Primary care physician versus urologist: How does their medical management of LUTS associated with BPH differ?
- Martin M. Miner
- … show all 1 hide
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.Get Access
Medical and surgical therapies for benign prostatic hyperplasia (BPH) are based largely on the results from adherence to the 2003 American Urological Association Guidelines. However, with the emergence of medical therapies as first-line treatment and the expansion of medical therapy for lower urinary tract symptoms (LUTS) into the primary care office, the evaluation and management of men presenting with urinary symptoms can vary depending on provider type. This review explains the basis for BPH medical management in primary care with the review of three key studies. In addition, this review utilizes the data provided by the first longitudinal, observational BPH registry to evaluate patient outcomes and practice patterns in both urologist and primary care offices. From these data, we can conclude that men seeing urologists were more likely to be on medical therapy than men seeing primary care physicians (PCPs), who more often utilized watchful waiting. Urologists also were more likely to prescribe 5-α-reductase inhibitors (5ARIs), combination therapy with an α-blocker and 5ARI, and anticholinergic therapy. In contrast, the use of nonselective α-blockers was appreciably greater among men seeing PCPs than men seeing urologists.
- Margolis S, Carter HB: Prostate disorders. In The Johns Hopkins White Paper. Baltimore: Johns Hopkins Medicine; 2002.
- Lepor H: Challenges in the detection and diagnosis of bladder dysfunction: optimal strategies for the primary care physician. Rev Urol 2004, 6(Suppl 1):S1–S2.
- McConnell JD, Roehrborn CG, Bautista OM, et al.: The long-term effect of doxazosin, finasteride, and combination therapy on the clinical progression of benign prostatic hyperplasia. N Engl J Med 2003, 349:2387–2398. CrossRef
- Barkin J, Guimarães M, Jacobi G, et al.: Alpha-blocker therapy can be withdrawn in the majority of men following initial combination therapy with the dual 5-alpha-reductase inhibitor dutasteride. Eur Urol 2003, 44:461–466. CrossRef
- Fitzpatrick JM: Should combination therapy be standard for benign prostatic hyperplasia? Nat Clin Pract Urol 2005, 2:574–575. CrossRef
- Roehrborn CG, Siami P, Barkin J, et al.: The effects of dutasteride, tamsulosin and combination therapy on lower urinary tract symptoms in men with benign prostatic hyperplasia and prostatic enlargement: 2-year results from the CombAT study. J Urol 2008, 179:616–621. (Published erratum appears in J Urol 2008, 180: 1191.) CrossRef
- Steers WD, Nuckolls J, Seftel AD, et al.: Differences between PCPs and urologists in the evaluation of men with LUTS/BPH [abstract 6]. Presented at the American Urological Association 2006 Annual Meeting. Atlanta, Georgia; May 20–25, 2006.
- Wei JT, Nuckolls J, Miner M, et al.: Differences in medical management of LUTS/BPH between PCPs and urologists [abstract 7]. Presented at the American Urological Association 2006 Annual Meeting. Atlanta, Georgia; May 20–25, 2006.
- Roehrborn CG, McConnell JD, Lieber M, et al.: Serum prostate-specific antigen concentration is a powerful predictor of acute urinary retention and need for surgery in men with clinical benign prostatic hyperplasia. PLESS Study Group. Urology 1999, 53:473–480. CrossRef
- Kuritzky L: A primary care physician’s perspective on benign prostatic hyperplasia. Rev Urol 2003, 5(Suppl 5):S42–S48.
