NEW DIAGNOSTIC AND TREATMENT GUIDELINES FOR BENIGN PROSTATIC HYPERPLASIA - POTENTIAL IMPACT IN THE UNITED-STATES

Background: The Agency for Health Care Policy and Research (AHCPR) rec ently released the clinical practice guidelines for the diagnosis and treatment of benign prostatic hyperplasia. Prevalence estimates from a population-based cross-sectional study, the baseline component of a c ohort study of the natural history of prostatism, were used to assess their potential. impact in the United States. Methods: The study group comprised a population-based sample of white men aged 50 to 79 years who were randomly selected within age- and residence-specific strata f rom the Olmsted County, Minnesota, population (1990 census, 105 720). These 1317 men completed symptom assessments and diagnostic evaluation s that paralleled the AHCPR guidelines, including the measurement of u rinary flow rates and, for a subset (n=303), ultrasonic determination of postvoiding residual urine volume. Results: The application of the AHCPR benign prostatic hyperplasia diagnostic guidelines to the study cohort (American Urologic Association Symptom Index >7 and peak urinar y flow rate <15 mL/s) suggests that 17% of men aged 50 to 59 years, 27 % of men aged 60 to 69 years, and 35% of men aged 70 to 79 years are e ligible to discuss treatment options. Application of these percentages to the 1990 US white population suggests that approximately 5.6 milli on men aged 50 to 79 years are eligible to discuss treatment options. This number will double by the year 2020 owing to the aging of the pop ulation. Conclusion: The projected number of men potentially meeting A HCPR guidelines to discuss treatment options for benign prostatic hype rplasia could have a substantial impact on the health care system; thi s will be compounded by the aging of the population.