Studies highlight complexity of benign prostatic hyperplasia, raise questions


A number of the leading studies that focus on the epidemiology, etiology, and treatment of BPH and lower urinary tract symptoms being presented at the upcoming AUA annual meeting seem to be characterized more by the questions they raise than by those they answer.

Key Points

Three large epidemiologic studies of race, BPH, and LUTS are prime examples. All three found differences in the way the diseases present and are treated across different races.

"These questions-whether blacks have larger prostates or are more likely to be treated with surgery or medications-have been around a long time," Dr. Kaplan told Urology Times. "We don't yet have the knowledge to answer them. The answers are important in terms of how we treat patients. If it is a physiologic difference, we may need to alter our diagnostic and therapeutic options."

Connections between weight, BPH examined

A series of studies examine the relationship between weight (body mass index), diabetes, BPH, and LUTS.

"There are always questions as to what is the best proxy for identifying physiological risk factors-body fat, body fat composition, waist circumference or neck circumference, and others. I can't say which is optimal, but it is clear to me that the heavier a patient is, the more likely he is to have male pelvic problems involving sexual health, voiding problems, bladder dysfunction, decreased libido, and others. I think there are multiple factors associated with these problems. I chose these studies because people should understand that these associations [between weight and pelvic disease] are real," said Dr. Kaplan.

A number of studies focus on BPH treatment technologies, including one study comparing holmium laser enucleation to photoselective vaporization (GreenLight HPS, American Medical Systems, Minnetonka, MN) in men with prostatic adenomas larger than 60 mL. Dr. Kaplan noted that such studies are not without weaknesses. He observed that technology trials are often conducted by those who are already considered to be experts in their use.

"I think that these technologies work well in the hands of those who use them frequently, and very few people who use a technology frequently tend to have bad results and/or report them. I would be more interested in how these technologies fare in the hands of practitioners who are not considered expert, who do not use them frequently," Dr. Kaplan said.

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