AUA releases guideline amendments for BPH-related LUTS and testicular cancer

The American Urological Association (AUA) has released 2023 clinical practice guideline amendments for the management of lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH) and for the diagnosis and treatment of early-stage testicular cancer.^1,2

BPH-related LUTS amendment

The amendment for the management of LUTS attributed to BPH³ is an update to the 2021 guideline on the topic.

According to the AUA,¹ the 2023 amendment now includes:

• [A] new section on "Legacy Technologies."
• New studies added for combination therapy using tolterodine (Detrol)/doxazosin (Cardura) vs combined mirabegron (Myrbetriq)/doxazosin and silodosin (Rapaflo) vs PDE-5
• [A] new statement on combination of low-dose daily tadalafil (Cialis) 5 mg with finasteride (Proscar)
• 60-month data added for water vapor thermal therapy
• Updates to the Prostatic Artery Embolization (PAE) statement and supporting text
• [A] new statement on temporary implanted prostatic devices

"In addressing troublesome LUTS, health care providers must acknowledge the intricate interplay among the bladder, bladder neck, prostate, and urethra. This updated guideline aims to serve as a valuable resource for the proficient and evidence-based management of LUTS/BPH,” said Jaspreet S. Sandhu, MD, in a news release on the amendment.¹ Sandhu is a urologic surgeon at Memorial Sloan Kettering Cancer Center in New York, New York and a member of the 2023 amendment panel for LUTS/BPH.

Early-stage testicular cancer amendment

The amendment for the diagnosis and treatment of early-stage testicular cancer⁴ is an update to the 2019 guideline on the topic.

According to the AUA,² the updated amendment now includes:

• New studies included to support the role of MRI in surveillance/staging of patients with germ cell tumors
• Retroperitoneal lymph node dissection added as a treatment option for patients with stage IIA or IIB seminoma with a lymph node of 3 cm or smaller
• Updated text to include long-term follow up for 2 cycles of etoposide and cisplatin chemotherapy without bleomycin for patients with non-seminoma germ cell tumors who have pathological stage II disease that is not pure teratoma
• New evidence added to support surveillance imaging for patients with stage I testicular cancer
• [An] updated statement and expanded text on survivorship

"Surveillance has become more important than ever for those with testicular cancer. Since the last testicular cancer guideline was released, the model for management has substantially changed, making an amendment like this critical to effectively treat and manage testicular cancer,” said Andrew Stephenson, MD, in a news release on the updates.² Stephenson is the director of urologic oncology at Rush University Medical Center in Chicago, Illinois and a member of the 2023 amendment panel for testicular cancer.

Both the LUTS/BPH and testicular cancer guidelines were updated based on the availability of new literature, as identified through an AUA Update Literature Review process.

References

1. AUA releases amendment to the management of lower urinary tract symptoms attributed to benign prostatic hyperplasia guideline. News release. American Urological Association. September 14, 2023. Accessed September 18, 2023. https://www.prnewswire.com/news-releases/aua-releases-amendment-to-the-management-of-lower-urinary-tract-symptoms-attributed-to-benign-prostatic-hyperplasia-guideline-301928085.html

2. AUA releases amendment to the diagnosis and treatment of early-stage testicular cancer guideline. News release. American Urological Association. September 14, 2023. Accessed September 18, 2023. https://www.prnewswire.com/news-releases/aua-releases-amendment-to-the-diagnosis-and-treatment-of-early-stage-testicular-cancer-guideline-301928122.html

3. Sandhu JS, Bixler BR, Dahm P, et al. Management of lower urinary tract symptoms attributed to benign prostatic hyperplasia (BPH): AUA Guideline amendment 2023. J Urol. 2023;10.1097/JU.0000000000003698. https://doi.org/10.1097/JU.0000000000003698

4. Stephenson A, Bass EB, Bixler BR, et al. Diagnosis and treatment of early-stage testicular cancer: AUA Guideline amendment 2023. J Urol. 2023;10.1097/JU.0000000000003694. https://doi.org/10.1097/JU.0000000000003694