Bishr Mohamed, Boehm Katharina, Trudeau Vincent, Tian Zhe, Dell'Oglio Paolo, Schiffmann Jonas, Jeldres Claudio, Sun Maxine, Shariat Sharokh F, Graefen Markus, Saad Fred, Karakiewicz Pierre I
Department of Urology, University of Montreal Health Centre, Montreal, QC, Canada;; Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Centre, Montreal, QC, Canada;
Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Centre, Montreal, QC, Canada;; Martini-Klinik am Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany;
Can Urol Assoc J. 2016 Jan-Feb;10(1-2):55-9. doi: 10.5489/cuaj.3058.
In men with bothersome lower urinary tract symptoms (LUTS), medical treatment usually represents the first line. We examined the patterns of medical management of benign prostatic hyperplasia (BPH) in the Montreal metropolitan area, within the context of a case control study focusing on incident prostate cancer.
Cases were 1933 men with incident prostate cancer. Population controls included 1994 age-matched men. In-person interviews collected sociodemographic characteristics and medical history, including BPH diagnosis, its duration, and type of medical treatment received. Baseline characteristics were compared by the chi-square likelihood test for categorical variables and by the students t-test for continuously coded variables.
Overall, 1120 participants had history of BPH; of those 53.7% received medical treatment for BPH. Individuals with medically treated BPH, compared to individuals with medically untreated BPH, were older at index date [mean: 66.9 vs. 64.9 years, p<0.001)] and at diagnosis of BPH [mean: 62.3 vs. 60.3 years, p<0.001]. They also had a longer duration of BPH-history [mean: 4.7 vs. 4.0 years, p=0.02]. Regarding medical treatment, mono-therapy was more often used than combination therapy [87.6% vs. 12.4%, p<0.001]. Alpha-blockers (69.9%) were most commonly used as monotherapy, followed by 5alpha-reductase inhibitors (5ARIs) (26.6%). Alpha-blockers plus 5ARIs were the most common combination therapy (97.3%).
Despite evidence from randomized, controlled trials for better efficacy with use of combination therapy, monotherapy consisting of alpha-blockers or 5ARI, in that order, is most frequently used. Additionally, 5ARI use was more common than previously reported (27% vs. 15%).
在患有令人烦恼的下尿路症状（LUTS）的男性中，药物治疗通常是一线治疗方法。我们在一项以新发前列腺癌为重点的病例对照研究背景下，研究了蒙特利尔大都市区良性前列腺增生（BPH）的药物治疗模式。
病例为1933例新发前列腺癌男性。人群对照包括1994例年龄匹配的男性。通过面对面访谈收集社会人口学特征和病史，包括BPH诊断、病程以及接受的药物治疗类型。分类变量通过卡方似然检验比较基线特征，连续编码变量通过学生t检验比较。
总体而言，1120名参与者有BPH病史；其中53.7%接受了BPH药物治疗。接受药物治疗的BPH患者与未接受药物治疗的BPH患者相比，在索引日期时年龄更大[平均：66.9岁对64.9岁，p<0.001]，在BPH诊断时年龄也更大[平均：62.3岁对60.3岁，p<0.001]。他们的BPH病史持续时间也更长[平均：4.7年对4.0年，p=0.02]。关于药物治疗，单药治疗比联合治疗更常用[87.6%对12.4%，p<0.001]。α受体阻滞剂（69.9%）最常作为单药使用，其次是5α还原酶抑制剂（5ARIs）（26.6%）。α受体阻滞剂加5ARIs是最常见的联合治疗（97.3%）。
尽管随机对照试验有证据表明联合治疗疗效更好，但最常使用的是依次由α受体阻滞剂或5ARI组成的单药治疗。此外，5ARI的使用比之前报道的更常见（27%对15%）。
