Advertisement

World Journal of Urology

, Volume 29, Issue 2, pp 171–178 | Cite as

Age-stratified normal values for prostate volume, PSA, maximum urinary flow rate, IPSS, and other LUTS/BPH indicators in the German male community-dwelling population aged 50 years or older

  • Richard Berges
  • Matthias Oelke
Topic Paper

Abstract

Purpose

To establish age-stratified normal values for prostate volume, serum total prostate-specific antigen (PSA) concentration, maximum urinary flow rate (Q max), micturition and postvoid residual urine volumes, IPSS, and quality of life. These community-derived values of healthy older men are necessary to correctly judge patients with lower urinary tract symptoms due to benign prostatic hyperplasia (LUTS/BPH).

Methods

Analysis of LUTS/BPH-related determinants in community-dwelling men in the city of Herne, Germany after exclusion of subgroups with co-morbidities or co-medications with possible influence on the key items.

Results

The analysis is based on 1,763 participants. In these men aged 50–80 years, mean total prostate volume continuously increased from 24 to 38 cc and mean PSA concentration from 1.1 to 2.5 ng/ml. PSA concentration in men with a prostate volume <25 cc also showed a continuous increase with aging, starting at 0.8 in the youngest and ending at 1.9 ng/ml in the oldest age group. Mean Q max of free uroflowmetry (from 22.1 to 13.7 ml/s) and mean micturition volume (from 329 to 193 cc) showed a continuous decrease that was dependent on prostate size. Mean postvoid residual urine was nearly unchanged over the age groups at approximately 20–30 cc. Although IPSS increased continuously with aging (from 4 to 7), QoL remained unchanged at 2 over the age groups. Prostate size had a minor impact on IPSS.

Conclusions

Normal values for investigated LUTS/BPH-related determinants and the influence of aging hereon should serve as references during the assessment of Caucasian patients in Europe.

Keywords

Benign prostatic hyperplasia Epidemiology Lower urinary tract symptoms Community-based participatory research Diagnosis Prostate-specific antigen Uroflowmetry Aging 

Abbreviations

BPE

Benign prostatic enlargement

BPH

Benign prostatic hyperplasia

5ARI

5α-reductase inhibitor

IPSS

International prostate symptom score

LUTS

Lower urinary tract symptoms

PSA

Prostate-specific antigen

PV

Prostate volume

Qmax

Maximum urinary flow rate

QoL

Quality of life derived from IPSS

Notes

Conflict of interest

The authors declare no conflict of interest.

