هذا البروتوكول مخصص للمرضى المصابين بتضخم البروستاتا الحميد وتضخم البروستاتا المؤكد الذين فشل فيهم مسار سابق من العلاج الدوائي في تحقيق التحسن المتوقع في درجة الأعراض أو تقليل حجم البروستاتا.
يُحدَّد تضخم البروستاتا بواحد على الأقل مما يلي: حجم البروستاتا أكبر من 30 غرام على التصوير، أو المستضد النوعي للبروستاتا (PSA) أكبر من 1.5 نانوغرام/مل، أو التضخم الملموس الذي يُكتشف عند الفحص الرقمي للمستقيم.
العلاج السابق — مثبط 5-ألفا اختزال (كعلاج وحيد أو بالتزامن مع حاصر ألفا أو تادالافيل) — لم يحقق انخفاضاً في IPSS أكثر من 3 نقاط عن الأساس، أو تخفيضاً في حجم البروستاتا بنسبة 15–25% في 6 أشهر. يؤدي الفشل في تحقيق أي من هذين الهدفين إلى تصعيد العلاج وفق هذا البروتوكول.
5-ARI monotherapy should be used as a treatment option in patients with LUTS/BPH with prostatic enlargement as judged by a prostate volume of > 30g on imaging, a prostate specific antigen (PSA) > 1.5ng/mL, or palpable prostate enlargement on digital rectal exam (DRE).
5-ARI in combination with an alpha blocker should be offered as a treatment option only to patients with LUTS associated with demonstrable prostatic enlargement as judged by a prostate volume of > 30g on imaging, a PSA > 1.5ng/mL, or palpable prostate enlargement on DRE.
TURP should be offered as a treatment option for patients with LUTS/BPH.
TUIP should be offered as an option for patients with prostates ≤30g for the surgical treatment of LUTS/BPH.
PVP should be offered as an option using 120W or 180W platforms for the treatment of LUTS/BPH.
Holmium laser enucleation of the prostate (HoLEP) or thulium laser enucleation of the prostate (ThuLEP) should be considered as an option, depending on the clinician's expertise with these techniques, as prostate size-independent options for the treatment of LUTS/BPH.
Bipolar TUVP may be offered as an option to patients for the treatment of LUTS/BPH.
PUL should be considered as a treatment option for patients with LUTS/BPH provided prostate volume 30–80g and verified absence of an obstructive middle lobe.
WVTT should be considered as a treatment option for patients with LUTS/BPH provided prostate volume 30–80g.
Robotic waterjet treatment (RWT) may be offered as a treatment option to patients with LUTS/BPH provided prostate volume 30–80g.
Open, laparoscopic, or robotic assisted prostatectomy should be considered as treatment options by clinicians, depending on their expertise with these techniques, only in patients with large to very large prostates.
PAE may be offered for the treatment of LUTS/BPH.
TIPD may be offered as a treatment option for patients with LUTS/BPH provided prostate volume is between 25 and 75g and lack of obstructive median lobe.
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