BPH

• Autopsy data indicates that anatomic (microscopic) evidence of BPH is seen in about:
  • 25 percent of men age 40 to 50 years,
  • 50 percent of men age 50 to 60,
  • 65 percent of men age 60 to 70,
  • 80 percent of men age 70 to 80,
  • 90 percent of men age 80 to 90.
• It has been classically stated that from 25 to 50 percent of individuals with microscopic and macroscopic evidence of BPH will progress to clinical BPH.
• Depending on the definition (urodynamic, macroscopic, etc.), the prevalence of clinical BPH in an individual community in men ages 55 to 74 years may vary from less than 5 percent to more than 30 percent.
  • Only 40 percent of this group, however, complain of lower urinary tract symptoms (LUTS)
  • Only about 20 percent seek medical advice because of them
• The total number of prostatectomies done yearly in the United States has declined drastically over the past 10-15 years.

United States

The National Institute of Diabetes & Digestive & Kidney Diseases (NIDDK) estimates that more than 50% of men in their 60's and as many as 90% in their 80's have symptoms of BPH
Link to NIDDK:www.niddk.nih.gov/health/urolog/pubs/prostate/index.htm

Diseases of the prostate

Prevalence (1996): 2.803 million men (in the noninstitutionalized population)¹

Enlarged prostate (BPH)

Prevalence: 50 percent of men age 51-60; 90 percent of men past age 80²
Hospital discharges listing a diagnosis of BPH among all listed diagnoses (1999): 388,000 hospitalizations³

LeBlanc M, Baum N: Medical Management of BPH in the elderly, Clinical Geriatrics web site.

The prevalence of BPH in 60-year-old men is greater than 50%. By age 85, it escalates to 90%.
Link to article:www.mmhc.com/cg/articles/CG9904/baum.html

Additional Prevalence Resources

The Triumph Project

Verhamme KM, Dieleman JP, Bleumink GS, van der Lei J, Sturkenboom MC, Artibani W, Begaud B, Berges R, Borkowski A, Chappel CR, Costello A, Dobronski P, Farmer RD, Jimenez Cruz F, Jonas U, MacRae K, Pientka L, Rutten FF, van Schayck CP, Speakman MJ, Sturkenboom MC, Tiellac P, Tubaro A, Vallencien G, Vela Navarrete R; Triumph Pan European Expert Panel: Incidence and prevalence of lower urinary tract symptoms suggestive of benign prostatic hyperplasia in primary care - the Triumph project, Eur Urol 2002 Oct ;42(4)323-8

Apolone G, Cattaneo A, Colombo P, La Vecchia C, Cavazzuti L, Bamfi F.: Knowledge and opinion on prostate and prevalence of self-reported BPH and prostate-related events. A cross-sectional survey in Italy. Eur J Cancer Prev 2002 Oct; 11(5):473-9.

Gu F. Epidemiological survey of benign prostatic hyperplasia and prostatic cancer in China. Chin Med J (Engl) 2000 Apr; 113(4)299-302.

Sources:

1. Current Estimates From the National Health Interview Survey, 1996. Atlanta, GA: National Center for Health Statistics (NCHS), Centers for Disease Control and Prevention (CDC), U.S. Dept. of Health and Human Services (DHHS); October 1999. Vital and Health Statistics. Series 10, No. 200.
2. McConnell JD. Epidemiology, etiology, pathophysiology, and diagnosis of benign prostatic hyperplasia. In: Walsh PC, et al., eds., Campbell's Urology. Vol. 2. 7th ed. Philadelphia: WB Saunders Company; 1998: 1429-1452.
3. 1999 National Hospital Discharge Survey: Annual Summary with Detailed Diagnoses and Procedures Data. Atlanta, GA: NCHS, CDC, DHHS; September 2001. Vital and Health Statistics. Series 13, No. 151.

