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BPH progression: concept and key learning from MTOPS, ALTESS, COMBAT, and ALF-ONE.
BJU Int. 2008 Mar; 101 Suppl 3:17-21.BI

Abstract

Benign prostatic hyperplasia (BPH) represents a significant burden in ageing men due to frequently associated lower urinary tract symptoms (LUTS), which may impair quality of life. BPH is also a progressive disease, mainly characterized by a deterioration of LUTS over time, and in some patients by the occurrence of serious outcomes such as acute urinary retention (AUR) and need for BPH-related surgery. The goals of therapy for BPH are not only to improve bothersome LUTS but also to identify those patients at risk of unfavourable outcomes, to optimize their management. In selected patients, combination of an alpha(1)-blocker and a 5alpha-reductase inhibitor is the most effective form of BPH medical therapy to reduce the risk of clinical progression and relieve LUTS. Monotherapy also significantly reduces the risk of BPH clinical progression, mainly through a reduction of LUTS deterioration for alpha(1)-blockers while 5alpha-reductase inhibitors also reduce the risk of AUR and need for BPH-related surgery. Enlarged prostate and high serum prostate-specific antigen levels have been consistently found to be good clinical predictors of AUR and BPH-related surgery in longitudinal population-based studies and placebo arms of controlled studies. High post-void residual urine (PVR) is also associated with an increased risk of LUTS deterioration and should thus be reconsidered in practice as a predictor of BPH progression. Conversely, baseline LUTS severity and low peak flow rate, initially identified as predictors of unfavourable outcomes in community setting, behave paradoxically in controlled trials, probably as a consequence of strict inclusion criteria and subsequent regression to the mean and glass ceiling effects. Lastly, there is increasing evidence that dynamic variables, such as LUTS and PVR worsening, and lack of symptomatic improvement with alpha(1)-blockers are important predictors of future LUTS/BPH-related events, allowing better identification and management of patients at risk of BPH progression.

Authors+Show Affiliations

UT Southwestern Medical Center at Dallas, Dallas, TX 75390-9110, USA. claus.roehrborn@utsouthwestern.edu

Pub Type(s)

Journal Article
Meta-Analysis
Review

Language

eng

PubMed ID

18307681

Citation

Roehrborn, Claus G.. "BPH Progression: Concept and Key Learning From MTOPS, ALTESS, COMBAT, and ALF-ONE." BJU International, vol. 101 Suppl 3, 2008, pp. 17-21.
Roehrborn CG. BPH progression: concept and key learning from MTOPS, ALTESS, COMBAT, and ALF-ONE. BJU Int. 2008;101 Suppl 3:17-21.
Roehrborn, C. G. (2008). BPH progression: concept and key learning from MTOPS, ALTESS, COMBAT, and ALF-ONE. BJU International, 101 Suppl 3, 17-21. https://doi.org/10.1111/j.1464-410X.2008.07497.x
Roehrborn CG. BPH Progression: Concept and Key Learning From MTOPS, ALTESS, COMBAT, and ALF-ONE. BJU Int. 2008;101 Suppl 3:17-21. PubMed PMID: 18307681.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - BPH progression: concept and key learning from MTOPS, ALTESS, COMBAT, and ALF-ONE. A1 - Roehrborn,Claus G, PY - 2008/3/1/pubmed PY - 2008/3/29/medline PY - 2008/3/1/entrez SP - 17 EP - 21 JF - BJU international JO - BJU Int. VL - 101 Suppl 3 N2 - Benign prostatic hyperplasia (BPH) represents a significant burden in ageing men due to frequently associated lower urinary tract symptoms (LUTS), which may impair quality of life. BPH is also a progressive disease, mainly characterized by a deterioration of LUTS over time, and in some patients by the occurrence of serious outcomes such as acute urinary retention (AUR) and need for BPH-related surgery. The goals of therapy for BPH are not only to improve bothersome LUTS but also to identify those patients at risk of unfavourable outcomes, to optimize their management. In selected patients, combination of an alpha(1)-blocker and a 5alpha-reductase inhibitor is the most effective form of BPH medical therapy to reduce the risk of clinical progression and relieve LUTS. Monotherapy also significantly reduces the risk of BPH clinical progression, mainly through a reduction of LUTS deterioration for alpha(1)-blockers while 5alpha-reductase inhibitors also reduce the risk of AUR and need for BPH-related surgery. Enlarged prostate and high serum prostate-specific antigen levels have been consistently found to be good clinical predictors of AUR and BPH-related surgery in longitudinal population-based studies and placebo arms of controlled studies. High post-void residual urine (PVR) is also associated with an increased risk of LUTS deterioration and should thus be reconsidered in practice as a predictor of BPH progression. Conversely, baseline LUTS severity and low peak flow rate, initially identified as predictors of unfavourable outcomes in community setting, behave paradoxically in controlled trials, probably as a consequence of strict inclusion criteria and subsequent regression to the mean and glass ceiling effects. Lastly, there is increasing evidence that dynamic variables, such as LUTS and PVR worsening, and lack of symptomatic improvement with alpha(1)-blockers are important predictors of future LUTS/BPH-related events, allowing better identification and management of patients at risk of BPH progression. SN - 1464-410X UR - https://www.unboundmedicine.com/medline/citation/18307681/BPH_progression:_concept_and_key_learning_from_MTOPS_ALTESS_COMBAT_and_ALF_ONE_ L2 - https://doi.org/10.1111/j.1464-410X.2008.07497.x DB - PRIME DP - Unbound Medicine ER -