Features of patients referring to the outpatient office due to benign prostatic hyperplasia: analysis of a national prospective cohort of 5815 cases.
Journal
Prostate cancer and prostatic diseases
ISSN: 1476-5608
Titre abrégé: Prostate Cancer Prostatic Dis
Pays: England
ID NLM: 9815755
Informations de publication
Date de publication:
Dec 2023
Dec 2023
Historique:
received:
13
03
2022
accepted:
02
07
2022
revised:
10
06
2022
medline:
13
11
2023
pubmed:
23
7
2022
entrez:
22
7
2022
Statut:
ppublish
Résumé
Evidence on clinical presentation of benign prostatic hyperplasia (BPH) is scarce, and studies involving outpatients are lacking. We aimed to provide an insight into the contemporary Italian scenario of BPH-affected outpatients using symptom scores (International Prostate Symptom Score [IPSS], BPH Impact Index [BII]), and to compare characteristics of patients with known BPH and those first-diagnosed at the visit. "IMPROVING THE PATH" project working group designed a questionary prospectively administered to BPH-affected outpatients by urologists. A cross-sectional study was performed. Data were adjusted for patient age as a potential confounding factor. Of 5815 patients enrolled, BPH was already diagnosed in 4144 (71.3%), and not in 1671 (28.7%). Patients with known BPH, compared to newly diagnosed, were older (median 68 versus [vs] 55), had more frequent smoking (smoker 27.2 vs 22.6%, and ex-smoker 16.4 vs 12.5%) and drinking habits (55.4 vs 45.1%), were more frequently affected by hypertension (60.0 vs 42.4%), obesity (15.3 vs 9.6%), diabetes (17.9 vs 12.5%), and cardiovascular diseases (14.2 vs 9.5%), p < 0.001. At IPSS, moderate and severe symptoms correlated with already known BPH (56.1 vs 47.3% and 24.8 vs 7.8%), whereas newly diagnosed patients showed milder symptoms (44.9 vs 19.1%), all p < 0.001. At BII, concern for one's health and time lost due to urinary problems were higher in patients with known BPH (p < 0.001). For these patients, the urologist changes at least one of the ongoing medications in 63.5%. For patients newly diagnosed, supplements/phytotherapeutics, alpha-blockers, and 5-alfa reductase inhibitors were prescribed in 54.6%, 21.6%, and 7.1%, respectively. Despite medical treatment, natural history of BPH leads to a progressive deterioration of symptoms. This may reflect the difference between newly diagnosed patients and those with known BPH in lifestyle and associated comorbidities. A healthy lifestyle and treatments including local anti-inflammatory agents may delay worsening of symptoms and improve quality of life.
Sections du résumé
BACKGROUND
BACKGROUND
Evidence on clinical presentation of benign prostatic hyperplasia (BPH) is scarce, and studies involving outpatients are lacking. We aimed to provide an insight into the contemporary Italian scenario of BPH-affected outpatients using symptom scores (International Prostate Symptom Score [IPSS], BPH Impact Index [BII]), and to compare characteristics of patients with known BPH and those first-diagnosed at the visit.
METHODS
METHODS
"IMPROVING THE PATH" project working group designed a questionary prospectively administered to BPH-affected outpatients by urologists. A cross-sectional study was performed. Data were adjusted for patient age as a potential confounding factor.
RESULTS
RESULTS
Of 5815 patients enrolled, BPH was already diagnosed in 4144 (71.3%), and not in 1671 (28.7%). Patients with known BPH, compared to newly diagnosed, were older (median 68 versus [vs] 55), had more frequent smoking (smoker 27.2 vs 22.6%, and ex-smoker 16.4 vs 12.5%) and drinking habits (55.4 vs 45.1%), were more frequently affected by hypertension (60.0 vs 42.4%), obesity (15.3 vs 9.6%), diabetes (17.9 vs 12.5%), and cardiovascular diseases (14.2 vs 9.5%), p < 0.001. At IPSS, moderate and severe symptoms correlated with already known BPH (56.1 vs 47.3% and 24.8 vs 7.8%), whereas newly diagnosed patients showed milder symptoms (44.9 vs 19.1%), all p < 0.001. At BII, concern for one's health and time lost due to urinary problems were higher in patients with known BPH (p < 0.001). For these patients, the urologist changes at least one of the ongoing medications in 63.5%. For patients newly diagnosed, supplements/phytotherapeutics, alpha-blockers, and 5-alfa reductase inhibitors were prescribed in 54.6%, 21.6%, and 7.1%, respectively.
