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The impact of early vs delayed initiation of combination therapy for BPH medical management
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What is BPH?
Benign Prostatic Hyperplasia (BPH) relates to the non-cancerous growth of the prostate.
As the prostate enlarges and BPH progresses, urinary frequency becomes an increasing issue and men may need to wake more often during the night. This degree of nocturia is not a natural part of aging, and seriously disrupts sleep, reducing daytime energy and negatively affecting daily activities and general well being.1
BPH can be progressive and, without treatment, the prostate continues to grow and symptoms become more severe. In some cases, this results in complete blockage of the urethra and a sudden inability to pass urine. This condition, known as acute urinary retention (AUR), is a medical emergency that is often unexpected and painful, and requires immediate catheterisation.2 3
Symptoms of BPH
Clinically, patients with lower urinary tract symptoms (LUTS) due to BPH present with two types of symptoms:
- Weak stream
- Urge incontinence
While voiding symptoms are more common, storage symptoms are more bothersome and interfere more with daily activities. Thus they have a considerable effect on quality of life and are the main reason that patients seek medical advice.4
Diagnosis of BPH
BPH is usually diagnosed on the basis of the patient’s medical history, a physical examination (including digital rectal examination [DRE]), an evaluation of LUTS severity, and the measurement of serum PSA levels.5
PSA and DRE should be investigated in accordance with the NCCP Prostate Cancer Referral Guideline.
The severity of LUTS associated with BPH is most commonly evaluated with a self administered questionnaire, such as the International Prostate Symptom Score
Progressive nature of BPH
The prostate grows slowly over time. BPH can be progressive in nature and can lead to worsening symptoms, increased adverse effect on quality of life, development of complications such as acute urinary retention (AUR) and urinary tract infections (UTIs) and need for surgical intervention.
- Enlarged prostate size (>30cm3)
- PSA > 1.4 mg/ml
- Age >50 years
- Severity of LUTS
- Cornu et al. Impact of nocturia on the daily life of patients with lower urinary tract symptoms due to benign prostatic hyperplasia (Article in French). Prog Urol 2007; 17(5 Suppl 1): 1033-1036
- Emberton et al. Fortnightly review: Acute urinary retention in men: An age old problem. BMJ 1999; 318: 921-5
- Emberton et al. Managing the progression of lower urinary tract symptoms, benign prostatic hyperplasia: therapeutic options for the man at risk. BJU Int. 2007; 100: 249-253
- Speakman et al. Guideline for the primary care management of male lower urinary tract symptoms BJU Int. 2004: 93: (7) 985-990
- McConnell JD et al. The long-term effect of doxazosin, finasteride, and combination therapy on the clinical progression of benign prostatic hyperplasia. N Engl J Med 2003; 349: 2387-2398
- Djavan et al. Benign prostatic hyperplasia progression and its impact on treatment. Curr Opin Urol 2004; 44:45-50