Storage (irritative) and voiding (obstructive) symptoms as predictors of benign prostatic hyperplasia progression and related outcomes.
OBJECTIVE
To assess the utility of voiding and filling symptom subscores in predicting features of benign prostatic hyperplasia (BPH) progression, including acute urinary retention (AUR) and prostate surgery.


METHODS
The Proscar Long-term Efficacy and Safety Study (PLESS) was a 4-year study designed to evaluate the effects of finasteride versus placebo in men with lower urinary tract symptoms (LUTS), clinical evidence of BPH, and no evidence of prostate cancer. A self-administered questionnaire was employed to quantify LUTS at baseline. Receiver operating characteristics (ROC) curves were used to assess baseline characteristics from patients treated with placebo as predictors of outcomes. The characteristics assessed included the overall symptom score (Quasi-AUA SI), separate voiding and filling subscores, prostate volume (PV) and serum prostate-specific antigen (PSA) levels.


RESULTS
PV and PSA were superior to the symptom scores at predicting episodes of spontaneous AUR and all types of AUR. The Quasi-AUA SI and the filling and voiding subscores were effective at predicting progression to surgery; however, PSA was more effective at predicting this outcome. To better evaluate symptoms as predictors of surgery, patients who experienced a preceding episode of AUR were excluded from the surgery analysis. In the absence of preceding AUR, the best predictors of future surgery were the Quasi-AUA SI and the filling subscore.


CONCLUSIONS
Among men with LUTS, clinical BPH and no history of AUR, the overall symptom score and storage subscore are useful parameters to aid clinicians in identifying patients at risk for future prostate surgery. PV and PSA were the best predictors of AUR, while PSA was the best predictor of prostate surgery (for all indications).
Department of Urology, The University of Texas Southwestern Medical Center at Dallas, 75390-9110, USA. claus.roehrborn@utsouthwestern.edu
Claus G
CG
Roehrborn
John D
JD
McConnell
Brian
B
Saltzman
Donald
D
Bergner
Todd
T
Gray
Perinchery
P
Narayan
Thomas J
TJ
Cook
Amy O
AO
Johnson-Levonas
Wilson A
WA
Quezada
Joanne
J
Waldstreicher
D000208:Acute Disease; D000328:Adult; D019540:Area Under Curve; D018450:Disease Progression; D004791:Enzyme Inhibitors / Q000627:therapeutic use; D018120:Finasteride / Q000627:therapeutic use; D006801:Humans; D008297:Male; D011237:Predictive Value of Tests; D017430:Prostate-Specific Antigen / Q000097:blood; D011468:Prostatectomy; D011470:Prostatic Hyperplasia / Q000150:complications / Q000188:drug therapy / Q000503:physiopathology* / Q000601:surgery; D012372:ROC Curve; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D001748:Urinary Bladder Neck Obstruction / Q000209:etiology / Q000503:physiopathology*; D016055:Urinary Retention / Q000209:etiology / Q000503:physiopathology*
D004791:Enzyme Inhibitors; D018120:Finasteride; D017430:Prostate-Specific Antigen