Baseline Characteristics Predict Risk of Progression and Response to Combined Medical Therapy for Benign Prostatic Hyperplasia (BPH)

Overview

Journal BJU Int

Specialty Urology

Date 2014 May 15

PMID 24825577

Citations 20

Authors

Michael A Kozminski

John T Wei

Jason Nelson

David M Kent

Affiliations

Soon will be listed here.

Abstract

Objective: To better risk stratify patients, using baseline characteristics, to help optimise decision-making for men with moderate-to-severe lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH) through a secondary analysis of the Medical Therapy of Prostatic Symptoms (MTOPS) trial.

Patients And Methods: After review of the literature, we identified potential baseline risk factors for BPH progression. Using bivariate tests in a secondary analysis of MTOPS data, we determined which variables retained prognostic significance. We then used these factors in Cox proportional hazard modelling to: i) more comprehensively risk stratify the study population based on pre-treatment parameters and ii) to determine which risk strata stood to benefit most from medical intervention.

Results: In all, 3047 men were followed in MTOPS for a mean of 4.5 years. We found varying risks of progression across quartiles. Baseline BPH Impact Index score, post-void residual urine volume, serum prostate-specific antigen (PSA) level, age, American Urological Association Symptom Index score, and maximum urinary flow rate were found to significantly correlate with overall BPH progression in multivariable analysis.

Conclusions: Using baseline factors permits estimation of individual patient risk for clinical progression and the benefits of medical therapy. A novel clinical decision tool based on these analyses will allow clinicians to weigh patient-specific benefits against possible risks of adverse effects for a given patient.

Citing Articles

Identifying possible biomarkers of lower urinary tract symptoms using metabolomics and partial least square regression.

Hopland-Nechita F, Andersen J, Rajalahti T, Andreassen T, Beisland C Metabolomics. 2023; 19(9):82.

PMID: 37698748 PMC: 10497431. DOI: 10.1007/s11306-023-02046-2.

Serenoa repens for the treatment of lower urinary tract symptoms due to benign prostatic enlargement.

Franco J, Trivisonno L, Sgarbossa N, Alvez G, Fieiras C, Escobar Liquitay C Cochrane Database Syst Rev. 2023; 6:CD001423.

PMID: 37345871 PMC: 10286776. DOI: 10.1002/14651858.CD001423.pub4.

A Novel Nomogram Based on Initial Features to Predict BPH Progression.

Luciani L, Mattevi D, Ravanelli D, Anceschi U, Giusti G, Cai T Int J Environ Res Public Health. 2022; 19(15).

PMID: 35955094 PMC: 9368684. DOI: 10.3390/ijerph19159738.

Shao W, Zheng C, Ge Y, Chen X, Zhang B, Wang G Asian J Androl. 2022; 25(1):132-136.

PMID: 35532557 PMC: 9933963. DOI: 10.4103/aja202223.

The effect of pharmacotherapy on prostate volume, prostate perfusion and prostate-specific antigen (prostate morphometric parameters) in patients with lower urinary tract symptoms and benign prostatic obstruction. A systematic review and....

Sakalis V, Gkotsi A, Charpidou D, Tsafrakidis P, Apostolidis A Cent European J Urol. 2021; 74(3):388-421.

PMID: 34729231 PMC: 8552938. DOI: 10.5173/ceju.2021.132.R1.

References

Emberton M, Zinner N, Michel M, Gittelman M, Chung M, Madersbacher S . Managing the progression of lower urinary tract symptoms/benign prostatic hyperplasia: therapeutic options for the man at risk. BJU Int. 2007; 100(2):249-53. DOI: 10.1111/j.1464-410X.2007.07056.x. View

Slawin K, Kattan M, Roehrborn C, Wilson T . Development of nomogram to predict acute urinary retention or surgical intervention, with or without dutasteride therapy, in men with benign prostatic hyperplasia. Urology. 2006; 67(1):84-8. DOI: 10.1016/j.urology.2005.07.013. View

Trachtenberg J . Treatment of lower urinary tract symptoms suggestive of benign prostatic hyperplasia in relation to the patient's risk profile for progression. BJU Int. 2005; 95 Suppl 4:6-11. DOI: 10.1111/j.1464-410X.2005.05488.x. View

Kent D, Rothwell P, Ioannidis J, Altman D, Hayward R . Assessing and reporting heterogeneity in treatment effects in clinical trials: a proposal. Trials. 2010; 11:85. PMC: 2928211. DOI: 10.1186/1745-6215-11-85. View

Slawin K, Kattan M . The Use of Nomograms for Selecting BPH Candidates for Dutasteride Therapy. Rev Urol. 2006; 6 Suppl 9:S40-5. PMC: 1472915. View

