As you get older, you may start to have annoying and disruptive urinary problems like waking up several times a night, having a weak or slow stream, feeling like you need to go right away, or feeling like your bladder never really empties. For millions of men with an enlarged prostate, or Benign Prostatic Hyperplasia (BPH), this is what they deal with every day. You don't have to "just live with it," which is good news. BPH is easy to treat, and the Direct Primary Care (DPC) model is the best way to work together to make a personalized, evidence-based plan to ease your symptoms and make your life better.
Benign Prostatic Hyperplasia is a non-cancerous growth of the prostate gland. Most men experience this as they get older. The prostate gland is around the urethra, which is the tube that carries urine out of the body. When the prostate gland grows, it can squeeze the urethra and cause problems.
How often does it happen?
A lot of people have BPH. By the time they are 60, about half of all men show signs of BPH, and by the time they are 85, up to 90% have it.
The bothersome symptoms (lower urinary tract symptoms, or LUTS):
Symptoms of obstruction: A weak urinary stream, trouble starting to urinate (hesitancy), straining to urinate, or the feeling that the bladder is not fully emptying.
Symptoms that cause irritation: Increased urination frequency, a sudden and intense urge to urinate, and nocturia, which is waking up often at night to urinate.
The goal of management is to: The goal is not to get rid of the enlarged prostate, but to make these annoying symptoms better so you can sleep well at night and not have to think about the nearest bathroom all the time during the day.
Direct Primary Care (DPC) is a membership-based system that lets patients talk to their doctor whenever they want. The DPC model's focus on time, shared decision-making, and continuity is a game-changer for a common and complex condition like BPH. This is why DPC is the best way to deal with your BPH:
A full assessment and a common understanding:
Your DPC doctor has the time to make sure the diagnosis and plan are correct.
A Conversation Without Rush: They can talk to you for a long time about your symptoms and, most importantly, how much they are affecting your quality of life.
Putting a number on the problem: They can use a validated questionnaire, like the International Prostate Symptom Score (IPSS), to find out how bad your symptoms are at the start. This is a great way to keep track of how well your treatment is working.
A Full Assessment: They can do a physical exam, which may include a digital rectal exam, and then, after talking about the options with you, they can order initial tests like a PSA test to make sure there are no other problems.
A Treatment Plan That Is Tailored to You:
DPC is a great way to keep track of the evidence-based treatment plan for BPH.
Making decisions together about medications: Your DPC doctor has the time to talk to you in depth about the two main types of drugs, including their pros and cons:
Alpha-blockers, such as tamsulosin, help relieve symptoms quickly by relaxing the muscles around the prostate.
5-alpha-reductase inhibitors, such as finasteride, take a long time to work and actually shrink a very large prostate.
A Plan That Works for You: This relaxed talk lets you pick a medicine based on your symptoms, the size of your prostate, and what you want to happen with the side effects.
Close follow-up and cheap medicines:
It's easy to tweak your treatment with the DPC model.
Easy Check-ins: DPC's easy access makes it easy to keep an eye on your medication and make any changes to your plan that are needed.
Cutting Your Costs: Many DPC practices give out common generic BPH drugs like tamsulosin and finasteride at wholesale prices. This saves patients a lot of money every month compared to what they would pay at a regular pharmacy.
Case 1: David, 68, is getting more and more upset about having to get up 3–4 times a night to pee. His DPC doctor has him fill out an IPSS form to show that his symptoms are not too bad. They talk for a long time about the options, and in the end, they all agree to start tamsulosin. The DPC practice has a pharmacy in their office where you can get a 90-day supply for just a few dollars. David says that he is now only waking up once a night and that his quality of life has greatly improved since his one-month telehealth check-in.
Case 2: Michael, 72, has a very large prostate and his alpha-blocker only helps him a little bit. His DPC doctor talks to him about the good and bad things about adding finasteride, a second medicine. The doctor says that it may help him avoid surgery and that it will take up to six months to see the full effect. Michael agrees to the trial, and the DPC doctor sets up a follow-up visit in six months to check his IPSS score again and see how he is doing.
Q: If my prostate is bigger, does that mean I'm more likely to get prostate cancer?
A: No. Benign Prostatic Hyperplasia (BPH) is not cancerous. If you have BPH, you are not more likely to get prostate cancer. But the symptoms can sometimes be the same, which is why it's always important to see your doctor for a full evaluation.
Q: What are the main differences between the two types of BPH drugs?
A: Alpha-blockers, like tamsulosin, are "quick-acting plumbers" that work by relaxing the muscles around the prostate to make it easier for urine to flow. 5-alpha-reductase inhibitors, such as finasteride, are "slow-acting architects" that work by actually making the prostate gland smaller over the course of many months.
Q: Do I need to see a urologist because of my BPH symptoms?
A: No, for most men. A skilled primary care doctor can usually manage BPH cases very well with lifestyle changes and medication. Your DPC doctor will only send you to a urologist if your symptoms are very bad and not getting better with treatment, or if there is a worry that you might have a more serious condition.
DPC has a clear advantage for this very common condition of aging because it gives you the time to make a real decision together. DPC's long appointments are necessary for the in-depth discussion needed to choose the best BPH treatment plan for you.
Doing a great job at Longitudinal Medication Management: The DPC model is set up perfectly for close monitoring and medication changes that help control symptoms the best.
Making it easy to get common medications at a low cost: Many DPC practices can give you generic BPH drugs like tamsulosin and finasteride for a lot less than what you would pay at a regular pharmacy, which saves you money every month.
You don't have to let the annoying symptoms of an enlarged prostate ruin your days and keep you up at night. A long talk and a personalized plan made with a trusted partner are the first steps to feeling better. Direct Primary Care gives you the time, knowledge, and ongoing help you need to deal with your BPH and make your life better.
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