Korean J Urol.  2010 Jul;51(7):488-491.

Prospective Factor Analysis of Alpha Blocker Monotherapy Failure in Benign Prostatic Hyperplasia

Affiliations
  • 1Department of Urology, Ewha Womans University School of Medicine, Seoul, Korea. woochung@ewha.ac.kr

Abstract

PURPOSE
We aimed to determine the treatment of choice criteria for benign prostatic hyperplasia (BPH) by analyzing the factors causing alpha-adrenergic receptor blocker (alpha-blocker) monotherapy failure.
MATERIALS AND METHODS
This retrospective study enrolled 129 patients with BPH who were prescribed an alpha-blocker. Patients were allocated to a transurethral resection of prostate (TURP) group (after having at least a 6-month duration of medication) and an alpha-blocker group. We compared the differences between the two groups for their initial prostate volume, serum prostate-specific antigen (PSA), maximum urinary flow rate (Qmax), International Prostate Symptom Score (IPSS), and postvoid residual urine volume (PVR).
RESULTS
Of the 129 patients, 54 were in the TURP group and 75 were in the alpha-blocker group. Statistically significant differences (p<0.05) between the two groups were found in the prostate volume (50.8 ml vs. 34.4 ml), PSA (6.8 ng/ml vs. 3.6 ng/ml), Qmax (6.84 ml/sec vs. 9.99 ml/sec), and IPSS (27.3 vs. 16.8). According to the multiple regression analysis, the significant factors in alpha-blocker monotherapy failure were the IPSS (p<0.001) and prostate volume (p=0.015). According to the receiver operating characteristic (ROC) curve-based prediction regarding surgical treatment, the best cutoff value for the prostate volume and IPSS were 35.65 ml (sensitivity 0.722, specificity 0.667) and 23.5 (sensitivity 0.852, specificity 0.840), respectively.
CONCLUSIONS
At the initial diagnosis of BPH, patients with a larger prostate volume and severe IPSS have a higher risk of alpha-blocker monotherapy failure. In this case, combined therapy with 5-alpha-reductase inhibitor (5-ARI) or surgical treatment may be useful.

Keyword

Adrenergic alpha-antagonists; Prostatic hyperplasia; Transurethral resection of prostate

MeSH Terms

Adrenergic alpha-Antagonists
Diagnosis
Factor Analysis, Statistical*
Humans
Prostate
Prostate-Specific Antigen
Prostatic Hyperplasia*
Retrospective Studies
ROC Curve
Sensitivity and Specificity
Transurethral Resection of Prostate
Adrenergic alpha-Antagonists
Prostate-Specific Antigen

Figure

  • FIG. 1 Receiver operation characteristics of each parameter. TRUS: transrectal ultrasonography (prostate volume), PSA: prostate-specific antigen, Qmax: maximum urinary flow rate, IPSS: International Prostate Symptom Score.


Reference

1. Djavan B, Fong YK, Harik M, Milani S, Reissigl A, Chaudry A, et al. Longitudinal study of men with mild symptoms of bladder outlet obstruction treated with watchful waiting for four years. Urology. 2004. 64:1144–1148.
2. Kim CI, Chang HS, Kim BK, Park CH. Long-term results of medical treatment in benign prostatic hyperplasia. Urology. 2006. 68:1015–1019.
3. Madersbacher S, Alivizatos G, Nordling J, Sanz CR, Emberton M, de la Rosette JJ. EAU 2004 guidelines on assessment, therapy and follow-up of men with lower urinary tract symptoms suggestive of benign prostatic obstruction (BPH guidelines). Eur Urol. 2004. 46:547–554.
4. Djavan B, Chapple C, Milani S, Marberger M. State of the art on the efficacy and tolerability of alpha1-adrenoceptor antagonists in patients with lower urinary tract symptoms suggestive of benign prostatic hyperplasia. Urology. 2004. 64:1081–1088.
5. McConnell JD, Roehrborn CG, Bautista OM, Andriole GL Jr, Dixon CM, Kusek JW, et al. The long-term effect of doxazosin, finasteride, and combination therapy on the clinical progression of benign prostatic hyperplasia. N Engl J Med. 2003. 349:2387–2398.
6. Roehrborn CG. Alfuzosin 10 mg once daily prevents overall clinical progression of benign prostatic hyperplasia but not acute urinary retention: results of a 2-year placebo-controlled study. BJU Int. 2006. 97:734–741.
7. Roberts RO, Jacobsen SJ, Jacobson DJ, Rhodes T, Girman CJ, Lieber MM. Longitudinal changes in peak urinary flow rates in a community based cohort. J Urol. 2000. 163:107–113.
8. Jacobsen SJ, Jacobson DJ, Girman CJ, Roberts RO, Rhodes T, Guess HA, et al. Natural history of prostatism: risk factors for acute urinary retention. J Urol. 1997. 158:481–487.
9. Roehrborn CG, McConnell JD, Lieber M, Kaplan S, Geller J, Malek GH, et al. PLESS Study Group. Serum prostate-specific antigen concentration is a powerful predictor of acute urinary retention and need for surgery in men with clinical benign prostatic hyperplasia. Urology. 1999. 53:473–480.
10. Marberger MJ, Andersen JT, Nickel JC, Malice MP, Gabriel M, Pappas F, et al. Prostate volume and serum prostate-specific antigen as predictors of acute urinary retention. Combined experience from three large multinational placebo-controlled trials. Eur Urol. 2000. 38:563–568.
11. Crawford ED, Wilson SS, McConnell JD, Slawin KM, Lieber MC, Smith JA, et al. Baseline factors as predictors of clinical progression of benign prostatic hyperplasia in men treated with placebo. J Urol. 2006. 175:1422–1426.
12. Hong SJ, Ko WJ, Kim SI, Chung BH. Identification of baseline clinical factors which predict medical treatment failure of benign prostatic hyperplasia: an observational cohort study. Eur Urol. 2003. 44:94–99.
13. Lee KS, Kim ME, Kim SJ, Kim HK, Kim HS, Kim CI, et al. Predictive factors of the long-term medical treatment failure in benign prostatic hyperplasia. Korean J Urol. 2008. 49:826–830.
14. Bartsch G, Fitzpatrick JM, Schalken JA, Isaacs J, Nordling J, Roehrborn CG. Consensus statement: the role of prostate-specific antigen in managing the patient with benign prostatic hyperplasia. BJU Int. 2004. 93:Suppl 1. 27–29.
15. Boyle P, Gould AL, Roehrborn CG. Prostate volume predicts outcome of treatment of benign prostatic hyperplasia with finasteride: meta-analysis of randomized clinical trials. Urology. 1996. 48:398–405.
Full Text Links
  • KJU
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr