Fitzpatrick John M
Mater Misericordiae Hospital and University College Dublin, Ireland.
BJU Int. 2006 Apr;97 Suppl 2:3-6; discussion 21-2. doi: 10.1111/j.1464-410X.2006.06097.x.
The progression of benign prostatic hyperplasia (BPH) can be defined as a deterioration of clinical variables such as lower urinary tract symptoms (LUTS), health-related quality of life and peak flow rate, increased prostate size, or unfavourable outcomes such as acute urinary retention (AUR) and BPH-related surgery. The natural history of BPH is best analysed from longitudinal studies of community-dwelling men. In the Olmsted county study, which followed for 12 years a randomly selected cohort of 2115 men aged 40-79 years, there was an average increase in the International Prostate Symptom Score (IPSS) of 0.18 points per year, ranging from 0.05 for men in their fifties to 0.44 for those in their seventies. There was also a decrease in peak flow rate of 2% per year and a median prostate growth of 1.9% per year. The cumulative incidence of AUR was low (2.7% over 4 years). Information can also be collected from the placebo arms of controlled studies of men with symptomatic BPH, although the strict trial inclusion criteria and indeed the taking of a placebo itself introduce biases which limit the analysis of the natural history of the disease in this way, and its applicability to the general population. Hence, in the Medical Therapy of Prostatic Symptoms study, there is clear evidence that symptom deterioration, defined by a worsening of the IPSS of > or = 4 points, was by far the most prevalent progression event (79.5%), with a cumulative incidence of 14% over a mean follow-up of 4.5 years. As in the longitudinal community-based studies, AUR was rather uncommon (14.8% of overall progression events) with a cumulative incidence of 2%. BPH-related surgery, which was a secondary criterion in the study, was required in 5% of men. Similar conclusions can be drawn from a 2-year placebo-controlled study (ALTESS) assessing the impact of alfuzosin 10 mg once daily on LUTS/BPH progression in 1522 men with symptomatic BPH at high risk of developing AUR. Symptom deterioration was clearly the main progression event, with a cumulative incidence of 16.8%, compared to BPH-related surgery (6.5%) and AUR (2.2%). Thus, there is evidence from longitudinal studies, and to a lesser extent from the placebo arms of large controlled studies, that BPH is a progressive disease. Symptom worsening is by far the most frequently occurring progression event. Identifying those patients at risk of BPH progression is crucial to optimize their management.
良性前列腺增生（BPH）的进展可定义为临床变量的恶化，如下尿路症状（LUTS）、健康相关生活质量和峰值流速，前列腺体积增大，或出现不良后果，如急性尿潴留（AUR）和与BPH相关的手术。BPH的自然病程最好通过对社区男性的纵向研究来分析。在奥尔姆斯特德县的研究中，对随机选取的2115名40 - 79岁男性进行了12年的随访，国际前列腺症状评分（IPSS）平均每年增加0.18分，50多岁的男性为0.05分，70多岁的男性为0.44分。峰值流速每年下降2%，前列腺体积中位数每年增长1.9%。AUR的累积发生率较低（4年内为2.7%）。也可以从有症状BPH男性的对照研究的安慰剂组中收集信息，尽管严格的试验纳入标准以及服用安慰剂本身会引入偏差，从而限制了以这种方式对疾病自然病程的分析及其对一般人群的适用性。因此，在前列腺症状医学治疗研究中，有明确证据表明，以IPSS恶化≥4分为定义的症状恶化是迄今为止最普遍的进展事件（79.5%），在平均4.5年的随访中累积发生率为14%。与基于社区的纵向研究一样，AUR相当少见（占总体进展事件的14.8%），累积发生率为2%。该研究的次要标准——与BPH相关的手术，在5%的男性中需要进行。从一项为期2年的安慰剂对照研究（ALTESS）中也能得出类似结论，该研究评估了每日一次服用10 mg阿夫唑嗪对1522名有症状且有发生AUR高风险的BPH男性的LUTS/BPH进展的影响。症状恶化显然是主要的进展事件，累积发生率为16.8%，而与BPH相关的手术为6.5%，AUR为2.2%。因此，纵向研究以及在较小程度上大型对照研究的安慰剂组都有证据表明BPH是一种进行性疾病。症状恶化是迄今为止最常发生的进展事件。识别有BPH进展风险的患者对于优化其管理至关重要。
