BPH data reveal key findings on epidemiology, treatment

August 15, 2005

The 2005 AUA annual meeting in San Antonio proved to be fertile ground for research on both epidemiologic trends and clinical aspects of benign prostatic hyperplasia and lower urinary tract symptoms—medical therapy, minimally invasive treatments, and phytotherapy. Data from several key studies appeared to clarify the role of various treatment modalities in selected patient populations. Not all the news was positive, however, as one study showed no significant effect with saw palmetto, a commonly used herbal therapy.

The 2005 AUA annual meeting in San Antonio proved to be fertile ground for research on both epidemiologic trends and clinical aspects of benign prostatic hyperplasia and lower urinary tract symptoms-medical therapy, minimally invasive treatments, and phytotherapy. Data from several key studies appeared to clarify the role of various treatment modalities in selected patient populations. Not all the news was positive, however, as one study showed no significant effect with saw palmetto, a commonly used herbal therapy.

Patients with acute or chronic inflammation of the prostate are more prone to clinical progression of BPH.

The investigators found that men with inflammation had larger prostates than those without inflammation (41.1 vs. 36.8 mL, p=.0002) and higher serum PSA levels (3.3 vs. 2.5 ng/mL, p<.0001). They also had a greater risk of acute urinary retention (2.4 vs. 0.6%, p=.011) and an increased rate of overall clinical progression (21.0% vs. 13.2%, p=.083).

"This is very exciting news because it gives us a glimpse into those factors that dictate and predict the natural history of BPH," said Dr. Roehrborn. "Eventually, we may be able to find serum markers correlating with the presence of inflammation to identify more patients with more aggressive forms of BPH."

The 1990s saw a clinically significant trend toward greater use of minimally invasive surgical therapies for BPH as well as fewer inpatient admissions and decreased length of stay.

Between 1992 and 1998, the number of U.S. patients undergoing transurethral resection of the prostate and open prostatectomy decreased by 54%. BPH-related admissions fell by 43%, while the direct Medicare cost of BPH inpatient care dipped by 58% over all.

Minimally invasive therapies increased in popularity during the same period, but other factors, such as advances in perioperative care, safer surgical techniques, and increased managed care, also were important contributors to this trend. The net result, say investigators from the University of Michigan, Ann Arbor, and the Mayo Clinic, Rochester, MN, was direct cost savings to the Medicare program.

Evidence of a strong link between LUTS and erectile dysfunction continues to mount.

Smaller studies have suggested this association before, but two papers from the AUA meeting presented some of the strongest evidence yet that LUTS and ED may be correlated.

A team from the University of Colorado Health Sciences Center, Denver, reviewed the records of 6,078 men who had been screened for prostate cancer and who had completed both the AUA Symptom Score assessment and the Sexual Health Inventory for Men (SHIM) questionnaire. They found that sexual function increased as LUTS increased. Mean SHIM score was 17 for men with mild urinary symptoms, 14 for those with moderate symptoms, and 11 for men with severe symptoms.

Separately, researchers from University Hospital Amsterdam, The Netherlands, conducted a meta-analysis of 10 studies involving 36,000 patients. Using multivariate analysis, they observed that LUTS was a risk factor for ED, ejaculatory dysfunction, and decreased libido, although no causality was implied.

"Physicians treating LUTS should always ask about sexual function, because it's highly likely that men with LUTS also have ED, but may not talk about it," advised Dr. Roehrborn.