Abstract
AimsBenign prostatic hyperplasia (BPH) is a bothersome disease that can progress if left untreated. However, patient and urologist perspectives on BPH management are not fully understood. The aim of the Prostate Research on Behaviour and Education (PROBE) Survey was to assess healthcare-seeking behaviour and attitudes to BPH treatment in 502 BPH patients, and the beliefs and management practices of 100 urologists, from France, Germany, Italy, Spain and the UK.ResultsThe principal concerns of patients seeking medical advice were fear of cancer, sleep disruption, discomfort or embarrassment. The majority of BPH patients recalled receiving a digital rectal examination (61%), routine prostate-specific antigen (PSA) tests (67%) and prescription medication (72%). Eighty per cent of 5α-reductase inhibitor (5ARI) users vs. 68% of α-blocker users were satisfied with their treatment. More than half of the patients were concerned about requiring surgery or developing acute urinary retention, and > 75% would prefer a drug that provides reduction in the risk of surgery than one that provides rapid symptom relief. Most urologists performed digital rectal examinations (96%) and PSA tests (71%) on > 90% of patients presenting with BPH symptoms. Eighty-seven per cent of urologists believe that BPH progresses, and 78% believe that 5ARIs prevent BPH progression. However, most urologists prescribe α-blockers while few prescribe 5ARIs.ConclusionsThis study highlights discrepancies between views and beliefs of patients and physicians regarding BPH and current practice in Europe.What's known There is increasing recognition of the importance of the role of the patient in clinical decision-making and the importance of consideration of patient perceptions and preferences in ensuring selection of the appropriate management strategy and treatment success.A recently reported US national survey indicated that currently there are significant differences in the beliefs and attitudes of patients and physicians towards benign prostatic hyperplasia (BPH) (also known as enlarged prostate) and its management.What's new This article provides information on the views and beliefs of both patients and urologists towards BPH and its management, and on current practice, across five European countries.This study confirms and extends the findings of the US survey and further highlights the need for improved communication between physicians and patients and greater involvement of the patient during clinical decision-making.
Highlights
Benign prostatic hyperplasia (BPH) is a highly prevalent, bothersome disorder in ageing men; symptomatic BPH has been reported in approximately 25% of men over 40 years and more than 30% of men over years [1]
Patients with BPH experience a significant deterioration in quality of life because of their condition, reporting changes in sleep patterns, anxiety and embarrassment, altered mobility, changes in leisure, daily-living and sexual activities and in satisfaction with sexual relationships [4,5,6]
BPH treatment has focussed on achieving short-term relief of symptoms
Summary
Benign prostatic hyperplasia (BPH) is a highly prevalent, bothersome disorder in ageing men; symptomatic BPH has been reported in approximately 25% of men over 40 years and more than 30% of men over years [1]. BPH treatment has focussed on achieving short-term relief of symptoms. While this remains a key management goal, there is a growing awareness that the progressive nature of the condition, coupled with patient perceptions and perspectives on treatment choices should inform management decisions [6]. Current drug treatment choices for management of BPH include the commonly prescribed a-blockers and 5a-reductase inhibitors (5ARIs). The former class of drugs relaxes smooth muscle in the bladder neck and the prostate to provide rapid symptom relief, while the 5ARIs by inhibiting the conversion of testosterone to dihydrotestosterone (DHT) – the principal driver of prostate growth – provide long-term symptom relief and a 2007 The Authors
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