THE AMERICAN-UROLOGICAL-ASSOCIATION SYMPTOM SCORE IN THE EVALUATION OF MEN WITH LOWER URINARY-TRACT SYMPTOMS - AT 2 YEARS OF FOLLOW-UP, DOES IT WORK

Purpose: The American Urological Association (AUA) benign prostatic hy perplasia (BPH) guidelines committee established criteria for the diag nosis and treatment of patients with BPH. In a prospective study we de termined the usefulness of these guidelines in 145 previously untreate d patients with BPH symptoms. Materials and Methods: Patients were eva luated initially by AUA symptom score, digital rectal examination, uri nalysis, serum creatinine and prostate specific antigen. Based on symp tom score, patients with mild symptoms were treated with watchful wait ing, while those with moderate and severe symptoms were offered watchf ul waiting, finasteride alpha-blockers, or laser or transurethral pros tatectomy. Minimum followup was 2 years. Patients were offered a chang e in therapy if they had an intolerable adverse event or no improvemen t. Analysis included maintenance of therapy at 1 and 2 years, number o f office visits and diagnostic tests performed. In addition, all patie nts were queried regarding which factors influenced their therapeutic choice. Results: Of 37 patients with mild symptoms 31 (81%) remained o n watchful waiting at 2 years and 6 advanced to medical therapy. Among 71 patients with moderate symptoms 9 of 15 (60%) remained on watchful waiting, 27 of 36 (75%) remained on alpha-blockers and 12 of 20 (60%) remained on finasteride at 2 years. Of the 37 patients with severe sy mptoms 1 of 5 (20%) remained on watchful waiting, 1 of 6 (17%) remaine d on finasteride and 9 of 15 (60%) remained on alpha-blockers, while 3 of 5 (60%) who underwent laser prostatectomy and all 6 (100%) who und erwent transurethral prostatectomy received no further treatment. At 2 years 83% of the men who selected either finasteride or ct-blockers a s either the primary or secondary therapeutic choice were still on med ications. Most patients with mild (61%) or moderate (51%) symptoms cit ed adverse events as the predominant concern when selecting therapeuti c options. In contrast, efficacy was the overriding concern (70%) in p atients with more severe symptoms. Conclusions: Overall, with these gu idelines and the AUA symptom score 110 men (76%) were still on origina l therapy at 1 year and 99 (68%) at 2 years. Additionally, 31 patients (21%) changed to an alternative, nonoperative therapy. These results suggest that the AUA BPH guidelines provide a rational and balanced ap proach for evaluation and management of patients with symptomatic BPH. Patients can reasonably expect to remain on the initial therapeutic o ption for at least 2 years.