Key Practice Recommendations

These key learning points summarize the consensus- and evidence-based recommendations included in this edition. The sources listed here for each statement recommend that physicians perform or implement these actions directly in a clinical setting. A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the Strength of Recommendation Taxonomy (SORT) evidence rating system, go to https://www.aafp.org/afp/2004/0201/p548.

1. Use a validated questionnaire, such as the National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI), to evaluate initial symptoms and treatment effectiveness in men with suspected chronic prostatitis/chronic pelvic pain syndrome.

Evidence rating: SORT B

Sources: Section One, references 3 and 4

2. Perform digital rectal examination of the prostate as part of the evaluation for chronic prostatitis/chronic pelvic pain syndrome to assess prostate size, tenderness, and nodularity as well as the tone of deep pelvic floor muscles.

Evidence rating: SORT C

Sources: Section One, references 4 and 5

3. In benign prostatic hyperplasia, use the International Prostate Symptom Score (IPSS) to quantify symptoms and their effect on quality of life, and for diagnosis and monitoring of treatment effectiveness.

Evidence rating: SORT C

Source: Section Two, reference 1

4. Offer patients with benign prostatic hyperplasia and moderate to severe lower urinary tract symptoms selective alpha-1 blockers as a first-line treatment option. The choice of selective alpha-1 blocker should be based on patient age and comorbidities, as well as adverse effects (eg, ejaculatory dysfunction, changes in blood pressure).

Evidence rating: SORT A

Source: Section Two, reference 1

5. Counsel men planning cancer treatment on the possibility of infertility, and refer those interested in future fertility for fertility preservation before treatment initiation.

Evidence rating: SORT C

Sources: Section Three, references 20 and 27

6. Offer prostate cancer screening using prostate-specific antigen testing beginning at age 40 to 45 years to people at increased risk of developing prostate cancer, including those who are Black, have germline variations, or have a strong family history of prostate cancer.

Evidence rating: SORT B

Source: Section Four, reference 7