Baseline BPH symptoms important to treatment selection for some patients with prostate cancer

A study published in BMC Urology stressed the importance of considering benign prostatic hyperplasia (BPH) symptoms at baseline to ensure optimal treatment selection for some patients with early early-stage prostate cancer.1

The Expanded Prostate Cancer Index Composite-50 (EPIC-50) scores were found to have declined significantly 5 weeks following surgery and recovered to either near or below baseline at 12 months. Moreover, some patients experienced an improvement past baseline in each subscale ranging from 3.3% to 51.0%. At baseline, patients who had benign BPH—defined by a prostate size of 40 g or more, an International Prostate Symptom Index Score of 8 or more, or use of BPH medications—had an improvement in outcomes following surgery, including voiding dysfunction bother at 5 weeks (OR, 3.9; 95% CI, 2.1-7.2) and 12 months (OR, 3.3; 95% CI, 2.0-5.7).

A total of 426 patients were eligible to complete the survey, of whom 395 provided EPIC-50 sub-scale data at baseline, 5 weeks, or 12 months. Of the patients enrolled, 167 had Charlson Comorbidity Index data and 103 had at least 1 comorbidity. Patient characteristics indicated that 78.5% of patients had clinical stage T1 disease and 88.9% had T3 with pre-surgical prostate-specific antigen concentration between 4 ng/mL and 10 ng/mL. Minimally invasive radical proctectomy was performed in 92.3% and 65.2% had bilateral nerve-sparing procedure.

At baseline, the majority of patients had a high urinary incontinence function (mean = 93.1) and bother scores (mean = 95.8), as well as voiding dysfunction-related bother (mean = 74.5). However, scores at baseline were lower for incontinence-related bother and urinary outcomes were also low. Patients had a lower score in relation to sexual outcomes (mean = 56.2) and bother (mean = 68.9) at baseline.

Outcomes notably decreased 5 weeks following surgery. At 6 months following surgery, incontinence-related outcome scores had increased to near but below baseline before evening out at 12 months. Additionally, voiding dysfunction related-bother levels recovered to above baseline levels at 6 months and remained consistent through 12 months. Mean baseline levels remained below baseline in terms of sexual-related outcomes but appeared to slowly improve through the 12-month post-surgical period.

Voiding dysfunction-related bother scores saw the most significant improvement from 22.1% of patients at 5 weeks vs 50.9% at 12 months, followed by sexual bother at 7.3% at 5 weeks vs 10.6% at 12 months, and urinary function at 9.8% at 12 months. Less than 5% of patients experienced improvement in incontinence-related bother and sexual function.

Investigators reported that individual measures of BPH and BPH composite measure were associated with an improvement in 5-week and 12-month post-surgical voiding dysfunction-related bother (odds ratio [OR], 3.9; 95% CI, 2.1-7.2) and 12 months (OR, 3.3; 95% CI, 2.0-5.7). Moreover, investigators did not identify any associations between erectile dysfunction medication, device use at baseline, or follow-up. Additionally, no significant associations between BPH and erectile dysfunction factors, and improved/maintained sexual function. BPH composite score was associated with improved sexual bother at 5 weeks (OR, 5.7; 95% CI, 1.7-19.3) and 12 months (OR, 3.0; 95% CI, 1.2-7.1).

Several individual measure of BPH including use of α-blocker had positive associations (OR, 4.4; 95% CI, 1.1-18.0) with improved sexual function at 12 months and BPH medication use (OR, 5.4, 95% CI; 2.2–13.0) and α-blocker use (OR, 5.6, 95% CI; 2.2–14.6) and improvement in sexual bother at 5 weeks. Erectile dysfunction medication use had an inverse association with sexual function (OR, 0.5, 95% CI; 0.3–0.9) and bother (OR, 0.5, 95% CI; 0.3–1.0) compared with 12 months post-surgery.

Reference

1. Yang L, Lee JA, Heer E, et al. One-year urinary and sexual outcome trajectories among prostate cancer patients treated by radical prostatectomy: a prospective study. BMC Urol. Published May 17, 2021. doi:10.1186/s12894-021-00845-0