Long-Term Risk of Surgery Following First Diagnosis of Benign Prostatic Hyperplasia in Middle-Aged Men

Abstract

Pharmacotherapy is often used to relieve lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH), yet surgery may be indicated for persistent bothersome symptoms. BPH is common among older men, yet the burden of BPH among middle-aged men may be under-recognized. This study examined the 5-year risk of BPH surgery among middle-aged men following the first BPH diagnosis. MethodsUsing the IBM MarketScan Commercial Claims and Encounters Database, males aged 35 to 64 years with a first-time primary diagnosis of BPH who were prescribed oral medication for LUTS were identified. The primary outcome was the risk of BPH surgery within five years of the first BPH diagnosis, which was analyzed using Kaplan-Meier methods. The influence of patient demographics, comorbidities, and medication use on the risk of BPH surgery was explored using a Cox proportional hazards model. ResultsFour thousand five hundred ten eligible men, 460 underwent BPH surgery within five years of BPH diagnosis. The most common surgical procedures were transurethral resection of the prostate and laser enucleation. The risk of BPH surgery over five years following BPH diagnosis was 10.2% (95% CI: 9.4% to 11.1%). In a multivariable Cox proportional hazards regression analysis, patient age was the primary factor associated with higher surgery risk. Compared to men aged 35 to 44 years, the hazard ratio for BPH surgery was 3.9 (95% CI: 1.9 to 8.4; p<0.001) among men aged 45 to 54 years, and 5.0 (95% CI: 2.4 to 10.6; p<0.001) among men aged 55 to 64 years. ConclusionsIn middle-aged men prescribed oral medication for LUTS secondary to BPH, the risk of BPH surgery was 10.2% over five years. This risk may be underappreciated and highlights the clinical need for surgical procedures with favorable risk-to-benefit profiles.

Intravesical Prostatic Protrusion as A Predictor of Need for Surgical Therapy in Benign Prostatic Hyperplasia Patients

“…In this study (over a 24 month follow up period) 56 patients (56%) were found to have required or had prostatectomy. The higher percentage requirement for BPH surgery in this study could be due to the fact that the risk for BPH surgery may be underappreciated in the previous study as opined by the authors or the mean age in this study being higher than the study by [23] (64 years versus 54 years). Old age has been found to be an independent predictor of the risk for BPH surgery [23].…”

“…Reference [23] in a study in 4,510 men with first time primary diagnosis of BPH followed up over a 5-year period on medical therapy found that 460 men (10.2%) had BPH surgery. In this study (over a 24 month follow up period) 56 patients (56%) were found to have required or had prostatectomy.…”