Barkin Jack
Humber River Regional Hospital, Toronto, Canada and Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
Patient Prefer Adherence. 2011;5:483-90. doi: 10.2147/PPA.S14032. Epub 2011 Oct 7.
Lower urinary tract symptoms (LUTS) caused by benign prostatic hyperplasia (BPH) will usually affect older men, of whom 50% over the age 60 years and almost 90% in their nineties will be bothered enough by their symptoms that they request some type of treatment. However, symptomatic bother may also affect men in their forties with a prevalence rate of almost 18%. The International Prostate Symptom Score (IPSS) has become the most widely used and best validated questionnaire to allow the patient to quantify the severity of his LUTS/BPH symptoms. This score has become the cornerstone in demonstrating the "rate of symptom response" for the patient who has been exposed to any type BPH management. Question 8 on the IPSS score is what is defined as the "Quality of Life" question or what is also termed the "Bothersome Index." The score out of 6 as declared by the patient will reflect the degree of concern that the patient is feeling about his symptoms and the reduction of the score after treatment is a statement of their improved quality of life. There are 2 families of accepted medical therapy to treat the symptoms of BPH and potentially prevent the most worrisome long-term sequelae of progression of BPH: urinary retention or the need for surgery. When defining the impact of the main types of medical therapy, the alpha blockers have been termed the "openers" and the 5 alpha-reductase inhibitors are described as the "shrinkers." Since they each offer a different mechanism of effect, the concept of combination therapy was raised and trialed many times over recent years. The final aspect of any medical therapy is the patient's satisfaction with the treatment and the side effects. In the CombAT (Combination of Avodart and Tamsulosin) trial a new assessment was developed and tested called the Patient's Perception of Study Medication (PPSM) which told the investigators if the patients, given free choice, would choose to take that combination of medication to treat their problem and stay on the medication.
良性前列腺增生（BPH）引起的下尿路症状（LUTS）通常会影响老年男性，其中60岁以上的男性中有50%会受到症状困扰，而90多岁的男性中几乎90%会因症状严重到需要某种治疗。然而，有症状困扰的情况也可能影响40多岁的男性，患病率近18%。国际前列腺症状评分（IPSS）已成为使用最广泛且验证最充分的问卷，用于让患者量化其LUTS/BPH症状的严重程度。该评分已成为衡量接受任何类型BPH治疗患者“症状缓解率”的基石。IPSS评分中的问题8被定义为“生活质量”问题或“困扰指数”。患者给出的6分制评分将反映其对症状的担忧程度，治疗后评分降低表明生活质量得到改善。有两类公认的药物疗法可治疗BPH症状，并有可能预防BPH进展最令人担忧的长期后遗症：尿潴留或手术需求。在定义主要药物疗法的影响时，α受体阻滞剂被称为“开启者”，5α还原酶抑制剂被描述为“缩小者”。由于它们各自提供不同的作用机制，近年来联合治疗的概念被多次提出并进行试验。任何药物治疗的最后一个方面是患者对治疗及其副作用的满意度。在CombAT（阿夫唑嗪和坦索罗辛联合使用）试验中，开发并测试了一种新的评估方法，称为患者对研究药物的认知（PPSM），它能告知研究人员，如果让患者自由选择，他们是否会选择服用该联合药物来治疗问题并持续用药。