References

• Abrams P: In support of pressure-flow studies for evaluating men with lower urinary tract symptoms. Urology 44:153-155, 1994.
• Ball AJ, Fenely RCL, Abrams PH: The natural history of untreated "prostatism " Br J Urol 53:613-616, 1981.
• Barry MJ: Epidemiology of benign prostatic hyperplasia. AUA Update Series 16:274-279, 1997.
• Barry MJ, Fowler FJ, Bin L, et al: The natural history of patients with benign prostatic hyperplasia as diagnosed by North American urologists. J Urol 157:10-15, 1997.
• Barry MJ, Fowler FJ, Jr., O'Leary MP, and the Measurement Committee of the AUA: The American Urological Association symptom index for benign prostatic hyperplasia. J Urol 148:1549-1557, 1992.
• Barry MJ, Williford WO, Chang Y, et al: Benign prostatic hyperplasia specific health status measures in clinical research: How much change in the AUA symptom index and the BPH impact index is perceptible to patients? J Urol 154:1770-1774, 1995.
• Blaivas J: The bladder is an unreliable witness. Neurourol Urodyn 15:443-445, 1996.
• Denis L, Griffiths K, Khoury S, et al, eds. 4th International Consultation on Benign Prostatic Hyperplasia (BPH). Plymouth, United Kingdom, Plymbridge Distributors, Ltd., 1998.

  Chapter 3: Regulation of prostatic growth. Cockett ATK, Coffey D, DiSant Agnese A, et al.
  Chapter 5: Initial evaluation of LUTS. Artibani W, Correa R, Desgranchamps F, et al.
  Chapter 6: Quantification of symptoms, quality of life and sexuality. Adolfsson J, Barry M, Batista JE, et al.
  Chapter 7: The urodynamics of LUTS. Abrams P, Buzelin JM, Griffiths D, et al.
  Chapter 10: Interventional therapy. Altwein J, Baba S, Blute M, et al. Chapter 11: Endocrine treatment. Akaza H, Bartsch G, Calais daSilva F, et al. Chapter 12: Alpha-blocker therapy. AldoBono V, Andersson KE, Chapple C, et al.
  Chapter 15: BPH 1997-New treatment strategy. ElHilali M, Kirby R, McConnell J.
  Lepor H, Williford WO, Barry MJ, et al: The efficacy of terazosin, finasteride, or both in BPH. N Engl J Med 335:533-539, 1996.

• McConnell J: Why pressure flow studies should be optional and not mandatory for evaluating men with benign prostatic hyperplasia. Urology 44:156-158, 1994.
• McConnell JD, Barry MJ, Bruskewitz R, et al: Benign prostatic hyperplasia: Diagnosis and treatment. Clinical Practice Guideline, no. 8, AHCPR publication No. 94-0582, Rockville, Md., Agency for Health Care Policy Research, Public Health Service, US Dept. Of Health and Human Services, 1994.
• Walsh PC, Retik AB, Vaughan ED Jr., Wein AJ, eds: Campbell's Urology, 7th ed. Philadelphia, Saunders Company, 1998. Chapter 45: The molecular biology, endocrinology, and physiology of the prostate and seminal vesicles. Partin AW, Coffey DS.

  Chapter 46: Epidemiology, etiology, pathophysiology, and diagnosis of benign prostatic hyperplasia. McConnell JD.
  Chapter 47: Natural history, evaluation, and nonsurgical management of benign prostatic hyperplasia. Lepor H.
  Chapter 48: Minimally invasive treatment of benign prostatic hyperplasia. McCullough DL.
  Chapter 49: Transurethral surgery. Mebust WK.

• Wasson JH, Reda DJ, Bruskewitz RC, et al: A comparison of transurethral surgery with watchful waiting for moderate symptoms of BPH. N Engl J Med 332:75-79,1995.
• Wein AJ: Criteria for assessing outcome following intervention for benign prostatic hyperplasia. In: Lepor H, ed. Prostatic Diseases. Philadelpha, Saunders, 1999, pp 210-231.

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