title: How much improvement is needed for a real difference of lower urinary tract symptoms after long-term combination therapy for benign prostatic hyperplasia.
abstract: OBJECTIVE
  Medical treatment is the first choice in the treatment of lower urinary tract symptoms (LUTS) suggestive of benign prostatic hyperplasia (BPH). This retrospective study investigated the changes of measured parameters after 4-year medical therapy based on the reported quality of life index (QoL-I) in the International Prostate Symptom Score (IPSS) questionnaire.
  
  
  METHODS
  Patients with symptomatic BPH received 4-year treatment with doxazosin 4 mg and dutasteride 0.5 mg daily. All patients had a total prostate volume (TPV) of ≥ 30 ml and IPSS ≥ 8 at baseline. The measured parameters included IPSS, maximum flow rate (Qmax), postvoid residual volume (PVR), TPV and prostate specific antigen (PSA). The changes of parameters from baseline to 4th year were compared between patients with different QoL-I.
  
  
  RESULTS
  Among 243 enrolled patients, 161(66.3%) completed the treatment, 82(33.7%) did not complete the 4-year treatment because of unsatisfactory results (51, 21%) or converted to surgery (31, 12.8%). At the 4th year, 147/161 (91.3%) patients reported a QoL-I of 0-2. All measured parameters show significant improvement. Among the patients with satisfactory QoL (QoL-I 0-2), IPSS ≤ 7 was noted in 113 (76.9%), Qmax ≥ 15 ml/s in 54 (36.79%), PVR < 50 ml in 83 (56.5%), TPV ≤ 39 ml in 63 (42.9%), and PSA ≤ 1.5 ng/ml in 66 (44.9%). Except for the IPSS, a significant change in each parameter from baseline to the 4th year was noted in less than 50% of the patients with satisfactory QoL.
  
  
  CONCLUSIONS
  Based on the patients' reported QoL-I, a successful therapeutic result does not need the improvement of all measured parameters.
authors.affiliation: Department of Urology, Buddhist Tzu Chi General Hospital and Tzu Chi University, Hualien, Taiwan.
authors.forename: Y-H
authors.initials: YH
authors.lastname: Jiang
authors.forename: C-H
authors.initials: CH
authors.lastname: Liao
authors.forename: H-C
authors.initials: HC
authors.lastname: Kuo
mesh_terms: D001378:Azasteroids / Q000627:therapeutic use; D017292:Doxazosin / Q000627:therapeutic use; D004359:Drug Therapy, Combination / Q000592:standards / Q000706:statistics & numerical data*; D006801:Humans; D059411:Lower Urinary Tract Symptoms / Q000188:drug therapy*; D008297:Male; D011470:Prostatic Hyperplasia / Q000188:drug therapy*; D011788:Quality of Life; D012189:Retrospective Studies; D013449:Sulfonamides / Q000627:therapeutic use; D011795:Surveys and Questionnaires
chemical_list: D001378:Azasteroids; D013449:Sulfonamides; D017292:Doxazosin