References

  1. 1.
    Berges R (2008) Epidemiology of benign prostatic syndrome. Associated risks and management data in German men over age 50. Der Urologe Ausg 47(2):141–148Google Scholar
  2. 2.
    Madersbacher S, Alivizatos G, Nordling J, Sanz CR, Emberton M, de la Rosette JJ (2004) EAU 2004 guidelines on assessment, therapy and follow-up of men with lower urinary tract symptoms suggestive of benign prostatic obstruction (BPH guidelines). Eur Urol 46(5):547–554PubMedCrossRefGoogle Scholar
  3. 3.
    Kaplan SA (2006) Update on the American urological association guidelines for the treatment of benign prostatic hyperplasia. Rev Urol 8(Suppl 4):S10–S17PubMedGoogle Scholar
  4. 4.
    Berges R, Dreikorn K, Hofner K, Madersbacher S, Michel MC, Muschter R, Oelke M, Reich O, Rulf W, Tschuschke C, Tunn U (2009) Diagnostic and differential diagnosis of benign prostate syndrome (BPS): guidelines of the German Urologists. Der Urologe Ausg 48 (11):1356–1360, 1362–1364Google Scholar
  5. 5.
    Roehrborn CG, Dolte KS, Ross KS, Girman CJ (2000) Incidence and risk reduction of long-term outcomes: a comparison of benign prostatic hyperplasia with several other disease areas. Urology 56(1):9–18PubMedCrossRefGoogle Scholar
  6. 6.
    Kok ET, Schouten BW, Bohnen AM, Groeneveld FP, Thomas S, Bosch JL (2009) Risk factors for lower urinary tract symptoms suggestive of benign prostatic hyperplasia in a community based population of healthy aging men: the Krimpen Study. J Urol 181(2):710–716PubMedCrossRefGoogle Scholar
  7. 7.
    Jacobsen SJ, Jacobson DJ, Girman CJ, Roberts RO, Rhodes T, Guess HA, Lieber MM (1997) Natural history of prostatism: risk factors for acute urinary retention. J Urol 158(2):481–487PubMedCrossRefGoogle Scholar
  8. 8.
    Speakman M, Batista J, Berges R, Chartier-Kastler E, Conti G, Desgrandchamps F, Dreikorn K, Lowe F, O’Leary M, Perez M, Trachtenberg J, Tubaro A, Meesen B, Smets L, Stoevelaar H (2005) Integrating risk profiles for disease progression in the treatment choice for patients with lower urinary tract symptoms/benign prostatic hyperplasia: a combined analysis of external evidence and clinical expertise. Prostate Cancer Prostatic Dis 8(4):369–374PubMedCrossRefGoogle Scholar
  9. 9.
    Kok ET, Bohnen AM, Bosch JL, Thomas S, Groeneveld FP (2006) Patient’s quality of life and coping style influence general practitioner’s management in men with lower urinary tract symptoms: the Krimpen Study. Qual Life Res 15(8):1335–1343PubMedCrossRefGoogle Scholar
  10. 10.
    Berges RR, Pientka L (1999) Management of the BPH syndrome in Germany: who is treated and how? Eur Urol 36(Suppl 3):21–27PubMedCrossRefGoogle Scholar
  11. 11.
    Hutchison A, Farmer R, Chapple C, Berges R, Pientka L, Teillac P, Borkowski A, Dobronski P (2006) Characteristics of patients presenting with LUTS/BPH in six European countries. Eur Urol 50(3):555–561 (discussion 562)Google Scholar
  12. 12.
    Bosch JL, Bangma CH, Groeneveld FP, Bohnen AM (2008) The long-term relationship between a real change in prostate volume and a significant change in lower urinary tract symptom severity in population-based men: the Krimpen study. Eur Urol 53(4):819–825 (discussion 825–817)Google Scholar
  13. 13.
    Lieber MM, Jacobson DJ, McGree ME, St Sauver JL, Girman CJ, Jacobsen SJ (2009) Intravesical prostatic protrusion in men in Olmsted County, Minnesota. J Urol 182(6):2819–2824PubMedCrossRefGoogle Scholar
  14. 14.
    Berges RR, Pientka L, Hofner K, Senge T, Jonas U (2001) Male lower urinary tract symptoms and related health care seeking in Germany. Eur Urol 39(6):682–687PubMedCrossRefGoogle Scholar
  15. 15.
    Bosch JL, Tilling K, Bohnen AM, Donovan JL (2006) Establishing normal reference ranges for PSA change with age in a population-based study: the Krimpen study. Prostate 66(4):335–343PubMedCrossRefGoogle Scholar
  16. 16.
