mL is a widely accepted cutoff value; however, no single PSA value avoids both false positives and missing important cancers at a curable stage.
¶ Lifestyle modifications include limiting fluid intake and maintaining physical activity; behavioral modifications include timed voiding and double voiding.
Δ Symptom severity is assessed using the American Urological Association urinary symptom score/International Prostate Symptom Score and the patient's perception of impact on quality of life. Please refer to related UpToDate content for a related scoresheet and calculator.
◊ Prostate size may be estimated with TRUS, MRI, or CT. MRI or CT are not indicated solely to determine medical therapy. Instead, previous imaging results from the last 2 years or imaging for another indication may be used to estimate prostate size.
§ Surgery is a reasonable alternative to medical therapy in patients with contraindications to medications, in patients who prefer not to take medications, and as second-line treatment for patients whose symptoms are refractory to medical therapy. Please refer to related UpToDate content for further details.
