Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Article
  • Clinical Research
  • Published:

Features of patients referring to the outpatient office due to benign prostatic hyperplasia: analysis of a national prospective cohort of 5815 cases

Prostate Cancer and Prostatic Diseases volume 26, pages 730–735 (2023)Cite this article

Subjects

Abstract

Background

Evidence on clinical presentation of benign prostatic hyperplasia (BPH) is scarce, and studies involving outpatients are lacking. We aimed to provide an insight into the contemporary Italian scenario of BPH-affected outpatients using symptom scores (International Prostate Symptom Score [IPSS], BPH Impact Index [BII]), and to compare characteristics of patients with known BPH and those first-diagnosed at the visit.

Methods

“IMPROVING THE PATH” project working group designed a questionary prospectively administered to BPH-affected outpatients by urologists. A cross-sectional study was performed. Data were adjusted for patient age as a potential confounding factor.

Results

Of 5815 patients enrolled, BPH was already diagnosed in 4144 (71.3%), and not in 1671 (28.7%). Patients with known BPH, compared to newly diagnosed, were older (median 68 versus [vs] 55), had more frequent smoking (smoker 27.2 vs 22.6%, and ex-smoker 16.4 vs 12.5%) and drinking habits (55.4 vs 45.1%), were more frequently affected by hypertension (60.0 vs 42.4%), obesity (15.3 vs 9.6%), diabetes (17.9 vs 12.5%), and cardiovascular diseases (14.2 vs 9.5%), p < 0.001. At IPSS, moderate and severe symptoms correlated with already known BPH (56.1 vs 47.3% and 24.8 vs 7.8%), whereas newly diagnosed patients showed milder symptoms (44.9 vs 19.1%), all p < 0.001. At BII, concern for one’s health and time lost due to urinary problems were higher in patients with known BPH (p < 0.001). For these patients, the urologist changes at least one of the ongoing medications in 63.5%. For patients newly diagnosed, supplements/phytotherapeutics, alpha-blockers, and 5-alfa reductase inhibitors were prescribed in 54.6%, 21.6%, and 7.1%, respectively.

Conclusions

Despite medical treatment, natural history of BPH leads to a progressive deterioration of symptoms. This may reflect the difference between newly diagnosed patients and those with known BPH in lifestyle and associated comorbidities. A healthy lifestyle and treatments including local anti-inflammatory agents may delay worsening of symptoms and improve quality of life.

Access through your institution
Buy or subscribe

This is a preview of subscription content, access via your institution

Access options

Access through your institution

Buy this article

  • Purchase on SpringerLink
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Fig. 1: Alluvial plot describing the pattern of change in therapy by the visiting urologist in patients with a known diagnosis of BPH.

Similar content being viewed by others

Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

References

  1. Devlin CM, Simms MS, Maitland NJ. Benign prostatic hyperplasia - what do we know? BJU Int. 2021;127:389–99. https://doi.org/10.1111/bju.15229

    Article  CAS  PubMed  Google Scholar 

  2. Vuichoud C, Loughlin KR. Benign prostatic hyperplasia: epidemiology, economics and evaluation. Can J Urol. 2015;22 Suppl 1:1–6.

    PubMed  Google Scholar 

  3. Rhodes T, Girman CJ, Jacobsen SJ, Roberts RO, Guess HA, Lieber MM. Longitudinal prostate growth rates during 5 years in randomly selected community men 40 to 79 years old. J Urol. 1999;161:1174–9.

    Article  CAS  PubMed  Google Scholar 

  4. Madersbacher S, Haidinger G, Temml C, Schmidbauer CP. Prevalence of lower urinary tract symptoms in Austria as assessed by an open survey of 2,096 men. Eur Urol. 1998;34:136–41. https://doi.org/10.1159/000019699

    Article  CAS  PubMed  Google Scholar 

  5. Egan KB. The epidemiology of benign prostatic hyperplasia associated with lower urinary tract symptoms: prevalence and incident rates. Urol Clin N Am. 2016;43:289–97. https://doi.org/10.1016/j.ucl.2016.04.001

    Article  Google Scholar 

  6. Madersbacher S, Sampson N, Culig Z. Pathophysiology of benign prostatic hyperplasia and benign prostatic enlargement: a mini-review. Gerontology. 2019;65:458–64. https://doi.org/10.1159/000496289

