Patterns of Care for Newly Diagnosed Benign Prostatic Hyperplasia in the United States

PURPOSE - To examine diagnostic tests and treatment patterns in men with new onset benign prostatic hyperplasia (BPH) using consolidated national electronic health record (EHR) data.

MATERIALS AND METHODS - The Humedica(®) EHR database consists of de-identified patient records from approximately 25 million patients in the US.

Using this database, men with a new BPH diagnosis (benign prostatic hyperplasia, bladder neck obstruction, urinary retention, incomplete bladder emptying) between 7/1/2009 and 6/30/2012 were included. Exclusion criteria included conditions such as genitourinary cancers, radiation cystitis, neurogenic bladder, and urologic pain diagnoses. Diagnostic tests and treatments were summarized and stratified by age (

RESULTS - A total of 38,252 men met inclusion criteria. Mean follow-up was 1020 days. Serum creatinine (92%), serum PSA (76%) and urinalysis (52%) were the most common tests. Invasive testing was obtained in <20% of patients. Treatments included watchful waiting in 40%, pharmacologic therapy in 59.4%, and surgery in 2.2%. Alpha-blockers were prescribed in 50.7% of men. Men over the age of 65 and with higher PSA levels were less likely to be managed with watchful waiting. Therapy with a 5-alpha reductase inhibitor (5-ARI) was prescribed in 23-29% of men across all PSA categories.

CONCLUSIONS - The majority of clinical care for new-onset BPH was in concordance with guideline recommendations. Based on PSA values, 5-ARI therapy was under-utilized in men with large prostates, and was over-utilized in men with small prostates.

The Journal of urology. 2016 Feb 09 [Epub ahead of print]

J Quentin Clemens, Howard B Goldman, Kelly H Zou, Xuemei Luo, David Russell, Douglass S Chapman, Canan B Esinduy, Jennifer T Anger

University of Michigan Medical Center , Ann Arbor, MI. Lerner College of Medicine, Cleveland Clinic, Cleveland, OH., Pfizer Inc., Pfizer Inc., Pfizer Inc., Pfizer Inc., Pfizer Inc., Cedars Sinai Medical Center, Los Angeles, CA.