CONCLUSIONS
CONCLUSIONS
Despite medical treatment, natural history of BPH leads to a progressive deterioration of symptoms. This may reflect the difference between newly diagnosed patients and those with known BPH in lifestyle and associated comorbidities. A healthy lifestyle and treatments including local anti-inflammatory agents may delay worsening of symptoms and improve quality of life.
Identifiants
pubmed: 35869394
doi: 10.1038/s41391-022-00575-w
pii: 10.1038/s41391-022-00575-w
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
730-735Informations de copyright
© 2022. The Author(s), under exclusive licence to Springer Nature Limited.
Références
Devlin CM, Simms MS, Maitland NJ. Benign prostatic hyperplasia - what do we know? BJU Int. 2021;127:389–99. https://doi.org/10.1111/bju.15229
doi: 10.1111/bju.15229
pubmed: 32893964
Vuichoud C, Loughlin KR. Benign prostatic hyperplasia: epidemiology, economics and evaluation. Can J Urol. 2015;22 Suppl 1:1–6.
pubmed: 26497338
Rhodes T, Girman CJ, Jacobsen SJ, Roberts RO, Guess HA, Lieber MM. Longitudinal prostate growth rates during 5 years in randomly selected community men 40 to 79 years old. J Urol. 1999;161:1174–9.
doi: 10.1016/S0022-5347(01)61621-5
pubmed: 10081864
Madersbacher S, Haidinger G, Temml C, Schmidbauer CP. Prevalence of lower urinary tract symptoms in Austria as assessed by an open survey of 2,096 men. Eur Urol. 1998;34:136–41. https://doi.org/10.1159/000019699
doi: 10.1159/000019699
pubmed: 9693249
Egan KB. The epidemiology of benign prostatic hyperplasia associated with lower urinary tract symptoms: prevalence and incident rates. Urol Clin N Am. 2016;43:289–97. https://doi.org/10.1016/j.ucl.2016.04.001
doi: 10.1016/j.ucl.2016.04.001
Madersbacher S, Sampson N, Culig Z. Pathophysiology of benign prostatic hyperplasia and benign prostatic enlargement: a mini-review. Gerontology. 2019;65:458–64. https://doi.org/10.1159/000496289
doi: 10.1159/000496289
pubmed: 30943489
Choi WS, Son H. The change of IPSS 7 (nocturia) score has the maximum influence on the change of Qol score in patients with lower urinary tract symptoms. World J Urol. 2019;37:719–25. https://doi.org/10.1007/s00345-018-2410-8
doi: 10.1007/s00345-018-2410-8
pubmed: 30073391
Albisinni S, Aoun F, Roumeguère T, Porpiglia F, Tubaro A, DE Nunzio C. New treatment strategies for benign prostatic hyperplasia in the frail elderly population: a systematic review. Minerva Urol Nefrol. 2017;69:119–32. https://doi.org/10.23736/S0393-2249.16.02743-0
doi: 10.23736/S0393-2249.16.02743-0
pubmed: 27681493
Barry MJ, Fowler FJ Jr, O’Leary MP, Bruskewitz RC, Holtgrewe HL, Mebust WK, et al. The American Urological Association symptom index for benign prostatic hyperplasia. The Measurement Committee of the American Urological Association. J Urol. 1992;148:1549–57. https://doi.org/10.1016/s0022-5347(17)36966-5 .
