Treatment choice for benign prostatic hyperplasia: A matter of urologist preference?

Purpose: New treatment modalities for benign prostatic hyperplasia (BPH) ha ve considerably altered the decision making process in daily clinical pract ice. Guidelines provide a framework for treatment choice but leave much roo m for physician personal opinions. We identified and quantified determinant s of treatment choice for BPH among urologists focusing on urologist treatm ent preferences. Materials and Methods: The study population consisted of 670 consecutive pa tients with BPH 50 years old or older newly referred to 1 of 39 urologists in a stratified sample of 13 hospitals throughout The Netherlands. Data on patient characteristics were retrieved from patient questionnaires (symptom atology, bothersomeness, sexual function), medical records (diagnostic outc omes, co-morbidity) and urologist questionnaire (initial treatment choice a nd main considerations for this decision). Urologist treatment preferences were inventoried using a mailed questionnaire. Polychotomous logistic regre ssion analysis was used to study the impact of patient characteristics and urologist preferences on treatment choice. Results: Among the patient characteristics maximum flow rate, residual urin e and prostate volume were strongly associated with the probability of surg ery and watchful waiting. However, the influence of urologist preferences o n actual decisions was also significant. Adjusted for case mix the differen ces in low and high preferences revealed a 2.2 times greater probability of surgery. For a-blockers and finasteride these ratios were 1.8 and 9.4, res pectively. An additional independent effect was seen for urologist extent o f experience. Conclusions: The influence of urologist personal preferences on treatment c hoice in BPH is considerable. Given the different efficacy and side effects of the various treatments, further consensus development is needed to enha nce appropriate treatment decisions and eliminate undue costs.