Management of patients with benign prostatic hyperplasia by urologists: the DUO study

Abstract

The DUO study intended to define the factors determining diagnostic and treatment strategies for benign prostatic hyperplasia (BPH) management.

Methods

This longitudinal, observational study was conducted in France (June 2004 to March 2005), with a representative sample of private and hospital urologists.

Results

1027 BPH patients were included by 202 urologists and 856 were followed-up 6 months later. Mean I-PSS was 14.9 (±6.7) at inclusion and 10.5 (±6.7) at the follow up visit. At inclusion, pharmacologic treatment was prescribed to 84% of the patients, surgery to 13% and no treatment to 3%. Factors in favour of surgery (versus drugs) were BPH severity (OR=2.5 if IPSS=20), patients' choice (0R=2.5), quality of life improvement (OR=2.2), post-void residual (OR=2.1) and dribbling (OR=1.6). Patients' age and prostatic volume have no impact on this choice. Factors in favour of a combination of an a-blocker plus an 5α-reductase inhibitor (versus an α-blocker) were prostate volume (OR=7.8), patient's age (OR-3.0 if âge=74) and post-void residual (OR=2.3) and those in favour of a 5α reductase inhibitor (versus an α-blocker) were prostate volume (OR=7.6), PSA results (OR=5.8), patients' age (OR=5.4 if > 74 years, OR= 2.1 if > 68 years).

Conclusion

Medical or surgical treatment of BPH results in IPSS improvement at 6 months. Patients' age and prostatic volume favour 5α-reductase inhibitor initiation and have no impact on surgical treatment decision. Surgery is performed in severe BPH or when patients expecting a quality of life improvement do that choice.