doi: 10.1016/s0022-5347(17)36966-5
pubmed: 1279218
Abrams P, Chapple C, Khoury S, Roehrborn C, de la Rosette J. International Scientific Committee. Evaluation and treatment of lower urinary tract symptoms in older men. J Urol. 2009;181:1779–87. https://doi.org/10.1016/j.juro.2008.11.127
doi: 10.1016/j.juro.2008.11.127
pubmed: 19233402
Barry MJ, Fowler FJ Jr, O’Leary MP, Bruskewitz RC, Holtgrewe HL, Mebust WK. Measuring disease-specific health status in men with benign prostatic hyperplasia. Measurement Committee of The American Urological Association. Med Care. 1995;33:AS145–55.
pubmed: 7536866
Mobley D, Feibus A, Baum N. Benign prostatic hyperplasia and urinary symptoms: evaluation and treatment. Postgrad Med. 2015;127:301–7. https://doi.org/10.1080/00325481.2015.1018799
doi: 10.1080/00325481.2015.1018799
pubmed: 25823641
O’Leary MP, Wei JT, Roehrborn CG, Miner M, BPH Registry and Patient Survey Steering Committee. Correlation of the International Prostate Symptom Score bother question with the Benign Prostatic Hyperplasia Impact Index in a clinical practice setting. BJU Int. 2008;101:1531–5. https://doi.org/10.1111/j.1464-410X.2008.07574.x
doi: 10.1111/j.1464-410X.2008.07574.x
pubmed: 18445080
Kingery L, Martin ML, Naegeli AN, Khan S, Viktrup L. Content validity of the Benign Prostatic Hyperplasia Impact Index (BII); a measure of how urinary trouble and problems associated with BPH may impact the patient. Int J Clin Pract. 2012;66:883–90. https://doi.org/10.1111/j.1742-1241.2012.02960.x
doi: 10.1111/j.1742-1241.2012.02960.x
pubmed: 22897465
Fusco F, Palmieri A, Ficarra V, Giannarini G, Novara G, Longo N, et al. α1-Blockers improve benign prostatic obstruction in men with lower urinary tract symptoms: a systematic review and meta-analysis of urodynamic studies. Eur Urol. 2016;69:1091–101. https://doi.org/10.1016/j.eururo.2015.12.034
doi: 10.1016/j.eururo.2015.12.034
pubmed: 26831507
Sebastianelli A, Spatafora P, Morselli S, Vignozzi L, Serni S, McVary KT, et al. Tadalafil alone or in combination with tamsulosin for the management for LUTS/BPH and ED. Curr Urol Rep. 2020;21:56 https://doi.org/10.1007/s11934-020-01009-7
doi: 10.1007/s11934-020-01009-7
pubmed: 33108544
pmcid: 7591403
Hong SK, Min GE, Ha SB, Doo SH, Kang MY, Park HJ, et al. Effect of the dual 5alpha-reductase inhibitor, dutasteride, on serum testosterone and body mass index in men with benign prostatic hyperplasia. BJU Int. 2010;105:970–4. https://doi.org/10.1111/j.1464-410X.2009.08915.x
doi: 10.1111/j.1464-410X.2009.08915.x
pubmed: 19793378
Joo K-J, Sung W-S, Park S-H, Yang W-J, Kim T-H. Comparison of α-blocker monotherapy and α-blocker plus 5α-reductase inhibitor combination therapy based on prostate volume for treatment of benign prostatic hyperplasia. J Int Med Res. 2012;40:899–908. https://doi.org/10.1177/147323001204000308
doi: 10.1177/147323001204000308
pubmed: 22906262
Roehrborn CG, Siami P, Barkin J, Damião R, Major-Walker K, Nandy I, et al. The effects of combination therapy with dutasteride and tamsulosin on clinical outcomes in men with symptomatic benign prostatic hyperplasia: 4-year results from the CombAT study. Eur Urol. 2010;57:123–31. https://doi.org/10.1016/j.eururo.2009.09.035
doi: 10.1016/j.eururo.2009.09.035
pubmed: 19825505
