Management of Symptomatic BPH in the UK: Who Is Treated and How?

Abstract

Objective: To review the contemporary management of symptomatic benign prostatic hyperplasia (BPH) in the United Kingdom (UK). Methods: Information was obtained from published scientific articles, IMS market analysis data and surveys among primary care practitioners and urologists. Results: A survey in Stirling (Scotland) identified the number of men aged 40–79 years with symptomatic BPH defined as a prostate size >20 g with urinary symptoms (total symptom score ≧11) and/or a maximum urinary flow rate <15 ml/s. It appeared that 25% of men had symptomatic BPH. Approximately 2.5 million men fall in this category in the UK currently and the number is expected to grow by almost 50% by the year 2025. Although not every man with symptomatic BPH is bothered by his LUTS and will therefore seek medical advice, many men with mainly filling symptoms and greater symptom severity do visit their physician, especially now more medical treatment options are available. Due to the low number of urologists in the UK, general practitioners (GPs) have traditionally been more involved in the diagnosis and management of symptomatic BPH than in other countries. The contribution of GPs and nurses in managing this condition will probably increase even more when the National Health Services (NHS) reform with GPs and nurses co-operating in primary care groups (PCGs) which are responsible for the total healthcare budget is fully implemented. Although urologists will have to define their role in this new system, this trend will probably help them to cope with the increasing numbers of elderly males seeking medical advice for LUT problems in the next millennium and to reduce already existing out-patient and surgical waiting lists. First results suggest that two thirds of patients attending shared care prostate clinics have uncomplicated LUTS related to BPH and can initially be managed at primary care level. The number of consultations and prescriptions for medical therapy for symptomatic BPH has increased considerably during the 1990s whereas the number of surgical procedures performed on an annual basis has remained stable at around 40,000 cases/year accounting for 70 million Euro/year. Of the two medical treatment approaches approved for the treatment of symptomatic BPH in the UK, the sales for α₁-adrenoceptor antagonists have increased steadily during the latter part of the 1990s whereas that for finasteride has remained flat. In 1998, α₁-adrenoceptor antagonists had 64% market share and finasteride 36% from a total market of 53 million Euro. Conclusions: In the UK, challenges for the future management of symptomatic BPH will be the increased number of patients, further enhancement of efficient co-operation between PCGs and urologists and evaluation of most appropriate management of this condition from a disease progression and cost-effectiveness point of view.