title: Prospective factor analysis of alpha blocker monotherapy failure in benign prostatic hyperplasia.
abstract: OBJECTIVE
  We aimed to determine the treatment of choice criteria for benign prostatic hyperplasia (BPH) by analyzing the factors causing alpha-adrenergic receptor blocker (alpha-blocker) monotherapy failure.
  
  
  METHODS
  This retrospective study enrolled 129 patients with BPH who were prescribed an alpha-blocker. Patients were allocated to a transurethral resection of prostate (TURP) group (after having at least a 6-month duration of medication) and an alpha-blocker group. We compared the differences between the two groups for their initial prostate volume, serum prostate-specific antigen (PSA), maximum urinary flow rate (Qmax), International Prostate Symptom Score (IPSS), and postvoid residual urine volume (PVR).
  
  
  RESULTS
  Of the 129 patients, 54 were in the TURP group and 75 were in the alpha-blocker group. Statistically significant differences (p<0.05) between the two groups were found in the prostate volume (50.8 ml vs. 34.4 ml), PSA (6.8 ng/ml vs. 3.6 ng/ml), Qmax (6.84 ml/sec vs. 9.99 ml/sec), and IPSS (27.3 vs. 16.8). According to the multiple regression analysis, the significant factors in alpha-blocker monotherapy failure were the IPSS (p<0.001) and prostate volume (p=0.015). According to the receiver operating characteristic (ROC) curve-based prediction regarding surgical treatment, the best cutoff value for the prostate volume and IPSS were 35.65 ml (sensitivity 0.722, specificity 0.667) and 23.5 (sensitivity 0.852, specificity 0.840), respectively.
  
  
  CONCLUSIONS
  At the initial diagnosis of BPH, patients with a larger prostate volume and severe IPSS have a higher risk of alpha-blocker monotherapy failure. In this case, combined therapy with 5-alpha-reductase inhibitor (5-ARI) or surgical treatment may be useful.
authors.affiliation: Department of Urology, Ewha Womans University School of Medicine, Seoul, Korea.
authors.forename: Kyoung Pyo
authors.initials: KP
authors.lastname: Hong
authors.forename: Young Joon
authors.initials: YJ
authors.lastname: Byun
authors.forename: Hana
authors.initials: H
authors.lastname: Yoon
authors.forename: Young Yo
authors.initials: YY
authors.lastname: Park
authors.forename: Woo Sik
authors.initials: WS
authors.lastname: Chung