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

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.

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

Data availability

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

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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.

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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.

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Correspondence to Alessandro Antonelli.

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

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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 (2022). https://doi.org/10.1038/s41391-022-00575-w

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