1. Baseline characteristics predict risk of progression and response to combined medical therapy for benign prostatic hyperplasia (BPH).
- Author
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Kozminski MA, Wei JT, Nelson J, and Kent DM
- Subjects
- Disease Progression, Drug Therapy, Combination, Humans, Male, Predictive Value of Tests, Prognosis, Prostatic Hyperplasia blood, Prostatic Hyperplasia therapy, Risk Factors, Treatment Outcome, Urinary Retention therapy, 5-alpha Reductase Inhibitors administration & dosage, Azasteroids administration & dosage, Prostate-Specific Antigen blood, Prostatic Hyperplasia pathology, Urinary Retention pathology
- Abstract
Objective: To better risk stratify patients, using baseline characteristics, to help optimise decision-making for men with moderate-to-severe lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH) through a secondary analysis of the Medical Therapy of Prostatic Symptoms (MTOPS) trial., Patients and Methods: After review of the literature, we identified potential baseline risk factors for BPH progression. Using bivariate tests in a secondary analysis of MTOPS data, we determined which variables retained prognostic significance. We then used these factors in Cox proportional hazard modelling to: i) more comprehensively risk stratify the study population based on pre-treatment parameters and ii) to determine which risk strata stood to benefit most from medical intervention., Results: In all, 3047 men were followed in MTOPS for a mean of 4.5 years. We found varying risks of progression across quartiles. Baseline BPH Impact Index score, post-void residual urine volume, serum prostate-specific antigen (PSA) level, age, American Urological Association Symptom Index score, and maximum urinary flow rate were found to significantly correlate with overall BPH progression in multivariable analysis., Conclusions: Using baseline factors permits estimation of individual patient risk for clinical progression and the benefits of medical therapy. A novel clinical decision tool based on these analyses will allow clinicians to weigh patient-specific benefits against possible risks of adverse effects for a given patient., (© 2014 The Authors. BJU International © 2014 BJU International.)
- Published
- 2015
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