Division of Urology, Albany Medical College, Albany, NY, USA.
Social & Scientific Systems, Inc., a DLH Holdings Company, Durham, NC, USA.
Prostate Cancer Prostatic Dis. 2022 Feb;25(2):269-273. doi: 10.1038/s41391-021-00435-z. Epub 2021 Sep 20.
The American Urological Association makes recommendations for evaluation and testing for lower urinary tract symptoms associated with benign prostatic hyperplasia (LUTS/BPH) to help primary care providers and specialists identify LUTS/BPH and harmful related conditions including urinary retention and prostate or bladder cancer. Our understanding of provider adherence to these Guidelines is limited to single-site or nonrepresentative settings.
We analyzed two insurance claims databases: the Optum de-identified Clinformatics Data Mart database for privately insured males aged 40-64 years (N ≈ 1,650,900 annually) and the Medicare 5% Sample for males aged ≥65 years (N ≈ 546,000 annually). We calculated the annual prevalence of LUTS/BPH and comorbid bladder cancer and bladder stones from 2004 to 2013. We additionally examined LUTS/BPH incidence and adherence to testing guidelines in a cohort of men newly diagnosed with LUTS/BPH in 2009.
While LUTS/BPH prevalence and incidence increased with increasing age, evaluation testing became less common. Urinalysis was the most common testing type but was performed in <60% of incident patients. Serum prostate-specific antigen (PSA) was the second most common test across age groups (range: 15-34%). Prevalence of comorbid bladder cancer (range: 0-4%), but not bladder stones (range: 1-2%), increased with increasing age.
Although older men were at greater risk of LUTS/BPH than younger men, they were less likely to undergo testing at diagnosis. Recommended testing with urinalysis was poor despite higher prevalence of bladder cancer in older men and a standard recommendation for urinalysis since 1994. Providers should be more cognizant of AUA Guidelines when assessing LUTS/BPH patients.
美国泌尿外科学会（AUA）针对良性前列腺增生（BPH）相关下尿路症状（LUTS）的评估和检测提出了建议，以帮助初级保健提供者和专家识别 LUTS/BPH 以及包括尿潴留、前列腺或膀胱癌在内的有害相关疾病。我们对这些指南的提供者依从性的了解仅限于单一地点或非代表性的环境。
我们分析了两个保险索赔数据库：Optum 去识别的 Clinformatics Data Mart 数据库，用于年龄在 40-64 岁的私人保险男性（每年约 1650900 人）和 Medicare 5%抽样，用于年龄≥65 岁的男性（每年约 546000 人）。我们计算了 2004 年至 2013 年 LUTS/BPH 和合并膀胱癌和膀胱结石的年患病率。我们还在 2009 年新诊断为 LUTS/BPH 的男性队列中检查了 LUTS/BPH 的发病率和检测指南的依从性。
虽然 LUTS/BPH 的患病率和发病率随年龄增长而增加，但评估检测变得不那么常见。尿液分析是最常见的检测类型，但在<60%的新发病例患者中进行。前列腺特异性抗原（PSA）是各年龄段中第二常见的检测类型（范围：15-34%）。合并膀胱癌（范围：0-4%）的患病率随着年龄的增长而增加，但不是膀胱结石（范围：1-2%）。
尽管年龄较大的男性患 LUTS/BPH 的风险高于年轻男性，但他们在诊断时进行检测的可能性较小。尽管年龄较大的男性膀胱癌患病率较高，且自 1994 年以来一直建议进行尿液分析，但推荐的尿液分析检测效果不佳。当评估 LUTS/BPH 患者时，提供者应更加关注 AUA 指南。
