What is the best next step in evaluating the 72-year-old man with urinary issues and prostate enlargement?

In evaluating a 72-year-old man with urinary issues and prostate enlargement, initiating the assessment with a urine analysis (UA) is critical. This allows for the detection of possible urinary tract infections, hematuria, or other abnormalities in the urine that could be contributing to the patient's symptoms. Given the high prevalence of benign prostatic hyperplasia (BPH) and other prostate issues at this age, it's essential to rule out conditions like urinary tract infections that can mimic or exacerbate urinary symptoms.

While prostate-specific antigen (PSA) testing is a valuable tool in assessing prostate health, particularly for prostate cancer screening, it is typically performed after considering the clinical context and either after aUA suggests abnormalities or in conjunction with other tests. Transrectal ultrasound is more invasive and is usually reserved for specific clinical scenarios, such as planning for surgical intervention or further evaluation when lesions are detected on other imaging or tests. A bladder scan is useful for assessing post-void residual urine volume but does not address the broader array of urinary issues the patient may be experiencing.

Therefore, starting with a urine analysis provides immediate and relevant insights needed to guide further evaluation and management of the patient's urinary concerns effectively.