    Article  CAS  PubMed  Google Scholar 

  7. Choi WS, Son H. The change of IPSS 7 (nocturia) score has the maximum influence on the change of Qol score in patients with lower urinary tract symptoms. World J Urol. 2019;37:719–25. https://doi.org/10.1007/s00345-018-2410-8

    Article  PubMed  Google Scholar 

  8. Albisinni S, Aoun F, Roumeguère T, Porpiglia F, Tubaro A, DE Nunzio C. New treatment strategies for benign prostatic hyperplasia in the frail elderly population: a systematic review. Minerva Urol Nefrol. 2017;69:119–32. https://doi.org/10.23736/S0393-2249.16.02743-0

    Article  PubMed  Google Scholar 

  9. Barry MJ, Fowler FJ Jr, O’Leary MP, Bruskewitz RC, Holtgrewe HL, Mebust WK, et al. The American Urological Association symptom index for benign prostatic hyperplasia. The Measurement Committee of the American Urological Association. J Urol. 1992;148:1549–57. https://doi.org/10.1016/s0022-5347(17)36966-5.

    Article  CAS  PubMed  Google Scholar 

  10. Abrams P, Chapple C, Khoury S, Roehrborn C, de la Rosette J. International Scientific Committee. Evaluation and treatment of lower urinary tract symptoms in older men. J Urol. 2009;181:1779–87. https://doi.org/10.1016/j.juro.2008.11.127

    Article  CAS  PubMed  Google Scholar 

  11. Barry MJ, Fowler FJ Jr, O’Leary MP, Bruskewitz RC, Holtgrewe HL, Mebust WK. Measuring disease-specific health status in men with benign prostatic hyperplasia. Measurement Committee of The American Urological Association. Med Care. 1995;33:AS145–55.

    CAS  PubMed  Google Scholar 

  12. Mobley D, Feibus A, Baum N. Benign prostatic hyperplasia and urinary symptoms: evaluation and treatment. Postgrad Med. 2015;127:301–7. https://doi.org/10.1080/00325481.2015.1018799

    Article  PubMed  Google Scholar 

  13. O’Leary MP, Wei JT, Roehrborn CG, Miner M, BPH Registry and Patient Survey Steering Committee. Correlation of the International Prostate Symptom Score bother question with the Benign Prostatic Hyperplasia Impact Index in a clinical practice setting. BJU Int. 2008;101:1531–5. https://doi.org/10.1111/j.1464-410X.2008.07574.x

    Article  PubMed  Google Scholar 

  14. Kingery L, Martin ML, Naegeli AN, Khan S, Viktrup L. Content validity of the Benign Prostatic Hyperplasia Impact Index (BII); a measure of how urinary trouble and problems associated with BPH may impact the patient. Int J Clin Pract. 2012;66:883–90. https://doi.org/10.1111/j.1742-1241.2012.02960.x

    Article  CAS  PubMed  Google Scholar 

  15. Fusco F, Palmieri A, Ficarra V, Giannarini G, Novara G, Longo N, et al. α1-Blockers improve benign prostatic obstruction in men with lower urinary tract symptoms: a systematic review and meta-analysis of urodynamic studies. Eur Urol. 2016;69:1091–101. https://doi.org/10.1016/j.eururo.2015.12.034

    Article  CAS  PubMed  Google Scholar 

  16. Sebastianelli A, Spatafora P, Morselli S, Vignozzi L, Serni S, McVary KT, et al. Tadalafil alone or in combination with tamsulosin for the management for LUTS/BPH and ED. Curr Urol Rep. 2020;21:56 https://doi.org/10.1007/s11934-020-01009-7

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Hong SK, Min GE, Ha SB, Doo SH, Kang MY, Park HJ, et al. Effect of the dual 5alpha-reductase inhibitor, dutasteride, on serum testosterone and body mass index in men with benign prostatic hyperplasia. BJU Int. 2010;105:970–4. https://doi.org/10.1111/j.1464-410X.2009.08915.x

    Article  CAS  PubMed  Google Scholar 

  18. Joo K-J, Sung W-S, Park S-H, Yang W-J, Kim T-H. Comparison of α-blocker monotherapy and α-blocker plus 5α-reductase inhibitor combination therapy based on prostate volume for treatment of benign prostatic hyperplasia. J Int Med Res. 2012;40:899–908. https://doi.org/10.1177/147323001204000308

