Benign Prostatic Hyperplasia (BPH)
Recent studies and analyses have confirmed that baseline prostate volume is 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, 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 4 cm surgery but that finasteride reduces these BPH 4 cm. Moreover, doxazosin and finasteride, alone and in BPH 4 cm, have been shown to significantly reduce BPH clinical progression. 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 BPH 4 cm longitudinal natural history follow-up, provide convincing evidence for an increase in LUTS and BOO measured by peak urinary BPH 4 cm rate over time. Progressive prostate growth has been confirmed in population-based studies. Median prostate growth has been noted to be approximately 1. Are BPH 4 cm 3 factors related?
Is BPH 4 cm 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 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.
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 BPH 4 cm finasteride therapy were found to increase with increasing prostate size.
Patients who received finasteride also demonstrated improvements in 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 outcome 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 BPH 4 cm 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 BPH 4 cm 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 Study 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 has been studied, mostly in efforts to increase the usefulness of PSA level BPH 4 cm 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 BPH 4 cm.
The analysis, which included patients from the BPH trials and from the safety studydetermined that BPH 4 cm 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 BPH 4 cm years, AUR was reported as 0. Similar to the incidence of AUR, the rates of surgery 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 with larger prostate volumes and higher PSA levels experienced a clinically significant BPH 4 cm to therapy compared with those with smaller prostates and lower PSA levels. Roehrborn and colleagues 25 analyzed prostate volume changes over time in the placebo BPH 4 cm 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 have 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 recurrent urinary tract infection.
The need for BPH-related BPH 4 cm therapy was a secondary outcome. Baseline prostate size and its surrogate baseline PSA level can be considered BPH 4 cm strong indictor of BPH 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. In 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 BPH 4 cm that men with higher serum PSA levels have an increased risk of developing AUR and the BPH 4 cm for surgery. The most clinically significant response to finasteride in terms of symptom amelioration, improvement in flow rates, quality of life, and reduction in AUR and surgical 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 both 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 Disclaimer. This article has been cited by other articles in PMC. Abstract Recent studies and analyses have confirmed that baseline prostate volume is 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, and can also BPH 4 cm response BPH 4 cm therapy.
Key words: Benign prostatic hyperplasia, Acute urinary 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 BPH 4 cm suggest that finasteride is most effective in men with BPH 4 cm 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 BPH 4 cm of prostatism: longitudinal changes in voiding symptoms in community dwelling men. J Urol. Longitudinal changes in BPH 4 cm urinary flow rates in a community-based BPH 4 cm. Abstract The effect of finasteride in men with benign prostatic hyperplasia. N Engl J Med. A randomized placebo controlled clinical trial of the safety and BPH 4 cm of therapies in men with clinical benign prostatic hyperplasia.
Prostate volume predicts outcome BPH 4 cm treatment of benign prostatic hyperplasia with finasteride: meta-analysis of randomized clinical trials. Benign prostatic hyperplasia: a progressive disease of aging men.
Natural history of prostatism: risk factors for acute urinary retention. Treatment for benign prostatic hyperplasia among community dwelling men: the Olmsted County study of urinary symptoms and health status. Symptoms and signs of prostatism as risk factors for prostatectomy. Prostate volume and serum prostate-specific antigen as predictors of acute urinary retention: combined experience from three large multinational placebo-controlled trials. The effect of finasteride on the risk of acute urinary retention and the need for surgical treatment among men with benign prostatic hyperplasia.
Serum BPH 4 cm antigen concentration is a powerful BPH 4 cm of acute urinary retention and need for surgery in men with clinical benign prostatic hyperplasia. Urinary retention in patients with BPH treated with finasteride or placebo over 4 years: characterization of patients and ultimate outcomes. Serum prostate-specific antigen and prostate volume predict long-term changes in symptoms and flow rate: results of a 4-year randomized trial comparing finasteride versus placebo.
Correlation between prostate size estimated by digital rectal examination and measured by transrectal ultrasound. Serum prostate-specific antigen as a predictor of prostate volume in men with benign prostatic hyperplasia. Serum prostate-specific antigen is a strong predictor of future prostate growth in men with benign prostatic hyperplasia: Proscar Long-Term Efficacy and Safety Study.
Serum prostate-specific antigen is a powerful predictor of acute urinary retention and the need for surgery in men with clinical benign prostatic hyperplasia. Effect of finasteride on bother and other health-related quality of life aspects associated with benign prostatic hyperplasia. Predictive model for acute urinary retention in men with benign prostatic 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 of benign prostatic hyperplasia progression.