Recent studies and analyses have confirmed that baseline prostate volume is related to progression of benign prostatic hyperplasia BPH normale Prostatavolumen well as to negative outcomes related to BPH, such as acute urinary retention AUR and need for surgery, and can also predict response to therapy. Other investigations have determined that prostate-specific antigen PSA level has good predictive value for assessing prostate volume.
Strong evidence exists that baseline serum PSA level, like baseline prostate volume, predicts future prostate growth. Randomized placebo-controlled finasteride trials have shown that men with larger prostate volumes and higher PSA levels experience a clinically significant response to therapy compared with those with smaller prostate volumes and lower PSA levels. It has also been demonstrated that men with larger prostate glands and higher PSA levels are at increased risk for AUR and BPH-related surgery but that finasteride reduces these risks.
Moreover, doxazosin and finasteride, alone and in combination, have been shown to significantly reduce BPH clinical normale Prostatavolumen. Benign prostatic hyperplasia BPH is the correct term to describe the histopathologic, hyperplastic changes noted in the aging prostate and mediated by circulating and intraprostatic androgens. Numerous studies, including the population-based Olmsted County study with long-term longitudinal natural normale Prostatavolumen follow-up, provide convincing evidence for an increase in LUTS and BOO measured by peak urinary normale Prostatavolumen rate over time.
Progressive prostate growth has been confirmed in population-based studies. Median prostate growth has been normale Prostatavolumen to be approximately 1.
Are these 3 factors related? Is prostate volume important? Does size matter? Prostate growth appears to be related to prostate volume. In the Olmsted County population-based study, men who had baseline prostate volumes of 30 mL or less had median prostate growth of 1. However, recent studies and analyses have confirmed that baseline prostate volume is related to Normale Prostatavolumen progression and negative outcomes related to BPH progression, such as acute urinary retention AUR and the need for normale Prostatavolumen, and can predict response to therapy.
These studies provide concordant evidence that size does matter. Analyses of multiple finasteride treatment trials have shown prostate volume to be an important factor in BPH. However, the subsequent Veterans Administration study evaluating finasteride, terazosin, and a combination of the 2 agents found that changes in peak flow rate and symptoms after treatment with finasteride were not statistically significantly different from placebo.
In an attempt to explain these conflicting results, Boyle and colleagues 6 analyzed 6 randomized, placebo-controlled trials of finasteride to determine if baseline characteristics, including prostate volume, were predictive of response to finasteride therapy. In this pooled analysis, mean improvements in symptoms and urinary flow rate with finasteride therapy were found to increase with increasing prostate size. Patients who received finasteride also demonstrated improvements normale Prostatavolumen symptom scores in all prostate volume categories, which were statistically superior to placebo in patients with prostate volumes greater than 40 mL.
The results of this meta-analysis demonstrated that baseline prostate volume is a powerful predictor of treatment normale Prostatavolumen with finasteride. Change from baseline in peak flow rate versus baseline prostate volume in placebo- and finasteride-treated patients in 6 clinical studies.
Data from Boyle P et al. It is generally accepted that significant evidence exists in the literature proving that BPH is a progressive disease. Because BPH is a progressive disease, its management should focus not only on symptom amelioration but also on risk factors for progression ie, identifying patients at increased risk of progression.
Numerous studies have confirmed that prostate volume is an important predictor of BPH progression. These studies provided reasonably longterm, reliable data characterizing prostate volume as a risk factor for AUR over 2 years. Two-year incidence of acute urinary retention AUR stratified according to baseline prostate volume and baseline serum prostate-specific antigen PSA level.
Data from Marberger MJ et al. Eur Urol. Similar to the rates of AUR, the rates of surgery increased by 6. Incidence rates of spontaneous and precipitated acute urinary retention in the Proscar Long-Term Efficacy and Safety Normale Prostatavolumen over 4 years in placebo-treated patients stratified by prostate-specific antigen PSA and prostate volume tertiles.
Reprinted from Roehrborn CG. Rev Urol. Serum PSA increases with age. The relationship between age-related increases in prostate volume and serum PSA normale Prostatavolumen been normale Prostatavolumen, mostly in efforts to increase the usefulness of PSA level in screening for prostate cancer.
As shown, evidence clearly demonstrates that prostate volume strongly predicts BPH-related outcomes, such as symptom progression, AUR, and the need for BPH-related surgery.
Digital rectal examination is an inaccurate determination of prostate size and, in fact, appears to significantly underestimate prostate volume. Roehrborn and colleagues 17 analyzed placebo-controlled multicenter trials of patients with BPH and a safety study in normal young men to determine the relationship between baseline measurements of serum PSA and prostate volume.
The analysis, which included patients from the BPH trials and from the safety studydetermined that serum PSA and prostate volume have an age-dependent log-linear relationship.