    Article  CAS  PubMed  Google Scholar 

  19. Roehrborn CG, Siami P, Barkin J, Damião R, Major-Walker K, Nandy I, et al. The effects of combination therapy with dutasteride and tamsulosin on clinical outcomes in men with symptomatic benign prostatic hyperplasia: 4-year results from the CombAT study. Eur Urol. 2010;57:123–31. https://doi.org/10.1016/j.eururo.2009.09.035

    Article  CAS  PubMed  Google Scholar 

  20. Roehrborn CG, Perez IO, Roos EPM, Calomfirescu N, Brotherton B, Wang F, et al. Efficacy and safety of a fixed-dose combination of dutasteride and tamsulosin treatment (Duodart(®)) compared with watchful waiting with initiation of tamsulosin therapy if symptoms do not improve, both provided with lifestyle advice, in the management of treatment-naïve men with moderately symptomatic benign prostatic hyperplasia: 2-year CONDUCT study results. BJU Int. 2015;116:450–9. https://doi.org/10.1111/bju.13033

    Article  CAS  PubMed  Google Scholar 

  21. Choi JD, Kim JH, Ahn SH. Transitional zone index as a predictor of the efficacy of α-blocker and 5α-reductase inhibitor combination therapy in Korean patients with benign prostatic hyperplasia. Urol Int. 2016;96:406–12. https://doi.org/10.1159/000442995

    Article  CAS  PubMed  Google Scholar 

  22. Mari A, Antonelli A, Cindolo L, Fusco F, Minervini A, De Nunzio C. Alfuzosin for the medical treatment of benign prostatic hyperplasia and lower urinary tract symptoms: a systematic review of the literature and narrative synthesis. Ther Adv Urol. 2021;13. https://doi.org/10.1177/1756287221993283

  23. Jiang Y-L, Qian L-J. Transurethral resection of the prostate versus prostatic artery embolization in the treatment of benign prostatic hyperplasia: a meta-analysis. BMC Urol. 2019;19:11 https://doi.org/10.1186/s12894-019-0440-1

    Article  PubMed  PubMed Central  Google Scholar 

  24. Liu Y, Cheng Y, Zhuo L, Liu K, Xiao C, Zhao R, et al. Impact on sexual function of endoscopic enucleation vs transurethral resection of the prostate for lower urinary tract symptoms due to benign prostatic hyperplasia: a systematic review and meta-analysis. J Endourol. 2020;34:1064–74. https://doi.org/10.1089/end.2020.0141

    Article  PubMed  Google Scholar 

  25. Tanneru K, Jazayeri SB, Alam MU, Kumar J, Bazargani S, Kuntz G, et al. An indirect comparison of newer minimally invasive treatments for benign prostatic hyperplasia: a network meta-analysis model. J Endourol. 2021;35:409–16. https://doi.org/10.1089/end.2020.0739

    Article  PubMed  Google Scholar 

  26. Abt D, Hechelhammer L, Müllhaupt G, Markart S, Güsewell S, Kessler TM, et al. Comparison of prostatic artery embolisation (PAE) versus transurethral resection of the prostate (TURP) for benign prostatic hyperplasia: randomised, open label, non-inferiority trial. BMJ. 2018;361:k2338 https://doi.org/10.1136/bmj.k2338

    Article  PubMed  PubMed Central  Google Scholar 

  27. Spatafora S, Canepa G, Migliari R, Rotondo S, Mandressi A, Puppo P. Diagnostic procedures by Italian general practitioners in response to lower urinary tract symptoms in male patients: a prospective study. Curr Med Res Opin. 2004;20:713–21. https://doi.org/10.1185/030079904125003557

    Article  PubMed  Google Scholar 

  28. McNicholas TA. Lower urinary tract symptoms suggestive of benign prostatic obstruction: what are the current practice patterns? Eur Urol. 2001;39 Suppl 3:26–30. https://doi.org/10.1159/000052564

    Article  PubMed  Google Scholar 

  29. Spatafora S, Canepa G, Migliari R, Rotondo S, Mandressi A, Puppo P, et al. Effects of a shared protocol between urologists and general practitioners on referral patterns and initial diagnostic management of men with lower urinary tract symptoms in Italy: the Prostate Destination study. BJU Int. 2005;95:563–70. https://doi.org/10.1111/j.1464-410X.2005.05340.x

    Article  PubMed  Google Scholar 

  30. Li J, Peng L, Cao D, Gou H, Li Y, Wei O. The association between metabolic syndrome and benign prostatic hyperplasia: a systematic review and meta-analysis. Aging Male. 2020;23:1388–99. https://doi.org/10.1080/13685538.2020.1771552

