OBJECTIVE: To better risk stratify patients, utilizing baseline characteristics, in order to help optimize decision making for men with moderate to severe lower urinary tract symptoms (LUTS) secondary to BPH through a secondary analysis of the Medical Therapy of Prostatic Symptoms (MTOPS) trial.
MATERIALS AND METHODS: After review of the literature, we identified potential baseline risk factors for BPH progression. Using bivariate tests in a secondary analysis of MTOPS data, we determined which variables retained prognostic significance. We then utilized these factors in Cox Proportional Hazard modeling to 1) more comprehensively risk stratify the study population based on pre-treatment parameters and 2) to determine which risk strata stood to benefit most from medical intervention.
RESULTS: 3047 men were followed in MTOPS for a mean of 4.5 years. We demonstrated varying risks of progression across quartiles. Baseline BPH Impact Index score, post-void residual, serum prostate specific antigen, age, AUA Symptom Index score, and maximum urinary flow rate were found to significantly correlate with overall BPH progression in multivariable analysis.
CONCLUSIONS: Utilizing baseline factors permits estimation of individual patient risk for clinical progression and the benefits of medical therapy. A novel clinical decision tool based on these analyses will allow clinicians to weigh patient-specific benefits against possible risks of adverse effects for a given patient.
Written by:
Kozminski MA, Wei JT, Nelson J, Kent DM. Are you the author?
Department of Urology, University of Michigan Medical School, Ann Arbor, MI, USA.
Reference: BJU Int. 2014 May 13. Epub ahead of print.
doi: 10.1111/bju.12802
PubMed Abstract
PMID: 24825577
