A Systematic Review of Patients’ Values, Preferences, and Expectations for the Diagnosis and Treatment of Male Lower Urinary Tract Symptoms

Malde, Sachin; Umbach, Roland; Wheeler, Jessica; Lytvyn, Lyubov; Cornu, Jean-Nicholas; Gacci, Mauro; Gratzke, Christian; Herrmann, Thomas; Mamoulakis, Charalampos; Rieken, Malte; Speakman, Mark; Gravas, Stavros; Drake, Marcus; Guyatt, Gordon; Tikkinen, Kari A.O.

doi:10.1016/j.eururo.2020.12.019

Cited by 80 publications

(61 citation statements)

References 41 publications

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“…In accordance with previous systematic reviews, high RoB was assigned when the measurement instrument was not valid. If the measurement instrument was valid, RoB was designated as low if there were no individual items marked as high RoB and as moderate if not more than two items had moderate RoB [23] . For qualitative studies, RoB was assessed using the SRQR criteria ( Supplementary Table 4 ) [22] .…”

Section: Evidence Acquisitionmentioning

confidence: 99%

A Systematic Review of Patients’ Values, Preferences, and Expectations for the Treatment of Metastatic Prostate Cancer

Connor

Genie

Burns

et al. 2022

European Urology Open Science

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Context Advances in systemic agents have increased overall survival for men diagnosed with metastatic prostate cancer. Additional cytoreductive prostate treatments and metastasis-directed therapies are under evaluation. These confer toxicity but may offer incremental survival benefits. Thus, an understanding of patients’ values and treatment preferences is important for counselling, decision-making, and guideline development. Objective To perform a systematic review of patients’ values, preferences, and expectations regarding treatment of metastatic prostate cancer. Evidence acquisition The MEDLINE, Embase, and CINAHL databases were systematically searched for qualitative and preference elucidation studies reporting on patients’ preferences for treatment of metastatic prostate cancer. Certainty of evidence was assessed using Grading of Recommendation, Assessment, Development and Evaluation (GRADE) or GRADE Confidence in the Evidence from Reviews of Qualitative Research (CERQual). The protocol was registered on PROSPERO as CRD42020201420. Evidence synthesis A total of 1491 participants from 15 studies met the prespecified eligibility for inclusion. The study designs included were discrete choice experiments ( n = 5), mixed methods ( n = 3), and qualitative methods ( n = 7). Disease states reported per study were: metastatic castration-resistant prostate cancer in nine studies (60.0%), metastatic hormone-sensitive prostate cancer in two studies (13.3%), and a mixed cohort in four studies (26.6%). In quantitative preference elicitation studies, patients consistently valued treatment effectiveness and delay in time to symptoms as the two top-ranked treatment attributes (low or very low certainty). Patients were willing to trade off treatment-related toxicity for potential oncological benefits (low certainty). In qualitative studies, thematic analysis revealed cancer progression and/or survival, pain, and fatigue as key components in treatment decisions (low or very low certainty). Patients continue to value oncological benefits in making decisions on treatments under qualitative assessment. Conclusions There is limited understanding of how patients make treatment and trade-off decisions following a diagnosis of metastatic prostate cancer. For appropriate investment in emerging cytoreductive local tumour and metastasis-directed therapies, we should seek to better understand how this cohort weighs the oncological benefits against the risks. Patient summary We looked at how men with advanced (metastatic) prostate cancer make treatment decisions. We found that little is known about patients’ preferences for current and proposed new treatments. Further studies are required to understand how patients make decisions to help guide the integration of new treatments into the standard of ca...

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Section: Evidence Acquisitionmentioning

confidence: 99%

A Systematic Review of Patients’ Values, Preferences, and Expectations for the Treatment of Metastatic Prostate Cancer

Connor

Genie

Burns

et al. 2022

European Urology Open Science

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“…6 In addition, many of the assessments were not necessarily those which have been identified as "most important to patients." A recent systematic review 35 identified that in males, improvements in urgency incontinence were more important to patients than other symptoms in any pharmaceutical treatments, along with options that can avoid sexual side effects, provide rapid symptom improvements, and reduce the need for future surgeries. However, very few studies have reported on these metrics.…”

Section: The Need For Future Studiesmentioning

confidence: 99%

The effectiveness of parasympathomimetics for treating underactive bladder: A systematic review and meta‐analysis