    Gades NM, Jacobson DJ, Girman CJ, Roberts RO, Lieber MM, Jacobsen SJ (2005) Prevalence of conditions potentially associated with lower urinary tract symptoms in men. BJU Int 95(4):549–553PubMedCrossRefGoogle Scholar
  17. 17.
    Bosch JL, Tilling K, Bohnen AM, Bangma CH, Donovan JL (2007) Establishing normal reference ranges for prostate volume change with age in the population-based Krimpen-study: prediction of future prostate volume in individual men. Prostate 67(16):1816–1824PubMedCrossRefGoogle Scholar
  18. 18.
    Thompson IM, Chi C, Ankerst DP, Goodman PJ, Tangen CM, Lippman SM, Lucia MS, Parnes HL, Coltman CA Jr (2006) Effect of finasteride on the sensitivity of PSA for detecting prostate cancer. J Natl Cancer Inst 98(16):1128–1133PubMedCrossRefGoogle Scholar
  19. 19.
    Wirth M (2010) Die neue Leitlinie zum Prostatakarzinom. Der Urologe Ausg 49(2):171–172Google Scholar
  20. 20.
    Abrahamsson PA, Artibani W, Chapple CR, Wirth M (2010) European Association of Urology. Position statement on screening for prostate cancer. Actas urologicas espanolas 34(3):221–222PubMedGoogle Scholar
  21. 21.
    Heidenreich A, Aus G, Bolla M, Joniau S, Matveev VB, Schmid HP, Zattoni F (2008) EAU guidelines on prostate cancer. Eur Urol 53(1):68–80PubMedCrossRefGoogle Scholar
  22. 22.
    Kawachi MH, Bahnson RR, Barry M, Carroll PR, Carter HB, Catalona WJ, Epstein JI, Etzioni RB, Hemstreet GP III, Howe RJ, Kopin JD, Lange PH, Lilja H, Mohler J, Moul J, Nadler RB, Patterson S, Pollack A, Presti JC, Stroup AM, Urban DA, Wake R, Wei JT (2007) Prostate cancer early detection. Clinical practice guidelines in oncology. J Natl Compr Canc Netw 5(7):714–736PubMedGoogle Scholar
  23. 23.
    Blanker MH, Driessen LF, Bosch JL, Bohnen AM, Thomas S, Prins A, Bernsen RM, Groeneveld FP (2002) Health status and its correlates among Dutch community-dwelling older men with and without lower urogenital tract dysfunction. Eur Urol 41(6):602–607PubMedCrossRefGoogle Scholar
  24. 24.
    Roberts RO, Jacobsen SJ, Jacobson DJ, Rhodes T, Girman CJ, Lieber MM (2000) Longitudinal changes in peak urinary flow rates in a community based cohort. J Urol 163(1):107–113PubMedCrossRefGoogle Scholar
  25. 25.
    Jacobsen SJ, Girman CJ, Guess HA, Panser LA, Chute CG, Oesterling JE, Lieber MM (1995) Do prostate size and urinary flow rates predict health care-seeking behavior for urinary symptoms in men? Urology 45(1):64–69PubMedCrossRefGoogle Scholar
  26. 26.
    Kok ET, Bohnen AM, Groeneveld FP, Busschbach JJ, Blanker MH, Bosch JL (2005) Changes in disease specific and generic quality of life related to changes in lower urinary tract symptoms: the Krimpen study. J Urol 174(3):1055–1058PubMedCrossRefGoogle Scholar
  27. 27.
    Lieber MM, Jacobsen SJ, Roberts RO, Rhodes T, Girman CJ (2001) Prostate volume and prostate-specific antigen in the absence of prostate cancer: a review of the relationship and prediction of long-term outcomes. Prostate 49(3):208–212PubMedCrossRefGoogle Scholar
  28. 28.
    Roehrborn CG, Bruskewitz R, Nickel JC, McConnell JD, Saltzman B, Gittelman MC, Malek GH, Gottesman JE, Suryawanshi S, Drisko J, Meehan A, Waldstreicher J (2004) Sustained decrease in incidence of acute urinary retention and surgery with finasteride for 6 years in men with benign prostatic hyperplasia. J Urol 171(3):1194–1198PubMedCrossRefGoogle Scholar
  29. 29.
    Roehrborn CG, Girman CJ, Rhodes T, Hanson KA, Collins GN, Sech SM, Jacobsen SJ, Garraway WM, Lieber MM (1997) Correlation between prostate size estimated by digital rectal examination and measured by transrectal ultrasound. Urology 49(4):548–557PubMedCrossRefGoogle Scholar
  30. 30.
    Madersbacher S, Pycha A, Schatzl G, Mian C, Klingler CH, Marberger M (1998) The aging lower urinary tract: a comparative urodynamic study of men and women. Urology 51(2):206–212PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  1. 1.Department of UrologyPAN-KlinikCologneGermany
  2. 2.Department of UrologyHannover Medical SchoolHannoverGermany

Personalised recommendations