Roehrborn CG, Perez IO, Roos EPM, Calomfirescu N, Brotherton B, Wang F, et al. Efficacy and safety of a fixed-dose combination of dutasteride and tamsulosin treatment (Duodart(®)) compared with watchful waiting with initiation of tamsulosin therapy if symptoms do not improve, both provided with lifestyle advice, in the management of treatment-naïve men with moderately symptomatic benign prostatic hyperplasia: 2-year CONDUCT study results. BJU Int. 2015;116:450–9. https://doi.org/10.1111/bju.13033
doi: 10.1111/bju.13033
pubmed: 25565364
Choi JD, Kim JH, Ahn SH. Transitional zone index as a predictor of the efficacy of α-blocker and 5α-reductase inhibitor combination therapy in Korean patients with benign prostatic hyperplasia. Urol Int. 2016;96:406–12. https://doi.org/10.1159/000442995
doi: 10.1159/000442995
pubmed: 26824527
Mari A, Antonelli A, Cindolo L, Fusco F, Minervini A, De Nunzio C. Alfuzosin for the medical treatment of benign prostatic hyperplasia and lower urinary tract symptoms: a systematic review of the literature and narrative synthesis. Ther Adv Urol. 2021;13. https://doi.org/10.1177/1756287221993283
Jiang Y-L, Qian L-J. Transurethral resection of the prostate versus prostatic artery embolization in the treatment of benign prostatic hyperplasia: a meta-analysis. BMC Urol. 2019;19:11 https://doi.org/10.1186/s12894-019-0440-1
doi: 10.1186/s12894-019-0440-1
pubmed: 30691478
pmcid: 6350315
Liu Y, Cheng Y, Zhuo L, Liu K, Xiao C, Zhao R, et al. Impact on sexual function of endoscopic enucleation vs transurethral resection of the prostate for lower urinary tract symptoms due to benign prostatic hyperplasia: a systematic review and meta-analysis. J Endourol. 2020;34:1064–74. https://doi.org/10.1089/end.2020.0141
doi: 10.1089/end.2020.0141
pubmed: 32242462
Tanneru K, Jazayeri SB, Alam MU, Kumar J, Bazargani S, Kuntz G, et al. An indirect comparison of newer minimally invasive treatments for benign prostatic hyperplasia: a network meta-analysis model. J Endourol. 2021;35:409–16. https://doi.org/10.1089/end.2020.0739
doi: 10.1089/end.2020.0739
pubmed: 32962442
Abt D, Hechelhammer L, Müllhaupt G, Markart S, Güsewell S, Kessler TM, et al. Comparison of prostatic artery embolisation (PAE) versus transurethral resection of the prostate (TURP) for benign prostatic hyperplasia: randomised, open label, non-inferiority trial. BMJ. 2018;361:k2338 https://doi.org/10.1136/bmj.k2338
doi: 10.1136/bmj.k2338
pubmed: 29921613
pmcid: 6006990
Spatafora S, Canepa G, Migliari R, Rotondo S, Mandressi A, Puppo P. Diagnostic procedures by Italian general practitioners in response to lower urinary tract symptoms in male patients: a prospective study. Curr Med Res Opin. 2004;20:713–21. https://doi.org/10.1185/030079904125003557
doi: 10.1185/030079904125003557
pubmed: 15140338
McNicholas TA. Lower urinary tract symptoms suggestive of benign prostatic obstruction: what are the current practice patterns? Eur Urol. 2001;39 Suppl 3:26–30. https://doi.org/10.1159/000052564
doi: 10.1159/000052564
pubmed: 11275739
Spatafora S, Canepa G, Migliari R, Rotondo S, Mandressi A, Puppo P, et al. Effects of a shared protocol between urologists and general practitioners on referral patterns and initial diagnostic management of men with lower urinary tract symptoms in Italy: the Prostate Destination study. BJU Int. 2005;95:563–70. https://doi.org/10.1111/j.1464-410X.2005.05340.x
