Impact of Therapy Used in Clinical Practice on Lower Urinary Tract Symptoms/Benign Prostatic Hyperplasia (LUTS/BPH) Disease Progression

Abstract

Lower urinary tract symptoms suggestive of benign prostatic hyperplasia (LUTS/BPH) is a progressive disease with some patients progressing more rapidly than others. Randomised controlled trials (RCTs) have demonstrated that α 1-adrenoceptor (AR) antagonists may reduce the clinical progression of LUTS/BPH to a comparable extent as the 5α-reductase inhibitor finasteride, although there seem to be differences in how this is achieved. As patient populations in RCTs are not necessarily representative of patients managed in clinical practice, evidence from RCTs needs to be complemented with data from patients managed in real life practice (RLP). The Triumph (Transeuropean Research Into the Use of Management policies for LUTS/BPH in Primary Healthcare) project provides data on the impact of medical therapy on LUTS/BPH progression and treatment failure. It includes a prospective survey initiated in 7 European countries and Australia that has recruited about 11,000 LUTS/BPH patients whose baseline data are currently being analysed. Another part consists of retrospective cohort studies of data prospectively collected from computerised medical records of LUTS/BPH patients managed by general practitioners in the UK and the Netherlands for respectively the General Research Practice Database (GPRD) and Integrated Primary Care Information (IPCI) database. Both show that the incidence of LUTS/BPH increases linearly with age. With respect to LUTS/BPH progression, it was shown that medical therapy reduces the risk of progressing to prostatic surgery compared to no treatment. More specifically, the newer, more selective α 1-AR antagonist tamsulosin was shown to have a similar risk of progressing to prostatic surgery and treatment failure as finasteride. In addition, it seems to have a lower risk of progressing to prostatic surgery and treatment failure than other less selective α 1-AR antagonists. The low risk of treatment failure with tamsulosin is confirmed by urologists’ clinical practice data. The newer, more selective α 1-AR antagonist tamsulosin therefore can be considered a first-choice treatment for LUTS/BPH. Selected patients, probably those at high risk of progression (i.e. a large prostate volume/high prostate specific antigen), may potentially benefit from adding a 5α-reductase inhibitor to continuous treatment with tamsulosin.