Quality of life score predicts risk of BPH-related surgery

At least half of all men age 50 and older will develop BPH, and of these, 29% may undergo BPH-related surgery during their lifetimes. Drawing on data from more than 6,900 men in the BPH Registry and Patient Survey, Claus Roehrborn, MD, and colleagues at the University of Texas Southwestern Medical Center in Dallas, sought to identify early factors related to the eventual surgeries.

A total of 3,854 men met the study criteria of being on some form of medical therapy and having been followed for at least 400 days. Of these men, 3.1% underwent surgery at a mean of 296 days from study entry.

"We wanted to identify those variables that might be independent predictors of progression to BPH-related surgery," Dr. Roehrborn told colleagues gathered here at the AUA annual meeting yesterday.

The investigators found that men on medical therapy at enrollment were more likely to undergo treatment than those who were not on therapy at entry (4.6% to 0.9%); that the incidence of surgery varied according to the type of medical treatment; and that of the other factors measured-age, PSA level, severity of lower urinary tract symptoms, BPH Impact Index, insurance, income, physician type, and treatment status-only the BPH Impact Index, a measure of quality of life, was a significant indicator of BPH-related surgery.

"A one-point increase in this particular instrument, whose scores range from 1 to 13, represented a hazard ratio [of proceeding to surgery] of 1.8, and that was statistically significant," Dr. Roehrborn said.

The medical treatments included selective alpha-blockers, non-selective alpha-blockers, 5-alpha-reductase inhibitors, and any combinations of alpha-blockers and 5-ARIs. Those men on combination treatment had the highest incidence of surgery: 32 of 488 (6.6%).

"This may seem paradoxical, and there may be a number of reasons for the higher rate of surgery in combination treatment. It may be that these men were more severely symptomatic," Dr. Roehrborn said.

Dr. Roehrborn and his colleagues are continuing to mine data from the registry.

"It is anticipated and hoped that in other meetings of this nature, many more reports from this unique registry will be forthcoming," he said.

The BPH Registry and Patient Survey is sponsored by sanofi-aventis.