doi: 10.1111/j.1464-410X.2005.05340.x
pubmed: 15705081
Li J, Peng L, Cao D, Gou H, Li Y, Wei O. The association between metabolic syndrome and benign prostatic hyperplasia: a systematic review and meta-analysis. Aging Male. 2020;23:1388–99. https://doi.org/10.1080/13685538.2020.1771552
doi: 10.1080/13685538.2020.1771552
pubmed: 32482153
Xia B-W, Zhao S, Chen Z, Chen C, Liu T, Yang F, et al. The underlying mechanism of metabolic syndrome on benign prostatic hyperplasia and prostate volume. Prostate. 2020;80:481–90. https://doi.org/10.1002/pros.23962
doi: 10.1002/pros.23962
pubmed: 32104919
Gandaglia G, Briganti A, Gontero P, Mondaini N, Novara G, Salonia A, et al. The role of chronic prostatic inflammation in the pathogenesis and progression of benign prostatic hyperplasia (BPH). BJU Int. 2013;112:432–41. https://doi.org/10.1111/bju.12118
doi: 10.1111/bju.12118
pubmed: 23650937
Abdollah F, Briganti A, Suardi N, Castiglione F, Gallina A, Capitanio U, et al. Metabolic syndrome and benign prostatic hyperplasia: evidence of a potential relationship, hypothesized etiology, and prevention. Korean J Urol. 2011;52:507–16. https://doi.org/10.4111/kju.2011.52.8.507
doi: 10.4111/kju.2011.52.8.507
pubmed: 21927696
pmcid: 3162215
Wang X, Su Y, Yang C, Hu Y, Dong J-Y. Benign prostatic hyperplasia and cardiovascular risk: a prospective study among Chinese men. World J Urol. 2021. https://doi.org/10.1007/s00345-021-03817-z.
doi: 10.1007/s00345-021-03817-z.
pubmed: 34766214
pmcid: 8813786
Vignozzi L, Gacci M, Maggi M. Lower urinary tract symptoms, benign prostatic hyperplasia and metabolic syndrome. Nat Rev Urol. 2016;13:108–19. https://doi.org/10.1038/nrurol.2015.301
doi: 10.1038/nrurol.2015.301
pubmed: 26754190
Ngai H-Y, Yuen K-KS, Ng C-M, Cheng C-H, Chu S-KP. Metabolic syndrome and benign prostatic hyperplasia: an update. Asian J Urol. 2017;4:164–73. https://doi.org/10.1016/j.ajur.2017.05.001
doi: 10.1016/j.ajur.2017.05.001
pubmed: 29264226
pmcid: 5717972
De Nunzio C, Presicce F, Tubaro A. Inflammatory mediators in the development and progression of benign prostatic hyperplasia. Nat Rev Urol. 2016;13:613–26. https://doi.org/10.1038/nrurol.2016.168
doi: 10.1038/nrurol.2016.168
pubmed: 27686153
Sarma AV, Burke JP, Jacobson DJ, McGree ME, St Sauver J, Girman CJ, et al. Associations between diabetes and clinical markers of benign prostatic hyperplasia among community-dwelling Black and White men. Diabetes Care. 2008;31:476–82. https://doi.org/10.2337/dc07-1148
doi: 10.2337/dc07-1148
pubmed: 18071006
Cornu JN, Ahyai S, Bachmann A, de la Rosette J, Gilling P, Gratzke C, et al. A systematic review and meta-analysis of functional outcomes and complications following transurethral procedures for lower urinary tract symptoms resulting from benign prostatic obstruction: an update. Eur Urol 2015;67:1066–96. https://doi.org/10.1016/j.eururo.2014.06.017
doi: 10.1016/j.eururo.2014.06.017
pubmed: 24972732
Cindolo L, Pirozzi L, Sountoulides P, Fanizza C, Romero M, Castellan P, et al. Patient’s adherence on pharmacological therapy for benign prostatic hyperplasia (BPH)-associated lower urinary tract symptoms (LUTS) is different: is combination therapy better than monotherapy? BMC Urol. 2015;15:96. https://doi.org/10.1186/s12894-015-0090-x
doi: 10.1186/s12894-015-0090-x
pubmed: 26391357
pmcid: 4578263