Moro

Phelps

Veer

et al. 2021

Neurourology and Urodynamics

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Aims: Biological rationale suggests that parasympathomimetics (cholinergic receptor stimulating agents) could be beneficial for patients with underactive bladder. However, no systematic review with meta-analysis addressing potential benefits or adverse effects exists. The aim of this review was to assess the effectiveness, both benefits and harms, of using parasympathomimetics for the treatment of underactive bladder. Methods: The protocol was registered in PROSPERO, and searches undertaken in PubMed, Embase, and CENTRAL, including randomized and nonrandomized controlled trials of patients with underactive bladder, comparing parasympathomimetic to placebo, no treatment, or other pharmaceuticals.Risk ratios, odds ratios, and mean differences were calculated. Results: Twelve trials with 3024 participants were included. There was a significant difference between parasympathomimetics and comparators (favoring parasympathomimetics) in the number of patients with urinary retention (risk ratio 0.55, 95% confidence interval [CI] 0.3-0.98, p = 0.04, low quality of evidence). There was no difference in mean postvoid volume overall (MD −41.4 ml, 95% CI −92.0 to 9.1, p = 0.11, low quality of evidence). There was a significant difference at up to 1 week post-intervention, favoring parasympathomimetics (MD −77.5 ml, 95% CI −90.9 to −64.1, p < 0.001, low quality of evidence), but no difference at 1 month post-intervention. There was no difference in adverse events (odds ratio 1.19, 95% CI 0.62-2.28, p = 0.6, moderate quality of evidence). Conclusions:The evidence supporting the use of parasympathomimetics is of low quality, with relatively short follow-up durations. Overall, it is not possible to draw clear evidence-based conclusions from the current literature, presenting the use of parasympathomimetics for treating underactive bladder as a key area that requires future well-controlled clinical trials.

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“…Clearly, one advantage of WW is that it avoids the side effects associated with treatments such as AB and 5ARIs, or interactions with drugs used to treat concurrent diseases. This is important, given that it has been shown that men undergoing medical treatment for LUTS/BPH consistently prefer treatment options with a low risk of adverse events; a recent study reported that 93% prefer a treatment with no sexual side effects [14]. In that regard, the HESr has been shown to improve symptoms and QoL in BPH patients with minimal side effects which do not impact sexual function [1,7,8,15].…”

Section: Introductionmentioning

confidence: 99%

“…Given that some patients who visit the urologist with bothersome symptoms decide to remain on WW, possibly due to concerns about the adverse effects of treatments [14], or potential drug interactions, it is of interest to evaluate how the HESr compares to WW in terms of change in symptoms and QoL, and whether additional benefits are associated with any impact on sexual function or severe AEs. To date, there are no published studies reporting a comparison of the HESr vs. WW, with adequate follow-up specifically focusing on QoL.…”

Section: Introductionmentioning

confidence: 99%

Efficacy and Safety of the Hexanic Extract of Serenoa repens vs. Watchful Waiting in Men with Moderate to Severe LUTS-BPH: Results of a Paired Matched Clinical Study

Alcaraz

Gacci

Ficarra

et al. 2022

JCM

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We investigated changes in symptoms and quality of life (QoL) in men with moderate-to-severe lower urinary tract symptoms associated with benign prostatic hyperplasia (LUTS/BPH) receiving the hexanic extract of Serenoa repens (HESr) and compared results with a matched group on watchful waiting (WW). Data was from a real-world, open-label, prospective, multicenter study. This sub-group analysis included patients with moderate-to-severe symptoms receiving either the HESr 320 mg/daily for six months (HESr) or who remained untreated for LUTS/BPH (WW). Changes in urinary symptoms and QoL were measured by IPSS and BII questionnaires. Two statistical approaches (iterative matching and propensity score pairing) were used to maximize between-group comparability at baseline. Tolerability was assessed in the HESr group. After iterative matching, data for analysis was available for 783 patients (102 WW, 681 HESr). IPSS scores improved by a mean (SD) of 3.8 (4.4) points in the HESr group and by 2.2 (4.5) points in the WW group (p = 0.002). Changes in BII score were 1.8 (2.4) points and 1.0 (2.2) points, respectively (p < 0.001). Three patients (0.9%) treated with the HESr reported mild adverse effects. Moderate-severe LUTS/BPH patients treated for six months with the HESr showed greater improvements in symptoms and QoL than matched patients on WW, with a very low rate of adverse effects.

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A Systematic Review of Patients’ Values, Preferences, and Expectations for the Diagnosis and Treatment of Male Lower Urinary Tract Symptoms

Cited by 80 publications

References 41 publications

A Systematic Review of Patients’ Values, Preferences, and Expectations for the Treatment of Metastatic Prostate Cancer

A Systematic Review of Patients’ Values, Preferences, and Expectations for the Treatment of Metastatic Prostate Cancer

The effectiveness of parasympathomimetics for treating underactive bladder: A systematic review and meta‐analysis

Efficacy and Safety of the Hexanic Extract of Serenoa repens vs. Watchful Waiting in Men with Moderate to Severe LUTS-BPH: Results of a Paired Matched Clinical Study

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