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Benign Prostatic Hyperplasia (BPH) Management in Primary Care: Screening and Therapy [Internet]

Benign Prostatic Hyperplasia (BPH) Management in Primary Care: Screening and Therapy [Internet]

Evidence-based Synthesis Program - Department of Veterans Affairs (US)

Version: February 2007

EXECUTIVE SUMMARY

Benign prostatic hyperplasia (BPH) causes urinary hesitancy and intermittency, weak urine stream, nocturia, frequency, urgency, and the sensation of incomplete bladder emptying. These symptoms, collectively called “lower urinary tract symptoms,” or LUTS, can significantly reduce quality of life. Men with no symptoms or mild symptoms (AUA Symptom Index [SI] score of <7 points), and those who tolerate moderate symptoms well, may be managed without pharmacotherapy (“watchful waiting”). For those who have moderate or severe symptoms, medical treatments include alpha-1-selective adrenergic receptor (a-1-AR) antagonists, 5-alpha-reductase inhibitors (5-aRIs), or a combination therapy with one drug from each of these classes.

RESULTS

Searches identified 10 relevant systematic reviews. [] We also identified 41 articles reporting 7 observational studies relevant to Key Question 1, including 11 about the risk for progression of BPH; 12 about prostate cancer detection or the incidence of cancer on treatment; and 18 about the comparative efficacy and/or safety of combination therapy, finasteride alone, and an alpha blocker alone. For comparisons of different alpha blockers (Key Question 2), we relied on relevant systematic reviews, [, ] supplemented by trials and observational studies published since 2003. For Key Question 3, we identified 11 publications of the use of alpha blockers or finasteride in the elderly or in patients with comorbid conditions, most commonly hypertension. []

INTRODUCTION

Benign prostatic hyperplasia (BPH) causes urinary hesitancy and intermittency, weak urine stream, nocturia, frequency, urgency, and the sensation of incomplete bladder emptying. These symptoms, collectively called “lower urinary tract symptoms,” or LUTS, can significantly reduce quality of life. Approximately 50% of men who have BPH develop moderate to severe symptoms. BPH is the 4th most commonly diagnosed disease among patients ≥50 years, after coronary disease and hyperlipidemia; hypertension; and type 2 diabetes. Among men over 50 years the prevalence of diagnosed BPH in the community is 13.5%.

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