    Article  PubMed  Google Scholar 

  31. Xia B-W, Zhao S, Chen Z, Chen C, Liu T, Yang F, et al. The underlying mechanism of metabolic syndrome on benign prostatic hyperplasia and prostate volume. Prostate. 2020;80:481–90. https://doi.org/10.1002/pros.23962

    Article  CAS  PubMed  Google Scholar 

  32. Gandaglia G, Briganti A, Gontero P, Mondaini N, Novara G, Salonia A, et al. The role of chronic prostatic inflammation in the pathogenesis and progression of benign prostatic hyperplasia (BPH). BJU Int. 2013;112:432–41. https://doi.org/10.1111/bju.12118

    Article  PubMed  Google Scholar 

  33. Abdollah F, Briganti A, Suardi N, Castiglione F, Gallina A, Capitanio U, et al. Metabolic syndrome and benign prostatic hyperplasia: evidence of a potential relationship, hypothesized etiology, and prevention. Korean J Urol. 2011;52:507–16. https://doi.org/10.4111/kju.2011.52.8.507

    Article  PubMed  PubMed Central  Google Scholar 

  34. Wang X, Su Y, Yang C, Hu Y, Dong J-Y. Benign prostatic hyperplasia and cardiovascular risk: a prospective study among Chinese men. World J Urol. 2021. https://doi.org/10.1007/s00345-021-03817-z.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Vignozzi L, Gacci M, Maggi M. Lower urinary tract symptoms, benign prostatic hyperplasia and metabolic syndrome. Nat Rev Urol. 2016;13:108–19. https://doi.org/10.1038/nrurol.2015.301

    Article  CAS  PubMed  Google Scholar 

  36. Ngai H-Y, Yuen K-KS, Ng C-M, Cheng C-H, Chu S-KP. Metabolic syndrome and benign prostatic hyperplasia: an update. Asian J Urol. 2017;4:164–73. https://doi.org/10.1016/j.ajur.2017.05.001

    Article  PubMed  PubMed Central  Google Scholar 

  37. De Nunzio C, Presicce F, Tubaro A. Inflammatory mediators in the development and progression of benign prostatic hyperplasia. Nat Rev Urol. 2016;13:613–26. https://doi.org/10.1038/nrurol.2016.168

    Article  CAS  PubMed  Google Scholar 

  38. Sarma AV, Burke JP, Jacobson DJ, McGree ME, St Sauver J, Girman CJ, et al. Associations between diabetes and clinical markers of benign prostatic hyperplasia among community-dwelling Black and White men. Diabetes Care. 2008;31:476–82. https://doi.org/10.2337/dc07-1148

    Article  PubMed  Google Scholar 

  39. Cornu JN, Ahyai S, Bachmann A, de la Rosette J, Gilling P, Gratzke C, et al. A systematic review and meta-analysis of functional outcomes and complications following transurethral procedures for lower urinary tract symptoms resulting from benign prostatic obstruction: an update. Eur Urol 2015;67:1066–96. https://doi.org/10.1016/j.eururo.2014.06.017

    Article  PubMed  Google Scholar 

  40. Cindolo L, Pirozzi L, Sountoulides P, Fanizza C, Romero M, Castellan P, et al. Patient’s adherence on pharmacological therapy for benign prostatic hyperplasia (BPH)-associated lower urinary tract symptoms (LUTS) is different: is combination therapy better than monotherapy? BMC Urol. 2015;15:96. https://doi.org/10.1186/s12894-015-0090-x

