Prognostic role of prostate-specific antigen and prostate volume for the risk of invasive therapy in patients with benign prostatic hyperplasia initially managed with alpha1-blockers and watchful waiting.
OBJECTIVE
To investigate the prognostic role of prostate-specific antigen (PSA) level and prostate volume (PV) for the need for benign prostatic hyperplasia (BPH)-related invasive therapy among patients initially treated with an alpha1-blocker or watchful waiting (WW) in real-life clinical practice.


METHODS
Data were collected from 2264 consecutive patients with clinical BPH. Patients initially treated with an alpha1-blocker or WW were included in this study. They were stratified by baseline PSA level (less than 1.5, 1.5 to less than 3.0, 3.0 to 10.0 ng/mL) and PV (less than 30 and 30 to 200 cm3), and analyzed for the time to BPH-related invasive therapy.


RESULTS
Of the 2264 patients, 389 treated with alpha1-blockers and 553 who chose WW were included. Across the PSA and PV strata, the alpha1-blocker group had worse symptoms, peak flow, postvoid residual urine volumes, and obstruction than did the WW group. Increasing PSA levels produced an increase in the 5-year cumulative risk of invasive treatment: 20%, 34%, and 44% in the alpha1-blocker and 8%, 9%, and 15% in the WW group for a PSA level of less than 1.5, 1.5 to less than 3.0, and 3.0 to 10.0 ng/mL, respectively. The hazard ratio for the highest compared with the lowest PSA strata was 2.8 for alpha1-blocker and 2.7 for WW patients. An increasing PV increased the 5-year cumulative risk from 21% to 35% in the alpha1-blocker group and 8% to 11% in the WW group. The hazard ratio for the large versus small prostates in the alpha1-blocker group was 1.8 and in the WW group was 1.0.


CONCLUSIONS
A higher PSA level and larger PV resulted in a greater risk of BPH-related invasive therapy that was more pronounced in the alpha1-blocker than in the WW patients. However, symptom severity, flow parameters, and obstruction grade may have contributed to the difference in risk between the two treatment groups.
Mochtar
C A
CA
Department of Urology, Academic Medical Centre, Amsterdam, The Netherlands. C.A.Mochtar@amc.uva.nl
Kiemeney
L A L M
LA
Laguna
M P
MP
van Riemsdijk
M M
MM
Barnett
G S
GS
Debruyne
F M J
FM
de la Rosette
J J M C H
JJ
D000317:Adrenergic alpha-Antagonists / Q000627:therapeutic use*; D000368:Aged; D015415:Biomarkers / Q000097:blood*; D019090:Case Management; D005500:Follow-Up Studies; D006801:Humans; D015993:Life Tables; D008297:Male; D008875:Middle Aged; D009929:Organ Size; D011379:Prognosis; D016016:Proportional Hazards Models; D011467:Prostate / Q000473:pathology*; D017430:Prostate-Specific Antigen / Q000097:blood*; D011468:Prostatectomy / Q000706:statistics & numerical data*; D011470:Prostatic Hyperplasia / Q000097:blood* / Q000150:complications / Q000188:drug therapy / Q000601:surgery; D012306:Risk; D001748:Urinary Bladder Neck Obstruction / Q000209:etiology; D016055:Urinary Retention / Q000209:etiology
D000317:Adrenergic alpha-Antagonists; D015415:Biomarkers; D017430:Prostate-Specific Antigen