Current management of patients affected by benign prostatic hyperplasia: a multi-institutional study from a contemporary large Italian cohort.

Abstract

Background: Despite a large amount of literature focused on pharmacologic and surgical therapy for benign prostate hyperplasia (BPH), little is known about clinical presentation and management of outpatient clinic patients. We aimed to conduct a tailored analysis of BPH-affected patients, comparing men with known BPH versus newly diagnosed. The analysis was made through International Prostate Symptom Score (IPSS) and BPH Impact index (BII).

Methods: "Intensive prostate benefit" project working group designed a questionnaire prospectively administered by urologists to patients affected by lower urinary tract symptoms (LUTS) related to BPH.

Results: Overall, 3198 (64%) patients were previously diagnosed with BPH versus 1800 (36%) received a first diagnosis. Patients previously diagnosed with BPH were older (median 69 vs. 66 years) and more comorbid (P<0.001). Moreover, median IPSS score was higher in these patients (16 vs. 14), who also experienced a higher rate of severe symptoms (32.0% vs 21.5%, P<0.0001). At BII, concerns for one's health and time lost due to urinary problems were higher in patients previously diagnosed with BPH (P<0.0001). In these patients, a BPH-specific therapy was already established (88.5% vs. 75.1%) and a higher rate of therapy adherence (55.0% vs. 27.0%, P<0.0001) was observed. Roughly 90% of patients already taking BPH therapy changed their therapy after urological examination. In these patients, supplements/phytotherapeutics, alpha blockers, 5-alfa-reductase inhibitors, were prescribed in 32.8%, 37.4%, 17.4%, respectively.

Conclusions: Patients with prior BPH diagnosis have severe LUTS that worsen over time, affecting quality of life despite treatment. LUTS management in primary care is crucial, emphasizing counseling for a healthy lifestyle, cardiovascular risk control, and medication adherence.