Real-world Therapeutic Management and Evolution of Patients with Benign Prostatic Hyperplasia in Primary Care and Urology in Spain

Overview

Journal Int J Clin Pract

Publisher Wiley

Specialty General Medicine

Date 2021 Apr 22

PMID 33884719

Citations 4

Authors

Bernardino Minana

Jose Maria Molero

Alfonso Agra Rolan

Miguel Tellez Martinez-Fornes

Rafael Cuervo Pinto

David Lorite Mingot

Agata Carreno

Juan Manuel Palacios-Moreno

Affiliations

Soon will be listed here.

Abstract

Objectives: This study aimed to describe the real-world therapeutic management of patients with lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH) (LUTS/BPH) attending primary care and urology clinics in Spain.

Methods: This observational, retrospective, multicentre study included men ≥50 years of age diagnosed with LUTS/BPH (≤8 years prior to study visit) (N = 670). Therapeutic management according to healthcare service (primary care vs. urology clinics) or progression criteria, proportion of patients with treatment change, patient profile according to therapy and evolution of LUTS severity were assessed.

Results: Overall differences were noticed in the management of patients between healthcare service (P < .001) and with or without progression criteria (P < .05). Most patients received pharmacological treatment at diagnosis (70.7%; 474/670), which increased at study visit (81.6%; 547/670) with overall similar profiles between primary care and urology clinics for each therapy. α1-Blockers were the most used pharmacological treatment across healthcare settings at diagnosis (61.8%; 293/474) and study visit (51%; 279/547). Only 27.1% (57/210) of patients with progression criteria at diagnosis and 35.6% (99/278) at study visit received 5α-reductase inhibitor (5ARI) alone or in combination with a α1-blocker. Overall, most patients did not change treatment (60%; 402/670) with a trend of more patients worsening in symptoms when not receiving α1-blocker plus 5ARI combination therapy.

Conclusion: Most patients with LUTS/BPH received pharmacological treatment; however, most men with progression criteria did not receive a 5ARI alone or in combination. These results support the need to reinforce both primary care and urologists existing clinical guideline recommendations for the appropriate medical management of patients with LUTS/BPH.

Citing Articles

A real-world evidence study of interhospital variability in the surgical treatment of patients with benign prostatic hyperplasia: the REVALURO study.

Ivan P, Alberto B, Lluis P, Maurizio D, Jose Luis G, Francisco Javier V Int Urol Nephrol. 2024; 57(3):775-784.

PMID: 39470938 PMC: 11821794. DOI: 10.1007/s11255-024-04239-7.

Phloretin in Benign Prostate Hyperplasia and Prostate Cancer: A Contemporary Systematic Review.

Yang C, Ou Y, Lin C, Lin Y, Tung M, Yu C Life (Basel). 2022; 12(7).

PMID: 35888117 PMC: 9322491. DOI: 10.3390/life12071029.

Phloretin Ameliorates Testosterone-Induced Benign Prostatic Hyperplasia in Rats by Regulating the Inflammatory Response, Oxidative Stress and Apoptosis.

Hsu C, Lin Y, Weng W, Panny L, Chen H, Tung M Life (Basel). 2021; 11(8).

PMID: 34440487 PMC: 8399389. DOI: 10.3390/life11080743.

Real-world therapeutic management and evolution of patients with benign prostatic hyperplasia in primary care and urology in Spain.

Minana B, Molero J, Agra Rolan A, Martinez-Fornes M, Cuervo Pinto R, Lorite Mingot D Int J Clin Pract. 2021; 75(8):e14250.

PMID: 33884719 PMC: 8365648. DOI: 10.1111/ijcp.14250.

References

Roehrborn C . Benign prostatic hyperplasia: an overview. Rev Urol. 2006; 7 Suppl 9:S3-S14. PMC: 1477638. View

OLeary M . Lower urinary tract symptoms/benign prostatic hyperplasia: maintaining symptom control and reducing complications. Urology. 2003; 62(3 Suppl 1):15-23. DOI: 10.1016/s0090-4295(03)00480-1. View

Minana B, Rodriguez-Antolin A, Prieto M, Pedrosa E . Severity profiles in patients diagnosed of benign prostatic hyperplasia in Spain. Actas Urol Esp. 2013; 37(9):544-8. DOI: 10.1016/j.acuro.2013.03.003. View

Bartsch G, Fitzpatrick J, Schalken J, Isaacs J, Nordling J, Roehrborn C . Consensus statement: the role of prostate-specific antigen in managing the patient with benign prostatic hyperplasia. BJU Int. 2004; 93 Suppl 1:27-9. DOI: 10.1111/j.1464-410x.2004.04646.x. View

