Clinical Implications for the Early Treatment of Benign Prostatic Enlargement (BPE): a Systematic Review
- 176 Downloads
Purpose of review
Therapeutic options for the management of lower urinary tract symptoms (LUTS) secondary to benign prostatic enlargement (BPE) have considerably increased in recent years. However, the ideal timing to initiate medical treatment of LUTS/BPE has not been fully established. The aim of this review was to systematically collect available evidence on the influence of early treatment on the natural history of LUTS/BPE patients.
A systematic literature search from January 1996 until April 2018 was performed by combining the following MESH terms: Lower Urinary Tract Symptoms, Benign Prostatic Enlargement, male, medical treatment, surgical treatment, early treatment/intervention, and early intervention/treatment. The Medline, PubMed, and Scopus databases were searched. Each article title and abstract was reviewed for relevance and appropriateness with regard to the topic of this review. In recent years, the medical armamentarium for the management of LUTS secondary to BPE has been extensively implemented, significantly improving treatment outcomes and markedly reducing the need for BPE surgery. Early intervention in patients at risk for disease progression may offer better clinical outcomes compared to a deferred approach. However, evidences supporting early treatment are scarce, and criteria to discriminate patients that could mostly benefit from immediate treatment remain poorly defined. Moreover, as a result of delayed surgery after prolonged medical treatment, patients undergoing surgical relief show larger prostates, older age, and comorbidities. Nevertheless, technological advancements in surgical techniques have largely counterweighed this critical scenario, and commonly, a non-pejorative trend has been reported in perioperative complications.
The timeliest moment to start a medical treatment in LUTS/BPE patients is still undefined, and unexpectedly, peer-reviewed evidence remains scarce. Further studies are awaited to better discriminate patients who mostly benefit from early treatment of LUTS/BPE.
KeywordsBenign prostatic hyperplasia LUTS Prostate Pharmacological treatment Early treatment Surgery Outcomes complications
Compliance with Ethical Standards
Conflict of Interest
Fabrizio Presicce, Cosimo De Nunzio, and Andrea Tubaro each declare no potential conflicts of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major Importance
- 7.Roehrborn CG, Barkin J, Siami P, Tubaro A, Wilson TH, Morrill BB, et al. Clinical outcomes after combined therapy with dutasteride plus tamsulosin or either monotherapy in men with benign prostatic hyperplasia (BPH) by baseline characteristics: 4-year results from the randomized, double-blind Combination of Avodart and Tamsulosin (CombAT) trial. BJU Int. 2011;107(6):946–54.CrossRefPubMedGoogle Scholar
- 8.Roehrborn CG, Oyarzabal Perez I, Roos EP, Calomfirescu N, Brotherton B, Wang F, et al. Efficacy and safety of a fixed-dose combination of dutasteride and tamsulosin treatment (Duodart(®) ) compared with watchful waiting with initiation of tamsulosin therapy if symptoms do not improve, both provided with lifestyle advice, in the management of treatment-naïve men with moderately symptomatic benign prostatic hyperplasia: 2-year CONDUCT study results. BJU Int. 2015;116(3):450–9.CrossRefPubMedGoogle Scholar
- 9.•• Roehrborn CG, Oyarzabal Perez I, Roos EP, Calomfirescu N, Brotherton B, Palacios JM, et al. Can we use baseline characteristics to assess which men with moderately symptomatic benign prostatic hyperplasia at risk of progression will benefit from treatment? A post hoc analysis of data from the 2-year CONDUCT study. World J Urol. 2017;35(3):421–7. Although this is just a subanalysis, it provides evidence that no treatment is necessary in patient with mild LUTS and no bother. CrossRefPubMedGoogle Scholar
- 14.• Cindolo L, Pirozzi L, Fanizza C, Romero M, Sountoulides P, Roehrborn CG, et al. Actual medical management of lower urinary tract symptoms related to benign prostatic hyperplasia: temporal trends of prescription and hospitalization rates over 5 years in a large population of Italian men. Int Urol Nephrol. 2014;46:695–701. This paper provides evidence that lack of adherence to pharmacological treatment of BPH results in a higher risk of hospital admission for patients with BPH. CrossRefPubMedGoogle Scholar
- 19.• Flanigan RC, Reda DJ, Wasson JH, Anderson RJ, Abdellatif M, Bruskewitz RC. 5-year outcome of surgical resection and watchful waiting for men with moderately symptomatic benign prostatic hyperplasia: a Department of Veterans Affairs cooperative study. J Urol. 1998;160:12–7. A unique study of immediate versus delayed surgery for BPH. CrossRefPubMedGoogle Scholar