Benign prostatic hyperplasia as a progressive disease: a guide to the risk factors and options for medical management

Abstract

Benign prostatic hyperplasia (BPH) is a complex disease that is progressive in many men. BPH is commonly associated with bothersome lower urinary tract symptoms; progressive disease can also result in complications such as acute urinary retention (AUR) and BPH-related surgery. It is therefore important to identify men at increased risk of BPH progression to optimise therapy. Several factors are associated with progression, including age and prostate volume (PV). Serum prostate-specific antigen level is closely correlated with PV, making it useful for determining the risk of BPH progression. Medical therapy is the most frequently used treatment for BPH. 5-alpha-reductase inhibitors impact the underlying disease and decrease PV; this results in improved symptoms, urinary flow and quality of life, and a reduced risk of AUR and BPH-related surgery. Alpha-blockers achieve rapid symptom relief but do not reduce the overall risk of AUR or BPH-related surgery, presumably because they have no effect on PV. Combination therapy provides greater and more durable benefits than either monotherapy and is a recommended option in treatment guidelines. The Combination of Avodart® and Tamsulosin (CombAT) study is currently evaluating the combination of dutasteride with tamsulosin over 4 years in a population of men at increased risk of BPH progression. A preplanned 2-year analysis has shown sustained symptom improvement with combination therapy, significantly greater than with either monotherapy. CombAT is also the first study to show benefit in improving BPH symptoms for combination therapy over the alpha-blocker, tamsulosin, from 9 months of treatment.

Understanding patient and physician perceptions of benign prostatic hyperplasia in Asia Pacific, Latin America and the Commonwealth of Independent States: the Prostate Research on Behaviour and Education ( PROBE ) II survey

“…There were some similarities, but also some differences, between our findings and those from the first PROBE study 3. A similar proportion of patients felt well informed about BPH (61% in PROBE II and 56% in PROBE I).…”

“…Histologically, BPH is defined as the presence of stromal‐glandular hyperplasia within the prostate gland 3. Many patients with BPH present with bothersome lower urinary tract symptoms (LUTS), typically an increase in urinary urgency and frequency, nocturia, decreased and intermittent force of stream and a sense of incomplete bladder emptying3; these symptoms can have a substantial negative impact on quality of life (QoL) 4.…”

“…Histologically, BPH is defined as the presence of stromal‐glandular hyperplasia within the prostate gland 3. Many patients with BPH present with bothersome lower urinary tract symptoms (LUTS), typically an increase in urinary urgency and frequency, nocturia, decreased and intermittent force of stream and a sense of incomplete bladder emptying3; these symptoms can have a substantial negative impact on quality of life (QoL) 4. BPH/LUTS is a progressive condition that can lead to serious long‐term complications such as acute urinary retention (AUR) and BPH‐related surgery,5 and is associated with a considerable economic burden 6, 7, 8…”

Decline of seminal parameters in middle-aged males is associated with lower urinary tract symptoms, prostate enlargement and bladder outlet obstruction

“…According to lower urinary tract symptoms, the subjects were divided into four groups -without LUTS score (IPSS 0) and with mild (I--PSS score 1-7), moderate (I-PSS score [8][9][10][11][12][13][14][15][16][17][18][19], and severe (I-PSS score 20-35) symptom scores (9). The separation of subjects according to total prostate volume was made using the cut-off levels of previous large-scale, long-term medical studies (14,15) and the risk for BPH progression (TPV < 30 and ≥ 30 mL, respectively) (16).…”

From evidence‐based medicine to evidence‐balanced medicine for individualized and personalized care: As applied to benign prostatic hyperplasia/male lower urinary tract symptoms

“…3 IPP helps to predict obstruction and disease progression. In our study of 200 patients, 94% of grade 3 IPP patients were obstructed compared with 21% of grade 1 IPP patients.…”