    Article  CAS  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements

We sincerely acknowledge all the urologists who participated in the project: AMBRUOSI Carlo, ANDRETTA Elena, AUTIERI Domenico, AZZARITO Giuseppina, BASSI Silvia, BERTOLONI Rossella, CALI’ Claudia Carmela Maria, CASSONE Giuseppe, CASTRO Riccardo, CATANZARITI Francesco, CECCHETTI Giampiero, CEGLIA Antonio, COCO Angela, CROCE Francesco, DE VECCHIS Massimiliano, DELL’AGLIO Francesco, DI GIROLAMO Angela Grazia, DI PALMA Paolo, DI TRAPANI Danilo, FERRI Claudio, FINOCCHIARO Marinella, FLORIO Mirko, FUCCI Carminantonio, GAETA Francesco, GALASSO Raffaele, GAMBARDELLA Raffaele, GAROFALO Francesco, GASTALDI Christian, GITANA Carlo, GRASSO Vincenzo Maria Giuseppe, HEFFAWI Naif, IACONA Gabriele, IACONE Mario, IACOVETTA Domenico, INGRASSIA Antonino, LEMBO Francesco, LEO Salvatore, LUCERA Rossana, MAIMONE Maria Rosa, MANASSERO Francesca, MANGRAVITI Giuseppe, MASIELLO Giuseppe, MATTIELLO Gennaro, MINI’ Salvatore, MOTTA Luigi, PAPERINI Davide, PEZZOTTI Domenico, PICOZZI Stefano, PIROLA Giacomo Maria, PORROZZI Carlo, PORTOGHESE Filippo, QUARESIMA Luigi, QUATTRONE Carmelo, REALE Giulio Francesco, ROMAGNOLI Daniele, ROMANO Giuseppe, SALAME’ Leonardo Mosé, SALDUTTO Pietro, SAVINO Mario Paolo Nicola, SIMONE Maurizio, SOZZI Francesco, SPERONI Alberto, STENER Silvio, TALLIS Valeria, VANNINI Luciano, VENEZIA Valeria Carolina, VITELLI Ferdinando Daniele, ZAPPIA Domenico Giuseppe.

Funding

The study was unconditionally supported by Neopharmed Gentili.

Author information

Authors and Affiliations

  1. Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata Verona, Piazzale Aristide Stefani, 1, 37126, Verona, VR, Italy

    Paola Irene Ornaghi, Maria Angela Cerruto & Alessandro Antonelli

  2. Department of Urology, Polyclinic of Abano Terme, Piazza Cristoforo Colombo, 1, 35031, Abano Terme, PD, Italy

    Angelo Porreca

  3. Big & Open Data Innovation Laboratory (BODaI-Lab), University of Brescia, Via S. Faustino 74/B, 25122, Brescia, BS, Italy

    Marco Sandri

  4. Department of Maternal and Child Health and Urological Sciences, Policlinico Umberto I, Viale Regina Elena, 328, 00161, Roma, RM, Italy

    Alessandro Sciarra

  5. Department of Urology, Azienda Ospedaliera di Rilievo Nazionale e di Alta Specializzazione Garibaldi, piazza Santa Maria di Gesù, 5, 95124, Catania, CT, Italy

    Mario Falsaperla

  6. Department of Urology, Regional General Hospital Francesco Miulli, Strada Prov. 127 Acquaviva – Santeramo Km. 4, 70021, Acquaviva delle Fonti, BA, Italy

    Giuseppe Mario Ludovico

Authors
  1. Paola Irene Ornaghi
    View author publications

    Search author on:PubMed Google Scholar

  2. Angelo Porreca
    View author publications

    Search author on:PubMed Google Scholar

  3. Marco Sandri
    View author publications

    Search author on:PubMed Google Scholar

  4. Alessandro Sciarra
    View author publications

    Search author on:PubMed Google Scholar

  5. Mario Falsaperla
    View author publications

    Search author on:PubMed Google Scholar

  6. Giuseppe Mario Ludovico
    View author publications

    Search author on:PubMed Google Scholar

  7. Maria Angela Cerruto
    View author publications

    Search author on:PubMed Google Scholar

  8. Alessandro Antonelli
    View author publications

    Search author on:PubMed Google Scholar

Contributions

All authors whose names appear on the submission have contributed sufficiently to the scientific work and share collective responsibility and accountability for the results. All authors read and approved the final version of the manuscript. PIO: Project development, data collection, data analysis, Manuscript writing/editing. AP: Project development, manuscript editing. MS: Project development, data analysis, manuscript editing. AS: Project development, manuscript editing. MF: Project development, manuscript editing. GML: Project development, manuscript editing. MAC: Project development, manuscript editing. AA: Project development, manuscript editing.

Corresponding author

Correspondence to Alessandro Antonelli.

Ethics declarations

Competing interests

The authors declare no competing interests.

Informed consent

Informed consent for the collection of anonymized data for scientific purposes was obtained from all patients included in the study.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary information

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ornaghi, P.I., Porreca, A., Sandri, M. et al. Features of patients referring to the outpatient office due to benign prostatic hyperplasia: analysis of a national prospective cohort of 5815 cases. Prostate Cancer Prostatic Dis 26, 730–735 (2023). https://doi.org/10.1038/s41391-022-00575-w

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue date:

  • DOI: https://doi.org/10.1038/s41391-022-00575-w

This article is cited by

Search

Advanced search

Quick links