- Naslund MJ, Costa FJ, Miner MM: Managing enlarged prostate in primary care. Int J Clin Pract 2006, 60:1609–1615. CrossRef
- Djavan B, Fong YK, Harik M, et al.: Longitudinal study of men with mild symptoms of bladder outlet obstruction treated with watchful waiting for four years. Urology 2004, 64:1144–1148. CrossRef
- Boyle P, Roehrborn CG, Harkaway R, et al.: 5-Alpha reductase inhibition provides superior benefits to alpha blockade by preventing AUR and BPH-related surgery. Eur Urol 2004, 45:620–627. CrossRef
- McConnell JD, Bruskewitz R, Walsh P, et al.: The effect of finasteride on the risk of acute urinary retention and the need for surgical treatment among men with benign prostatic hyperplasia. Finasteride Long-Term Efficacy and Safety Study Group. N Engl J Med 1998, 338:557–563. CrossRef
- Roehrborn CG, Boyle P, Nickel JC, et al.: Efficacy and safety of a dual inhibitor of 5-alpha-reductase types 1 and 2 (dutasteride) in men with benign prostatic hyperplasia. Urology 2002, 60:431–434. CrossRef
- Roehrborn CG, Marks LS, Fenter T, et al.: Efficacy and safety of dutasteride in the four-year treatment of men with benign prostatic hyperplasia. Urology 2004, 63:709–715. CrossRef
- Andriole G, Bruchovsky N, Chung LW, et al.: Dihydrotestosterone and the prostate: the scientific rationale for 5-alpha-reductase inhibitors in the treatment of benign prostatic hyperplasia. J Urol 2004, 172(4 Pt 1):1399–1403. CrossRef
- Kaplan SA: Use of alpha-adrenergic inhibitors in treatment of benign prostatic hyperplasia and implications on sexual functioning. Urology 2004, 63:428–434. CrossRef
- Lepor H: Long-term efficacy and safety of terazosin in patients with benign prostatic hyperplasia. Terazosin Research Group. Urology 1995, 45:406–413. CrossRef
- Lepor H: Phase III multicenter placebo-controlled study of tamsulosin in benign prostatic hyperplasia. Tamsulosin Investigator Group. Urology 1998, 51:892–900. CrossRef
- Narayan P, Tewari A: A second phase III multicenter placebo controlled study of 2 dosages of modified release tamsulosin in patients with symptoms of benign prostatic hyperplasia. J Urol 1998, 160:1701–1706. CrossRef
- Roehrborn CG: Efficacy and safety of once-daily alfuzosin in the treatment of lower urinary tract symptoms and clinical benign prostatic hyperplasia: a randomized, placebo-controlled trial. Alfus Study Group. Urology 2001, 58:953–959. CrossRef
- AUA Practice Guidelines Committee: AUA guideline on management of benign prostatic hyperplasia (2003). Chapter 1: Diagnosis and treatment recommendations. J Urol 2003, 170(2 Pt 1):530–537.
- Wright EJ, Fang J, Metter EJ, et al.: Prostate specific antigen predicts the long-term risk of prostate enlargement: results from the Baltimore Longitudinal Study of Aging. J Urol 2002, 167:2482–2488. CrossRef
- Roehrborn CG: Alfuzosin 10 mg once daily prevents overall clinical progression of benign prostatic hyperplasia, but not acute urinary retention: results of a 2-year placebocontrolled study. BJU Int 2006, 97:734–741. CrossRef
- Miner M, Rosenberg MT, Perelman MA: Treatment of lower urinary tract symptoms in benign prostatic hyperplasia and its impact on sexual function. Clin Ther 2006, 28:13–25. CrossRef
- Rosen R, Altwein J, Boyle P, et al.: Lower urinary tract symptoms and male sexual dysfunction: the Multinational Survey of the Aging Male (MSAM-7). Eur Urol 2003, 44:637–649. CrossRef
- Siami P, Roehrborn CG, Barkin J, et al.: Combination therapy with dutasteride and tamsulosin in men with moderate-to-severe benign prostatic hyperplasia and prostate enlargement: the CombAT (Combination of Avodart and Tamsulosin) trial rationale and study design. Contemp Clin Trials 2007, 28:770–779. CrossRef
- Primary care physician versus urologist: How does their medical management of LUTS associated with BPH differ?
Current Urology Reports
Volume 10, Issue 4 , pp 254-260
- Cover Date
- Print ISSN
- Online ISSN
- Current Science Inc.
- Additional Links
- Martin M. Miner (1)
- Author Affiliations
- 1. Men’s Health Center, Miriam Hospital, Warren Alpert Medical School, Brown University, 164 Summit Avenue, Providence, RI, 02906, USA