title: Medical management of benign prostatic hyperplasia: Results from a population-based study.
abstract: BACKGROUND
  In men with bothersome lower urinary tract symptoms (LUTS), medical treatment usually represents the first line. We examined the patterns of medical management of benign prostatic hyperplasia (BPH) in the Montreal metropolitan area, within the context of a case control study focusing on incident prostate cancer.
  
  
  METHODS
  Cases were 1933 men with incident prostate cancer. Population controls included 1994 age-matched men. In-person interviews collected sociodemographic characteristics and medical history, including BPH diagnosis, its duration, and type of medical treatment received. Baseline characteristics were compared by the chi-square likelihood test for categorical variables and by the students t-test for continuously coded variables.
  
  
  RESULTS
  Overall, 1120 participants had history of BPH; of those 53.7% received medical treatment for BPH. Individuals with medically treated BPH, compared to individuals with medically untreated BPH, were older at index date [mean: 66.9 vs. 64.9 years, p<0.001)] and at diagnosis of BPH [mean: 62.3 vs. 60.3 years, p<0.001]. They also had a longer duration of BPH-history [mean: 4.7 vs. 4.0 years, p=0.02]. Regarding medical treatment, mono-therapy was more often used than combination therapy [87.6% vs. 12.4%, p<0.001]. Alpha-blockers (69.9%) were most commonly used as monotherapy, followed by 5alpha-reductase inhibitors (5ARIs) (26.6%). Alpha-blockers plus 5ARIs were the most common combination therapy (97.3%).
  
  
  CONCLUSIONS
  Despite evidence from randomized, controlled trials for better efficacy with use of combination therapy, monotherapy consisting of alpha-blockers or 5ARI, in that order, is most frequently used. Additionally, 5ARI use was more common than previously reported (27% vs. 15%).
authors.affiliation: Department of Urology, University of Montreal Health Centre, Montreal, QC, Canada;; Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Centre, Montreal, QC, Canada;
authors.forename: Mohamed
authors.initials: M
authors.lastname: Bishr
authors.affiliation: Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Centre, Montreal, QC, Canada;; Martini-Klinik am Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany;
authors.forename: Katharina
authors.initials: K
authors.lastname: Boehm
authors.affiliation: Department of Urology, University of Montreal Health Centre, Montreal, QC, Canada;; Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Centre, Montreal, QC, Canada;
authors.forename: Vincent
authors.initials: V
authors.lastname: Trudeau
authors.affiliation: Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Centre, Montreal, QC, Canada;; McGill University, Department of Epidemiology, Biostatistics and Occupational Health, Montreal, QC, Canada;
authors.forename: Zhe
authors.initials: Z
authors.lastname: Tian
authors.affiliation: Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Centre, Montreal, QC, Canada;; Division of Oncology, Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy;
authors.forename: Paolo
authors.initials: P
authors.lastname: Dell'Oglio
authors.affiliation: Martini-Klinik am Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany;
authors.forename: Jonas
authors.initials: J
authors.lastname: Schiffmann
authors.affiliation: Department of Urology, University of Montreal Health Centre, Montreal, QC, Canada;
authors.forename: Claudio
authors.initials: C
authors.lastname: Jeldres
authors.affiliation: Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Centre, Montreal, QC, Canada;
authors.forename: Maxine
authors.initials: M
authors.lastname: Sun
authors.affiliation: Department of Urology, Medical University of Vienna, Vienna, Austria;
authors.forename: Sharokh F
authors.initials: SF
authors.lastname: Shariat
authors.affiliation: Martini-Klinik am Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany;
authors.forename: Markus
authors.initials: M
authors.lastname: Graefen
authors.affiliation: Department of Urology, University of Montreal Health Centre, Montreal, QC, Canada;
authors.forename: Fred
authors.initials: F
authors.lastname: Saad
authors.affiliation: Department of Urology, University of Montreal Health Centre, Montreal, QC, Canada;; Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Centre, Montreal, QC, Canada;
authors.forename: Pierre I
authors.initials: PI
authors.lastname: Karakiewicz