Predictive tool uses baseline characteristics to determine treatment response in patients with LUTS/BPE

Investigators have developed a tool that can aid in treatment decisions for patients with lower urinary tract symptoms/benign prostatic enlargement (LUTS/BPE).¹

Findings showed that overall, nocturia, voiding, and storage symptoms improved with CT compared with DUT or TAM therapies for most patient profiles.

The tool uses clinical covariates to predict changes in storage, voiding, and nocturia LUTS for patients receiving placebo, dutasteride (Avodart, DUT), tamsulosin (Flomax, TAM), or DUT/TAM combination therapy (CT). Data on the predictive model were presented at the 2023 American Urological Association Annual Meeting in Chicago, Illinois.

The results were presented by lead author, Claus Roehrborn, MD, who explained the model by saying, “It's based on nearly 10,000 patients who were enrolled in phase 3 dutasteride studies comparing dutasteride vs placebo, and the CombAT study that compared tamsulosin with combination therapy and placebo, over 4 years. The nomogram takes baseline parameters of these patients with all the inclusion parameters that are germane to these studies: men over 50 and with a prostate volume over 30 grams, PSA [prostate-specific antigen] over 1.5, the characteristic symptom flow rate, prostate size, and PSA inclusion, and then develops a nomogram to predict symptoms score changes, and in this case, voiding and storage sub-score changes and nocturia changes, based on the patient's baseline parameters.” Roehrborn is the E.E. Fogelson and Greer Garson Fogelson Distinguished Chair in Urology and S.T. Harris Family Chair in Medical Science, in Honor of John D. McConnell, MD, at the University of Texas Southwestern Medical Center in Dallas.

Baseline characteristics that were used by the tool to predict outcomes were age, International Prostate Symptom Score, total prostate volume (PV), maximum urine flow rate (Q_max), PSA, postvoid residual urine (PVR), α-blocker (AB) usage within 12 months, and randomized treatment.

Findings showed that overall, nocturia, voiding, and storage symptoms improved with CT compared with DUT or TAM therapies for most patient profiles. Characteristics that were predictive of worsening of storage symptoms were older age, higher PVR, and previous treatment with AB. Characteristics associated with a worsening of voiding and nocturia symptoms included higher PVR at baseline and low Q_max.

A greater improvement in outcomes for DUT compared with placebo was observed in patients with higher PSA and PV values. Higher PSA was predictive of a greater improvement in nocturia among all treatments. Higher Q_max levels showed improvements in nocturia and voiding scores among all treatments.

Roehrborn concluded, “No physician can juggle 10 parameters in [their] mind, and so [this tool is] a convenient way to actually see how the parameters influence the outcomes.”

Reference

1. Roehrborn C, Manuel Palacios-Moreno J, Chavan C, et al. Impact of medical treatment on storage vs voiding symptoms and nocturia frequency: a dynamic nomogram N=9167 men with prostatic enlargement. Presented at: American Urological Association Annual Meeting, April 28-May 1, Chicago. Abstract LBA01-02