Treatment for benign prostatic hyperplasia among community dwelling men: The Olmsted County study of urinary symptoms and health status

Purpose: We describe treatments for benign prostatic hyperplasia (BPH) amon g men participating in the Olmsted County study of urinary symptoms and hea lth status among men during 10,000 person-years of followup. Materials and Methods: A cohort of 2,115 men 40 to 79 years old was randoml y selected from an enumeration of the Olmsted County, Minnesota population (55% response rate). Participants completed a previously validated baseline questionnaire to assess symptom severity and voided into a portable uromet er. A 25% random subsample underwent transrectal sonographic imaging of the prostate to determine prostate volume and measurement of serum prostate sp ecific antigen. Followup included retrospective review of community medical records and completion of a biennial questionnaire to determine the occurr ence of medical and surgical treatment for BPH in the subsequent 6 years. Results: During more than 10,000 person-years of followup 167 men were trea ted, yielding an overall incidence of 16.0/1,000 person-years. There was a strong age related increase in risk of any treatment from 3.3/1,000 person- years for men 40 to 49 years old to more than 30/1,000 person-years for tho se 70 years old or older. Men with moderate to severe symptoms (American Ur ological Association symptom index greater than 7), depressed peak urinary flow rates (less than 12 ml. per second), enlarged prostate (greater than 3 0 ml.) or elevated serum prostate specific antigen (1.4 ng./ml. or greater) had about 4 times the risk of BPH treatment than those who did not. After adjustment for all measures simultaneously an enlarged prostate (hazard rat io 2.3, 95% confidence interval [CI] 1.1, 4.7), depressed peak flow rate (h azard ratio 2.7, 95% CI 1.4, 5.3) and moderate to severe symptoms (hazard r atio 5.3, 95% CI 2.5, 11.1) at baseline each independently predicted subseq uent treatment. Conclusions: While repeat contact and availability of urological measuremen ts during the study period may have influenced treatment decisions in this cohort, the data demonstrate that treatment is common in elderly men with n early 1 in 4 receiving treatment in the eighth decade of life. Furthermore, these data suggest that men with moderate to severe lower urinary tract sy mptoms, impaired flow rates or enlarged prostates are more likely to underg o treatment, with increases in risk of similar magnitude to those associate d with adverse outcomes, such as acute urinary retention.