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.
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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
- Q max :
-
Maximum urinary flow rate
- QoL:
-
Quality of life derived from IPSS
References
Berges R (2008) Epidemiology of benign prostatic syndrome. Associated risks and management data in German men over age 50. Der Urologe Ausg 47(2):141–148
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):547–554
Kaplan SA (2006) Update on the American urological association guidelines for the treatment of benign prostatic hyperplasia. Rev Urol 8(Suppl 4):S10–S17
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, 1362–1364
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):9–18
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):710–716
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):481–487
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):369–374
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):1335–1343
Berges RR, Pientka L (1999) Management of the BPH syndrome in Germany: who is treated and how? Eur Urol 36(Suppl 3):21–27
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)
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)
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):2819–2824
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):682–687
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):335–343
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):549–553
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):1816–1824
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):1128–1133
Wirth M (2010) Die neue Leitlinie zum Prostatakarzinom. Der Urologe Ausg 49(2):171–172
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):221–222
Heidenreich A, Aus G, Bolla M, Joniau S, Matveev VB, Schmid HP, Zattoni F (2008) EAU guidelines on prostate cancer. Eur Urol 53(1):68–80
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):714–736
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):602–607
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):107–113
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):64–69
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):1055–1058
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):208–212
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):1194–1198
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):548–557
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):206–212
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Berges, R., Oelke, M. 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. World J Urol 29, 171–178 (2011). https://doi.org/10.1007/s00345-010-0638-z
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DOI: https://doi.org/10.1007/s00345-010-0638-z