Clinical Letter (Urology)

**PROBLEM LIST:** 1. Benign Prostatic Hyperplasia (BPH) with lower urinary tract symptoms (LUTS). 2. Elevated PSA. - PSA: 6.2 ng/mL (most recent), 5.8 ng/mL (prior). **MANAGEMENT PLAN:** - Continue Tamsulosin 0.4mg daily. - Schedule repeat PSA in 3 months. - Discussed the option of a TURP procedure if symptoms worsen. **Past Medical History:** - Hypertension. - Hyperlipidemia. **Prior Abdominal Surgical History:** - Appendectomy, 1998. **Occupation:** The patient is a retired accountant. **CONSULTATION NOTES:** It was a pleasure to see John today. John presented today with worsening urinary frequency, nocturia (3-4 times per night), and hesitancy. He reports these symptoms have been gradually worsening over the past six months. He denies any hematuria, incontinence, or significant pain. He has a family history of prostate cancer (father). He has been taking Tamsulosin for the past year with some initial improvement, but now reports a decline in efficacy. Ultrasound of the prostate performed 6 months ago showed an enlarged prostate with no evidence of malignancy. No other imaging was performed today. PSA was checked today and the result was 6.2 ng/mL. The patient's previous PSA was 5.8 ng/mL. **PHYSICAL EXAMINATION:** Digital rectal examination revealed an enlarged, smooth prostate. No nodules were palpated. No tenderness was elicited. **ASSESSMENT:** Mr. Smith presents with symptomatic BPH, with a rising PSA. The patient's symptoms are not adequately controlled with current medical management. The patient is aware of the risks and benefits of further treatment options. **PLAN:** - Continue Tamsulosin 0.4mg daily. - Schedule repeat PSA in 3 months. - Discussed the option of a TURP procedure if symptoms worsen. - Schedule follow-up appointment in 3 months. Date: 1 November 2024