Maserejian N, Chen S, Chiu G, Araujo A, Kupelian V, Hall S . Treatment status and progression or regression of lower urinary tract symptoms in a general adult population sample. J Urol. 2013; 191(1):107-13. PMC: 4012380. DOI: 10.1016/j.juro.2013.07.005. View

Burke J, Hayward R, Nelson J, Kent D . Using internally developed risk models to assess heterogeneity in treatment effects in clinical trials. Circ Cardiovasc Qual Outcomes. 2014; 7(1):163-9. PMC: 3957096. DOI: 10.1161/CIRCOUTCOMES.113.000497. View

Dorresteijn J, Visseren F, Ridker P, Wassink A, Paynter N, Steyerberg E . Estimating treatment effects for individual patients based on the results of randomised clinical trials. BMJ. 2011; 343:d5888. PMC: 3184644. DOI: 10.1136/bmj.d5888. View

Kok E, Schouten B, Bohnen A, Groeneveld F, Thomas S, Bosch J . Risk factors for lower urinary tract symptoms suggestive of benign prostatic hyperplasia in a community based population of healthy aging men: the Krimpen Study. J Urol. 2008; 181(2):710-6. DOI: 10.1016/j.juro.2008.10.025. View

10.

Barry M, Fowler Jr F, OLeary M, Bruskewitz R, HOLTGREWE H, MEBUST W . The American Urological Association symptom index for benign prostatic hyperplasia. The Measurement Committee of the American Urological Association. J Urol. 1992; 148(5):1549-57; discussion 1564. DOI: 10.1016/s0022-5347(17)36966-5. View

11.

Kaplan S, McConnell J, Roehrborn C, Meehan A, Lee M, Noble W . Combination therapy with doxazosin and finasteride for benign prostatic hyperplasia in patients with lower urinary tract symptoms and a baseline total prostate volume of 25 ml or greater. J Urol. 2006; 175(1):217-20. DOI: 10.1016/S0022-5347(05)00041-8. View

12.

Jacobsen S, Girman C, Lieber M . Natural history of benign prostatic hyperplasia. Urology. 2001; 58(6 Suppl 1):5-16; discussion 16. DOI: 10.1016/s0090-4295(01)01298-5. View

13.

Hong S, Ko W, Kim S, Chung B . Identification of baseline clinical factors which predict medical treatment failure of benign prostatic hyperplasia: an observational cohort study. Eur Urol. 2003; 44(1):94-9; discussion 99-100. DOI: 10.1016/s0302-2838(03)00199-4. View

14.

Lowe F, Batista J, Berges R, Chartier-Kastler E, Conti G, Desgrandchamps F . Risk factors for disease progression in patients with lower urinary tract symptoms/benign prostatic hyperplasia (LUTS/BPH): a systematic analysis of expert opinion. Prostate Cancer Prostatic Dis. 2005; 8(3):206-9. DOI: 10.1038/sj.pcan.4500806. View

15.

Flanigan R, Reda D, Wasson J, Anderson R, Abdellatif M, Bruskewitz R . 5-year outcome of surgical resection and watchful waiting for men with moderately symptomatic benign prostatic hyperplasia: a Department of Veterans Affairs cooperative study. J Urol. 1998; 160(1):12-6; discussion 16-7. View

16.

Anderson J, Roehrborn C, Schalken J, Emberton M . The progression of benign prostatic hyperplasia: examining the evidence and determining the risk. Eur Urol. 2001; 39(4):390-9. DOI: 10.1159/000052475. View

17.

Crawford E, Wilson S, McConnell J, Slawin K, Lieber M, Smith J . Baseline factors as predictors of clinical progression of benign prostatic hyperplasia in men treated with placebo. J Urol. 2006; 175(4):1422-6. DOI: 10.1016/S0022-5347(05)00708-1. View

18.

McConnell J, Roehrborn C, Bautista O, Andriole Jr G, Dixon C, Kusek J . The long-term effect of doxazosin, finasteride, and combination therapy on the clinical progression of benign prostatic hyperplasia. N Engl J Med. 2003; 349(25):2387-98. DOI: 10.1056/NEJMoa030656. View

19.

Parsons J . Modifiable risk factors for benign prostatic hyperplasia and lower urinary tract symptoms: new approaches to old problems. J Urol. 2007; 178(2):395-401. DOI: 10.1016/j.juro.2007.03.103. View

20.

Cuticchia A, Cooley P, Hall R, Qin Y . NIDDK data repository: a central collection of clinical trial data. BMC Med Inform Decis Mak. 2006; 6:19. PMC: 1481598. DOI: 10.1186/1472-6947-6-19. View