Urology

Medical management of benign prostatic hyperplasia: results from a population-based study

Bishr M, Boehm K, Trudeau V, Tian Z, Dell'Oglio P, Schiffmann J, Jeldres C, Sun M, Shariat SF, Graefen M, Saad F, Karakiewicz PI. Can Urol Assoc J 2016; 10(1–2): 55–59

BPH treatment for lower urinary tract symptoms

Benign prostatic hyperplasia (BPH) is commonly treated by monotherapy with α-adrenergic-receptor-blocking agents (α-blockers) or 5α-reductase inhibitors (5ARIs), despite evidence from clinical trials indicating that combination therapy is more effective, according to a recent report in the Canadian Urological Association Journal.1

In men older than 40 years of age, BPH is the leading cause of lower urinary tract symptoms (LUTS).1

Medical treatment of BPH is the standard of care for LUTS in Western countries and has been shown to reduce the requirement for transurethral prostate resection procedures.1

Randomised clinical trials have shown that combination therapy is superior to monotherapy in the management of BPH with respect to symptom control, disease progression and reduced risk of BPH-related-surgery.1

In Canada and the US, current guidelines for the treatment of LUTS recommend the use of 5ARIs and α-blockers as monotherapy or in combination.1 However, there is a lack of data documenting prescribing patterns at a population level.1 To address this, the authors surveyed Canadian practice patterns using data from the prostate cancer and environmental study (PROtEuS), a case-control study conducted in Montreal between 2005 and 2012. In total, 1,120 of the 3,790 evaluable PROtEuS participants reported a diagnosis of BPH and were eligible for inclusion in this study; all participants were Canadian males aged less than 76 years.1

Of the BPH study cohort, 601 (53.7%) participants received medical treatment. The treatment group consisted of 338 case and 263 control participants.1

Compared with the untreated BPH group, the participants receiving medical treatment for BPH had:1

• Older age at index date (mean age: 66.9 versus 64.9 years; p<0.001)
• Older age at diagnosis of BPH (mean age: 62.3 versus 60.3 years; p<0.001)
• Longer history of BPH (mean: 4.7 versus 4.0 years; p=0.02)
• More frequent physician visits (³1 physician visit per year: 91.5% versus 82%; p<0.001)
• Lower family income (income <$50,000/year: 52.9% versus 42.4%; p<0.01).

Of the treatment group, 460 (76.5%) participants had detailed information on BPH medications.1

• In this subgroup, initial monotherapy was reported more frequently than initial combination therapy (87.6% versus 12.4%; p<0.001)
• Following stratification according to case versus control status, monotherapy was reported more frequently by cases than controls (91.2% versus 82.7%; p=0.02).

The most common monotherapies were:1

• α-blockers (69.9%)
• 5ARIs (26.6%)
• Phytotherapy (2.3%)
• Anticholinergics (1.2%).

The most common combination therapies were:1

• α-blockers + 5ARIs (97.3%)
• 5ARIs + anticholinergics (2.7%).

Conclusions

Despite strong clinical evidence, rates of monotherapy for BPH treatment in Canada remain high compared with combination therapy, and are similar to rates in Europe and the US (80–90%).1 The authors also highlighted that 5ARI use was more common than previously reported and that 9 patients reported receiving phytotherapy alone, a practice not recommended by current guidelines.1

Report on: Medical management of benign prostatic hyperplasia: results from a population-based study. Bishr M, Boehm K, Trudeau V, Tian Z, Dell'Oglio P, Schiffmann J, Jeldres C, Sun M, Shariat SF, Graefen M, Saad F, Karakiewicz PI. Can Urol Assoc J 2016; 10(1–2): 55–59.