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BJU Int. 2015 Feb;115(2):308-16. doi: 10.1111/bju.12802. Epub 2014 Aug 13.

Baseline characteristics predict risk of progression and response to combined medical therapy for benign prostatic hyperplasia (BPH).

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  • 1Department of Urology, University of Michigan Medical School, Ann Arbor, MI, USA.

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.

KEYWORDS:

benign prostatic hyperplasia (BPH); lower urinary tract symptoms (LUTS); risk factors

PMID:
24825577
PMCID:
PMC4231026
DOI:
10.1111/bju.12802
[PubMed - indexed for MEDLINE]
Free PMC Article
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