The FDA has approved the use of a permanent prostatic urethral lift implant (UroLift – NeoTract) to relieve low or blocked urine flow in men ≥50 years old with benign prostatic hyperplasia (BPH).

Serum measurements of prostate specific antigen (PSA) are now being used in the diagnosis and management of prostate cancer. Produced by prostatic epithelium, PSA is a protease involved in liquefaction of the seminal coagulum. Whether this test should be used for routine screening is a matter of controversy; it is currently approved by the US Food and Drug Administration (FDA) only for monitoring after treatment for prostate cancer.

The US Preventive Services Task Force (USPSTF) has recently concluded that available evidence is insufficient to assess the balance between potential benefits and harms of using the prostate-specific antigen (PSA) to screen men < 75 years old for prostate cancer and has recommended against screening men > 75 years old.

To avoid the morbidity and occasional mortality of transurethral resection or open prostatectomy, some urologists are now using balloon dilatation of the prostatic urethra to treat benign prostatic hypertrophy.

Bicalutamide (Casodex - Zeneca), an oral nonsteroidal antiandrogen similar to flutamide (Eulexin - Medical Letter, 31:72, 1989), is now available in the USA for treat-ment of advanced prostate cancer. The drug is recommended by the manufacturer for use concurrently with an analog of luteinizing hormone-releasing hormone (LHRH) such as leuprolide (Lupron; Lupron Depot) or goserelin (Zoladex -Medical Letter, 32:102, 1990).

Flutamide (Eulexin - Schering), an oral antiandrogen, is now available in the USA for treatment of metastatic prostate cancer. Flutamide is recommended by the manufacturer only for use concurrently with an analog of luteinizing hormone-releasing hormone (LHRH) such as leuprolide (Lupron - Medical Letter, 27:71, 1985).

Finasteride (Proscar - Merck) has now been approved by the US Food and Drug Administration (FDA) for oral treatment of benign prostatic hyperplasia. A 4-aza-steroid, the drug is a specific inhibitor of steroid 5 -reductase, the enzyme that catalyzes conversion of testosterone to dihydrotestosterone. Dihydrotestosterone is required for development and maintenance of prostatic hypertrophy (JS Tenover, Endocrinol Metab Clin North Am, 20:893, 1991).

Patients are asking physicians about an article on the front page of the June 15th New York Times, in which some prostate cancer experts were quoted as suggesting that men 55 and older might be well advised to take finasteride (Proscar, and others) to prevent prostate cancer.

Terazosin (Hytrin - Abbott), a postsynaptic alpha 1 -adrenoreceptor blocker previ-ously available for treatment of hypertension (Medical Letter, 29:113, 1987), has now been approved by the US Food and Drug Administration (FDA) for treatment of benign prostatic hyperplasia (BPH). Although not previously approved by the FDA, terazosin and other alpha-blockers such as prazosin (Minipress, and others) or doxazosin (Car-dura) have been used for this indication for many years.

About 60% of men ≥60 years old have clinically relevant prostatic enlargement due to benign prostatic hyperplasia (BPH). The goals of treatment are to decrease lower urinary tract symptoms and to prevent disease progression and complications such as acute urinary retention. The American Urologic Association's guidelines for treatment of BPH were recently updated.