Rensing A, Kuxhausen A, Vetter J, Strope S . Differences in the Treatment of Benign Prostatic Hyperplasia: Comparing the Primary Care Physician and the Urologist. Urol Pract. 2017; 4(3):193-199. PMC: 5451141. DOI: 10.1016/j.urpr.2016.07.002. View

Kim H, Kim J . Proceed with Caution When Using Real World Data and Real World Evidence. J Korean Med Sci. 2019; 34(4):e28. PMC: 6345637. DOI: 10.3346/jkms.2019.34.e28. View

Rosen R, Altwein J, Boyle P, Kirby R, Lukacs B, Meuleman E . Lower urinary tract symptoms and male sexual dysfunction: the multinational survey of the aging male (MSAM-7). Eur Urol. 2003; 44(6):637-49. DOI: 10.1016/j.eururo.2003.08.015. View

Emberton M, Cornel E, Bassi P, Fourcade R, Gomez J, Castro R . Benign prostatic hyperplasia as a progressive disease: a guide to the risk factors and options for medical management. Int J Clin Pract. 2008; 62(7):1076-86. PMC: 2440415. DOI: 10.1111/j.1742-1241.2008.01785.x. View

Molero J, Minana B, Palacios-Moreno J, Martinez-Fornes M, Lorite Mingot D, Agra Rolan A . Real-world assessment and characteristics of men with benign prostatic hyperplasia (BPH) in primary care and urology clinics in Spain. Int J Clin Pract. 2020; 74(11):e13602. PMC: 7685138. DOI: 10.1111/ijcp.13602. View

10.

Carballido Rodriguez J, Badia Llach X, Gimeno Collado A, Regadera Anechina L, Regadera Sejas L, Dal-Re Saavedra R . [Validity of tests for initial diagnosis and its concordance with final diagnosis in patients with suspected benign prostatic hyperplasia]. Actas Urol Esp. 2006; 30(7):667-74. DOI: 10.1016/s0210-4806(06)73516-1. View

11.

Lim K . Epidemiology of clinical benign prostatic hyperplasia. Asian J Urol. 2017; 4(3):148-151. PMC: 5717991. DOI: 10.1016/j.ajur.2017.06.004. View

12.

Nickel J, Mendez-Probst C, Whelan T, Paterson R, Razvi H . 2010 Update: Guidelines for the management of benign prostatic hyperplasia. Can Urol Assoc J. 2010; 4(5):310-6. PMC: 2950766. DOI: 10.5489/cuaj.10124. View

13.

Carballido J, Fourcade R, Pagliarulo A, Brenes F, Boye A, Sessa A . Can benign prostatic hyperplasia be identified in the primary care setting using only simple tests? Results of the Diagnosis IMprovement in PrimAry Care Trial. Int J Clin Pract. 2011; 65(9):989-96. DOI: 10.1111/j.1742-1241.2011.02735.x. View

14.

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

15.

Tanguay S, Awde M, Brock G, Casey R, Kozak J, Lee J . Diagnosis and management of benign prostatic hyperplasia in primary care. Can Urol Assoc J. 2009; 3(3 Suppl 2):S92-S100. PMC: 2698785. DOI: 10.5489/cuaj.1116. View

16.

Roehrborn C . BPH progression: concept and key learning from MTOPS, ALTESS, COMBAT, and ALF-ONE. BJU Int. 2008; 101 Suppl 3:17-21. DOI: 10.1111/j.1464-410X.2008.07497.x. View

17.

Minana B, Molero J, Agra Rolan A, Martinez-Fornes M, Cuervo Pinto R, Lorite Mingot D . Real-world therapeutic management and evolution of patients with benign prostatic hyperplasia in primary care and urology in Spain. Int J Clin Pract. 2021; 75(8):e14250. PMC: 8365648. DOI: 10.1111/ijcp.14250. View

18.

Brenes Bermudez F, Brotons Munto F, Castineiras Fernandez J, Cozar Olmo J, Fernandez-Pro Ledesma A, Martin Jimenez J . [Consensus document on the management and follow-up of the male with lower urinary tract symptoms secondary to benign prostate hyperplasia]. Semergen. 2017; 42(8):547-556. DOI: 10.1016/j.semerg.2016.09.008. View

19.

Speakman M, Kirby R, Doyle S, Ioannou C . Burden of male lower urinary tract symptoms (LUTS) suggestive of benign prostatic hyperplasia (BPH) - focus on the UK. BJU Int. 2014; 115(4):508-19. DOI: 10.1111/bju.12745. View

20.

Johnson T, Abbasi A, Ehrlich S, Kleris R, Schoenberg E, Owen-Smith A . Patient misunderstanding of the individual questions of the American Urological Association symptom score. J Urol. 2008; 179(6):2291-4. DOI: 10.1016/j.juro.2008.01.140. View