Treatment of Benign Prostatic Hypertrophy in a 64-Year-Old Man Using Dutasteride

Some Background

Benign prostatic hyperplasia (BPH) is a common urological condition affecting aging men, often leading to lower urinary tract symptoms (LUTS) that can significantly impact quality of life. This case report describes the evaluation and management of a 64-year-old man referred to a urologist for progressive BPH-related symptoms. H.I.’s diagnostic workup, treatment plan, and clinical outcome are discussed to highlight best practices in the transition of care from primary to specialist management.

H.I. was 64 years old when he was referred to a urologist for evaluation of progressively worsening LUTS over the previous year. He reported increased urinary frequency, nocturia (waking to urinate 3–4 times per night), hesitancy, a weak urinary stream, and a sensation of incomplete bladder emptying. There was no history of hematuria, dysuria, or urinary tract infections. His medical history included well-controlled hypertension and hyperlipidemia. At the time of referral, he was not taking any medications for urinary symptoms.

The Urologist’s Evaluation

The patient appeared well during the physical examination, and the abdominal exam revealed no bladder distention. A digital rectal examination showed a symmetrically enlarged, firm, non-nodular prostate, estimated to weigh 40–50 grams. Post-void residual (PVR) volume measured by ultrasound was 130 mL. Urinalysis was unremarkable, and the prostate-specific antigen (PSA) level was 2.6 ng/mL, within the normal range for his age.

A validated symptom score (International Prostate Symptom Score, IPSS) indicated moderate to severe LUTS, with a total score of 21 and a quality-of-life score of 5. The urologist diagnosed H.I. with BPH and discussed both medical and surgical treatment options.

H.I. opted for a trial of medical therapy. He was started on dutasteride 0.5 mg daily to reduce prostate size and improve urinary flow. In addition, he was advised to implement behavioral modifications, including evening fluid restriction and double voiding.

More on Dutasteride

Dutasteride is a 5-alpha-reductase inhibitor that blocks both type I and type II isoenzymes of 5-alpha-reductase—the enzyme responsible for converting testosterone to dihydrotestosterone (DHT), a potent androgen that stimulates prostate growth. By reducing DHT levels, dutasteride leads to gradual shrinkage of the prostate and alleviation of lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH). Its therapeutic value lies in targeting the hormonal cause of prostate enlargement, making it particularly beneficial for patients with significantly enlarged prostates. Unlike alpha-blockers, which provide rapid symptom relief by relaxing smooth muscle, dutasteride offers long-term disease modification by slowing disease progression and reducing the risk of acute urinary retention and the need for surgical intervention.

Before starting dutasteride, the urologist informed H.I. that the medication typically takes 3 to 6 months to produce noticeable improvement in urinary symptoms, as it works by gradually shrinking the prostate. It is important to take the medication daily as prescribed, even if symptom relief is not immediate. Potential side effects include decreased libido, erectile dysfunction, and reduced ejaculate volume, which are generally reversible upon discontinuation. Dutasteride should not be handled by women who are pregnant or may become pregnant, as it can be absorbed through the skin and may harm a male fetus. Additionally, dutasteride lowers prostate-specific antigen (PSA) levels by approximately 50%, so any PSA measurements taken during treatment must be interpreted accordingly. The urologist also advised H.I. to promptly report any breast changes or lumps, and to follow up regularly for monitoring treatment response and ruling out other potential causes of symptoms.

Treatment Results

At follow-up six weeks later, H.I. reported a marked improvement in symptoms. His International Prostate Symptom Score (IPSS) had decreased to 10, and his post-void residual (PVR) volume was reduced to 50 mL. He reported no adverse effects from the medication. The patient was advised to continue medical therapy with periodic monitoring and to report any worsening symptoms or side effects. Surgical options, including transurethral resection of the prostate (TURP), were reserved for consideration in the event of future disease progression or medication intolerance.

H.I.’s case underscores the importance of structured evaluation and shared decision-making in the management of BPH. Alpha-blockers are an effective first-line therapy for most men with moderate to severe LUTS, and early urologic referral can help guide appropriate intervention—especially in patients with elevated PVR or an uncertain diagnosis. Long-term follow-up remains critical to monitor symptom progression and treatment response.

If you or someone you care about is experiencing symptoms such as frequent urination, nighttime urination, a weak urinary stream, hesitancy, or a sensation of incomplete bladder emptying, it is important to seek medical advice from a licensed healthcare professional. These symptoms may indicate BPH. Left untreated, BPH can lead to complications such as bladder damage or urinary retention. A licensed provider can perform the necessary evaluations—including physical examinations, imaging, and lab tests—to accurately diagnose the cause and recommend appropriate treatment. Early medical intervention can relieve symptoms, reduce the risk of more serious complications, and ensure a safe, effective management plan tailored to the individual’s health needs.