title: Can benign prostatic hyperplasia be identified in the primary care setting using only simple tests? Results of the Diagnosis IMprovement in PrimAry Care Trial.
abstract: OBJECTIVE
  Diagnosis IMprovement in PrimAry Care Trial (D-IMPACT) was a prospective, multicentre epidemiological study in three European countries to identify the optimal subset of simple tests applied in primary care to diagnose benign prostatic hyperplasia (BPH) in men who spontaneously present with lower urinary tract symptoms (LUTS).
  
  
  METHODS
  Consecutive male patients aged ≥ 50 years who spontaneously attended their regular general practitioner (GP) office with LUTS were eligible for inclusion if they had not previously undergone BPH diagnostic tests or received treatment for BPH. Patients were assessed on three occasions, twice by their regular GP (visits 1 and 2) and once by a urologist (visit 3). The diagnostic accuracy of each variable was determined using the urologists' final BPH diagnosis (at visit 3) as gold-standard. Independent variables analysed were as follows: age; BPH diagnosis performed by GP in visit 1 (yes/no); probability of BPH diagnosis assessed by GP in visit 1; urinalysis (normal/abnormal); prostate-specific antigen (PSA); International Prostate Symptom Score (IPSS); diagnosis of BPH performed by GP in visit 2 (yes/no); and probability of BPH diagnosis assessed by GP in visit 2. Statistically significant variables (p < 0.1) were included in a logistic regression model to identify the best algorithm and describe each test contribution.
  
  
  RESULTS
  The most frequent spontaneously reported LUTS were nocturia and weak urinary stream. BPH study prevalence was 66.0% (95%CI: 62.3-69.5) and 32% of patients were at risk of BPH progression (PSA > 1.5 ng/ml and prostate volume ≥ 30 cm(3)). Among the independent variables analysed, only age, IPSS and PSA showed a statistically significant relationship with BPH diagnosis. In a logistic regression model including age, IPSS, PSA and probability of BPH (based on physical examination and symptoms), positive predictive value (PPV) was 77.1%. Exclusion of BPH probability resulted in a PPV of 75.7%.
  
  
  CONCLUSIONS
  A diagnostic algorithm including only objective variables (age, IPSS and PSA), easily implemented in any GP office, allows GPs to accurately diagnose BPH in approximately three-quarters of patients spontaneously reporting LUTS.
authors: Hospital Universitario 'Puerta de Hierro-Majadahonda', Madrid, Spain. j.carballido@terra.es
authors: J
authors: J
authors: Carballido
authors: R
authors: R
authors: Fourcade
authors: A
authors: A
authors: Pagliarulo
authors: F
authors: F
authors: Brenes
authors: A
authors: A
authors: Boye
authors: A
authors: A
authors: Sessa
authors: M
authors: M
authors: Gilson
authors: R
authors: R
authors: Castro
mesh_terms: D000368:Aged; D000465:Algorithms; D051517:Digital Rectal Examination / Q000379:methods / Q000592:standards; D058006:General Practice / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D019095:Point-of-Care Systems; D011446:Prospective Studies; D017430:Prostate-Specific Antigen / Q000097:blood; D011470:Prostatic Hyperplasia / Q000175:diagnosis*; D053448:Prostatism / Q000209:etiology*; D011788:Quality of Life; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index
chemical_list: D017430:Prostate-Specific Antigen