Reaching a tipping point: A qualitative exploration of quality of life and treatment decision-making in people living with benign prostatic hyperplasia.

Abstract

Benign prostatic hyperplasia (BPH) is a common condition amongst older men and is associated with lower urinary tract symptoms and erectile dysfunction; these symptoms can be burdensome and negatively affect quality of life. Various surgical and pharmaceutical treatment options exist for BPH but there is a paucity of qualitative research exploring men’s decision-making when seeking BPH treatment. This study therefore qualitatively explored men’s experience of living with BPH and seeking treatment for BPH. Twenty men (aged 52-75) were recruited from outpatient urology clinics at a hospital trust in Southern England. Data were collected using semi-structured interviews (via video or telephone call) and were audio-recorded; transcripts were analysed using thematic analysis. Four themes were generated: “It’s about more than just symptoms”, “The path towards treatment”, “The process of information gathering’, and “Navigating hopes, fears and uncertainty”. Results indicate most men appear to seek treatment for BPH following a gradual, and sometimes lengthy, period of deterioration in symptoms; for some men, however, treatment seeking follows an acute episode of sudden or severe symptoms. The decision to proceed with surgical or minimally invasive treatment options appears to be dependent on men reaching a tipping-point; they no longer perceive their symptoms as tolerable and feel their ability to cope with symptoms is reduced. Men each bring their own set of concerns and preferences about side effects and risk-benefit profiles of different treatments. Clinicians need to be sensitive to these individual differences and incorporate them into shared decision-making for choosing between treatment options for BPH.

Difficulties experienced by patients with benign prostatic hyperplasia regarding their physical symptoms

“…Benign prostatic hyperplasia (BPH) is a condition characterized by clinical symptoms resulting from the benign growth of tissues in the prostate gland in men over 50 years old 1–4 . BPH, which is closely related to ageing, is one of the most common diseases in the world and is a progressive disease that reduces the patient's quality of life by presenting as lower urinary tract symptoms (LUTS), despite not being life‐threatening 5–7 . A meta‐analysis of the global prevalence of BPH reported a lifetime prevalence of 26.2%, indicating that approximately 1 in 4 men will suffer from BPH throughout their lives 8 …”

“…[1][2][3][4] BPH, which is closely related to ageing, is one of the most common diseases in the world and is a progressive disease that reduces the patient's quality of life by presenting as lower urinary tract symptoms (LUTS), despite not being life-threatening. [5][6][7] A meta-analysis of the global prevalence of BPH reported a lifetime prevalence of 26.2%, indicating that approximately 1 in 4 men will suffer from BPH throughout their lives. 8 BPH is a significant health concern feared by all ageing men, and symptoms associated with the disease include nocturia, increased frequency of urination, intermittent urine flow, poor urine flow, residual feeling, sudden urge to urinate, and hesitancy.…”