title: Diagnosis and treatment of benign prostatic hyperplasia. Practice patterns of primary care physicians.
abstract: OBJECTIVE
  To define primary care physicians' (PCPs) practices in managing patients with benign prostatic hyperplasia [BPH], and to compare these practices to portions of the Agency for Health Care Policy and Research BPH guideline and urologists' practices.
  
  
  METHODS
  Mail survey.
  
  
  METHODS
  Nationwide random sample of PCPs and urologists, selected from the American Medical Association Registry.
  
  
  METHODS
  Initial mailing, postcard reminder, second mailing, telephone reminder, final mailing.
  
  
  RESULTS
  Primary care physicians (n = 444, response = 51%) reported seeing a median of 35 patients with BPH over the preceding year, in contrast to 240 for urologists (n = 394, response = 68%). Regarding tests recommended by the guideline, two thirds of PCPs reported rarely or never using the American Urological Association (AUA) symptom index, nearly all reported routinely performing digital rectal examinations, and many (66%) reported routinely ordering tests to determine the serum creatinine level. Although considered "optional" by the guideline, more than 90% of PCPs reported routinely ordering a prostate-specific antigen test, while infrequently using other optional tests. Regarding "not recommended" studies, a substantial minority reported selectively or routinely ordering intravenous pyelography (34%) and renal ultrasound (33%), while two thirds reported rarely or never ordering these tests. Eighty-six percent of PCPs reported prescribing medications for BPH over the preceding year; alpha blockers to a median of 12 patients, and finasteride to a median of 2. Variation in urology referral thresholds was suggested in responses to two patient scenarios.
  
  
  CONCLUSIONS
  Primary care physicians are actively managing patients with BPH. Some of their diagnostic evaluations vary from the recommendations of a national guideline and urologists' practices. Referral thresholds appear to vary considerably.
authors.affiliation: General Medicine Division, Massachusetts General Hospital, Boston 02114, USA.
authors.forename: M M
authors.initials: MM
authors.lastname: Collins
authors.forename: M J
authors.initials: MJ
authors.lastname: Barry
authors.forename: L
authors.initials: L
authors.lastname: Bin
authors.forename: R G
authors.initials: RG
authors.lastname: Roberts
authors.forename: J E
authors.initials: JE
authors.lastname: Oesterling
authors.forename: F J
authors.initials: FJ
authors.lastname: Fowler
mesh_terms: D000328:Adult; D000368:Aged; D005194:Family Practice / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011159:Population Surveillance; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000706:statistics & numerical data; D011470:Prostatic Hyperplasia / Q000175:diagnosis* / Q000628:therapy*; D011897:Random Allocation; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012494:Sampling Studies; D014572:Urology