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Of all the measurable factors a urologist must weigh when developing a prognosis for the patient with BPH, only health-related quality of life as assessed by the Benign Prostatic Hyperplasia Impact Index significantly raises the potential for surgical intervention.
Researchers led by Claus G. Roehrborn, MD, used a Cox proportional-hazards regression model that adjusts for baseline BPH treatment, watchful waiting or medical therapy, total bother score, BPH Impact Index, total age, PSA, physician specialty, insurance type, and income.
"Only the BPH Impact Index was an independent predictor of BPH-related surgery," Dr. Roehrborn, professor and chairman of the department of urology at the University of Texas Southwestern Medical Center, Dallas, told colleagues at the AUA annual meeting.
Dr. Roehrborn and colleagues arrived at their findings by drawing on data from the multicenter, observational, longitudinal BPH Registry, which prospectively collects demographic, clinical, and quality of life data. The registry tracks BPH management by both urologists and general practitioners in the United States. It closed enrollment in March 2006 with more than 6,900 men in its database. Of these men, nearly two-thirds (65%) were in the care of urologists and the remainder (35%) were treated by primary care physicians.
"The objective of the registry is to examine management practices and patient outcomes to include symptom amelioration and disease progression in a real-world setting," Dr. Roehrborn explained.
In the current study, 3,854 men were included. All had at least one follow-up visit within 400 days of enrollment and were taking the same BPH medical therapy since enrollment.
Of these men, 3.1% underwent surgery within a year. The mean time to surgery was 223 days. Dr. Roehrborn noted that half of all men age 50 years and older develop BPH and that about 29% undergo BPH-related surgery during their lifetimes.
The data offered evidence of a number of trends. For instance, men receiving medical therapy were far more likely to undergo surgery than those who were not (4.06% vs. 0.9%, p<.0001). Higher rates of surgery were also seen among patients being managed by a urologist and among those with more severe lower urinary tract symptoms.
The rate of surgery also varied according to the nature of the medical therapy. For example, 6.6% of those on a combination regimen (any alpha-blocker plus a 5-alpha-reductase inhibitor) underwent surgery compared to 4.6% of those on a selective alpha-blocker, 4.7% of those on a non-selective alpha-blocker, and 1.4% of those on a 5-alpha-reductase inhibitor.
Dr. Roehrborn said that the greater prevalence of surgery seen among those on combination drug therapy might seem "somewhat paradoxical" at first, but the reason may not be related to the nature of the therapy itself.
"These patients might be thought of as being more severely symptomatic, and that may be why the rate of surgery is higher than the alpha-blocker or 5-alpha-reductase groups," he said.
Dr. Roehrborn was asked by an audience member whether a proportion of the patients on medical therapy might have undergone surgery before the medical treatment had reached its full potential.
"We have data on the dosages and we know the individual types of drugs being utilized. It is quite possible to analyze [the data] by drug class and by drugs within the class, and also by dosages, to include PDE-5 inhibitors. As the data get richer, other analyses will be possible. The steering committee oversees the conduct and design of this registry, and it is anticipated that at future meetings, more reports from this unique registry will be forthcoming," he said.
The BPH Registry is funded by sanofi-aventis.