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[Primary and secondary prevention of benign prostatic hyperplasia: current knowledge and implications for clinical management].

[Article in German] Oelke M, Madersbacher S.

Source
Klinik fr Urologie und Urologische Onkologie, Medizinische Hochschule Hannover, CarlNeuberg-Strae 1, 30625, Hannover, Deutschland. oelke.matthias@mh-hannover.de

Abstract
Histological benign prostatic hyperplasia (BPH) and the BPH disease are frequent, lead to a reduction of quality of life, are both progressive and potentially associated with complications in the lower and upper urinary tract. A PubMed/MEDLINE search was conducted for the years 1990 to 2011. This article summarizes known selective measures of primary and secondary disease prevention.Measures of primary disease prevention aim to inhibit histological BPH and the development of clinically relevant BPH. Weight loss, regular physical activity, vegetable consumption, alcohol intake, 5-reductase inhibitors, avoidance of overweight and reduction of fatty food can reduce the probability of histological and clinical BPH. Selective measures of secondary prevention aim to inhibit disease progression and BPH-associated complications. The regular and long-term use of 1-blockers reduces lower urinary tract symptoms (LUTS) and inhibits symptomatic disease progression but cannot prevent BPH-associated complications (e.g. urinary retention or need for prostate surgery). 5-Reductase inhibitors can reduce the probability of symptomatic disease progression, urinary retention or need for surgery but the combination of 1-blocker and 5reductase inhibitor is more efficacious than either monotherapy. Especially older men with enlarged prostates (>40 cm(3)) and elevated serum PSA concentration (>1.6 g/l) profit from measures of secondary disease prevention.For primary disease prevention, data quality is low and early treatment with 5-reductase inhibitors is not been approved. For secondary disease prevention, men with risk factors of disease progression should use a treatment containing 5-reductase inhibitors. Despite several epidemiological and clinical investigations on BPH disease progression no official programme exists in Germany for disease prevention.

Prognosis
The majority of patients with BPH can expect at least moderate improvement of their symptoms with a decreased bother score and improved quality of life. Lower urinary tract symptoms (LUTS), secondary to BPH, may affect sexual wellbeing including erectile function. Medical therapy for BPH may also effect sexual function, beneficially and harmfully, so this must be considered on an individual basis. [46] [47] [48] [49] Some studies suggest that patients with a low risk for progression may be able to discontinue first-line therapy with alpha-blockers after several months of therapy. [50] [51] However, the majority of patients will require ongoing therapy.

Clinical progression of BPH


Clinical progression of BPH (as defined by symptom progression >3 points) occurs in approximately 20% of patients as demonstrated in the Medical Therapy of Prostate Symptoms (MTOP) study. [21] Approximately 2.5% of patients will develop acute urinary retention and another 6% will require invasive therapy over a 5-year time-frame. Risk for BPH progression is increased in patients with higher prostate volumes and PSA levels. Risk reduction of clinical BPH progression has been demonstrated by 39% in patients on doxazosin and 34% in patients on finasteride. Patients on combination therapy had a 66% reduction in clinical BPH progression. The MTOP study also demonstrated the risk reduction in acute urinary retention was most significant with finasteride (68%) and for invasive surgery (64%). Doxazosin alone did not significantly reduce the risk of urinary retention or the need for invasive surgery. A combination of doxazosin and finasteride reduced the risk of acute urinary retention by 81% and invasive surgery by 69%. [21]

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