Preparing for a urology visit
Lower urinary tract symptoms and rising PSA — consultation
Patient: Thomas Baker, born 8 Nov 1950 (75 years) · Regular medication: tamsulosin 0.4 mg; ramipril 5 mg; metformin 1000 mg twice daily; atorvastatin 20 mg; aspirin 75 mg
LOGISTICS (when booking the appointment): the referral for the urology consultation is active. Bring the ultrasound report of the prostate and urinary tract
and both PSA results (current and last year's — the trend matters). If a digital rectal exam was done, bring the report. Take the voiding diary (below) with you.
1. Questions / topics to discuss
- PSA 5.8 ng/ml — up from 4.1 a year ago. What next: prostate MRI (mpMRI), biopsy, or watchful waiting?
With a prostate of ~58 ml it may be worth calculating PSA density; my brother had prostate cancer — does that lower the decision threshold?
- Lower urinary tract symptoms: getting up to urinate 3–4 times a night, weak and interrupted stream, feeling of incomplete emptying (moderate/severe).
Tamsulosin brought partial improvement. Should a 5-alpha-reductase inhibitor (finasteride/dutasteride) be added given the enlarged prostate?
- Post-void residual of about 95 ml + bladder wall trabeculation.
Is this already a risk of urinary retention? When should surgery (e.g. TURP) be considered, and when are medicines enough?
- Type 2 diabetes (HbA1c 7.3%) and night-time urination.
How much of the nocturia is the prostate, and how much is excess urine from poorly controlled glucose? How to tell them apart?
- Family history: brother — prostate cancer diagnosed at ~72 (treated).
Does this change how often PSA should be checked and the threshold for further diagnostics?
2. Results to show bring printouts
| Ultrasound — prostate and urinary tract |
|---|
| Prostate | enlarged, ~58 ml |
| Post-void residual | approx. 95 ml (raised) |
| Bladder | wall trabeculation (chronic obstruction) |
| Right / left kidney | normal, no stones |
| Hydronephrosis (both kidneys) | none |
| Blood / urine |
|---|
| Total PSA | 5.8 ng/ml | 4.1 a year ago — rising |
| Free / total PSA | 12 % | low — discuss |
| Creatinine / eGFR | 1.32 / 55 | mildly reduced (age, diabetes) |
| HbA1c / glucose | 7.3 % / 138 | diabetes — not well controlled |
| Potassium | 4.6 mmol/l | OK (ramipril) |
| Urinalysis | trace protein | no signs of infection |
History: benign prostate enlargement for ~5 years, tamsulosin for 2 years. Hypertension and type 2 diabetes for ~8 years. No blood in urine, no kidney stones, no urinary tract infections. Kidney context: eGFR 55 given age and diabetes — mild picture, urine without signs of inflammation.
What I am already doing (to confirm with the doctor): limiting fluids for 2–3 hours before bed (nocturia), keeping a voiding diary (times and volumes), watching glucose and blood pressure, avoiding decongestant medicines (e.g. pseudoephedrine in cold remedies, which worsens urinary retention).
3. Checklist — what to bring
- Ultrasound report (prostate 58 ml, residual 95 ml)
- Both PSA results — current 5.8 and previous 4.1 (trend)
- Blood results with creatinine/eGFR and HbA1c
- Voiding diary (frequency and volumes)
- Referral for the urology consultation
- List of medicines and supplements (below)
4. Medicines and supplements (urological context)
| Product | Dose / schedule | Notes |
|---|
| Tamsulosin | 0.4 mg | LUTS, partial improvement — ask about adding a 5-alpha-reductase inhibitor |
| Ramipril | 5 mg | hypertension |
| Metformin | 1000 mg twice daily | type 2 diabetes (HbA1c 7.3) |
| Atorvastatin | 20 mg in the evening | cholesterol |
| Aspirin (acetylsalicylic acid) | 75 mg | cardiovascular prevention |
| Vitamin D3 | 2000 IU | — |