Tamsulosin (urinary symptoms while waiting), Bicalutamide (started by urology — flare cover for the first LHRH injection)
Advice and when to refer
Raised PSA or hard prostate: Repeat PSA (no UTI, no recent catheter or ejaculation) and refer urology for MRI before biopsy (EAU 2026; NICE NG131 2021)
On hormone therapy: Calcium + vitamin D, bone density, glucose, lipids and BP yearly; back pain with leg weakness = cord compression → admit the same day (EAU 2026)
Investigations
First visit
PSA — After counselling; avoid within 48 h of ejaculation or vigorous exercise, and 6 weeks of a UTI.
Digital rectal examination — Hard or irregular prostate.
Only if indicated
Multiparametric MRI prostate — Raised PSA or abnormal DRE, before biopsy.
Prostate biopsy — After MRI.
Bone scan / PSMA PET — High-risk disease.
Follow-up and monitoring
PSA — Every 6–12 months on surveillance or after treatment.
Locked
The adult dose for each drug
Indian brand names for each drug, with a link to buy
ICU Decoded — original critical-care and internal-medicine pathways by
Dr Javed Akhtar, each cited to a current guideline. For education and quick
reference; verify every dose against local protocols before prescribing.