Strong evidence exists showing that baseline serum PSA level, like baseline prostate volume, predicts future prostate growth. At 2 years, AUR was reported as 0. Normale Prostatavolumen to the incidence of AUR, the rates of normale Prostatavolumen increased by 6. The finasteride meta-analysis showing prostate volume to be a key predictor of outcomes with finasteride therapy was the first to suggest that finasteride is most effective in men with large prostate glands.
The combined analyses of the 2-year international randomized placebo-controlled finasteride trials showed that men normale Prostatavolumen larger prostate volumes and higher PSA normale Prostatavolumen experienced a clinically significant response to therapy compared with those with smaller prostates and lower PSA levels. Roehrborn and colleagues 25 analyzed normale Prostatavolumen volume changes normale Prostatavolumen time in the placebo group of this large long-term study and determined that both baseline prostate volume and PSA level were excellent predictors of future prostate growth.
This prediction of prostate growth suggests that baseline prostate volume and PSA level may also normale Prostatavolumen utility in predicting clinical parameters of progression.
Clinical progression of BPH was predefined as an increase in AUA symptom score of 4 or more points, AUR, incontinence, renal insufficiency, or normale Prostatavolumen urinary tract infection.
Normale Prostatavolumen need for BPH-related invasive therapy was a secondary outcome. Baseline prostate size and its surrogate baseline PSA level can be considered a strong indictor of Normale Prostatavolumen progression, particularly for AUR and BPH-related surgery but also for long-term changes in symptoms, bother, quality of life, and flow rate. Size does matter! Recent studies and analyses have confirmed that baseline prostate volume is related to benign prostatic hyperplasia BPH progression and negative outcomes related to BPH progression, such as acute urinary retention AUR and the need for surgery, and can predict response to therapy.
Normale Prostatavolumen a meta-analysis by Boyle and colleagues, mean improvement in symptoms and urinary flow rate with finasteride were found to increase with increasing prostate size. Clinical trial data show evidence that baseline prostate-specific antigen PSA level, like baseline prostate volume, predicts future prostate growth and that men with higher serum PSA levels have an increased risk normale Prostatavolumen developing AUR and the need for surgery.
The most clinically significant response to finasteride in terms of symptom amelioration, improvement normale Prostatavolumen flow rates, quality of life, and reduction in AUR and normale Prostatavolumen rates occurred in the patients at highest risk, that is, those with large prostate glands and higher baseline serum PSA values.
Roehrborn and colleagues analyzed prostate volume changes over time in the placebo group of the Medical Therapy of Prostatic Symptoms study and determined that normale Prostatavolumen baseline prostate volume and PSA level were excellent predictors of future prostate growth. National Center for Biotechnology InformationU. Journal List Rev Urol v.
Author information Copyright and License information Normale Prostatavolumen. This article has been cited by other articles in PMC. Abstract Recent studies and analyses have normale Prostatavolumen that baseline prostate volume normale Prostatavolumen related to progression of benign prostatic hyperplasia BPH as well as to negative outcomes related to BPH, such as acute urinary retention AUR and need for surgery, normale Prostatavolumen can also predict response normale Prostatavolumen therapy.
Key words: Benign prostatic hyperplasia, Acute normale Prostatavolumen retention, Prostate volume, Prostate-specific antigen, Bladder outlet obstruction. Open in a separate window. Figure 1. Figure 2. Figure 3. Prostate Volume and PSA Level : Implications for Therapy The finasteride meta-analysis showing prostate volume to be a key predictor of outcomes with finasteride therapy was the first to suggest that finasteride normale Prostatavolumen most effective in men with large prostate glands.
Main Points Recent studies and analyses have confirmed that baseline prostate volume is related to benign prostatic hyperplasia BPH progression and negative outcomes related to BPH progression, such as acute urinary retention AUR and the need for surgery, and can predict response to therapy. References 1. Natural history of prostatism: longitudinal changes in voiding symptoms in community dwelling men. J Urol. Longitudinal changes in peak normale Prostatavolumen flow rates in a community-based cohort.
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Prostate volume and serum prostate-specific antigen as predictors of acute urinary retention: combined experience from three large multinational placebo-controlled trials.
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Effect of finasteride normale Prostatavolumen bother and other health-related normale Prostatavolumen of life aspects associated with benign prostatic hyperplasia. Predictive model for acute urinary retention in men with benign normale Prostatavolumen hyperplasia. Long-term risk of re-treatment of patients using alpha-blockers for lower urinary tract symptoms. McConnell JD. Baseline measures predict the risk of benign prostatic hyperplasia clinical progression in placebo-treated patients. Roehrborn CG.
Reducing the risk normale Prostatavolumen benign prostatic hyperplasia progression.