Can we use baseline characteristics to assess which men with moderately symptomatic benign prostatic hyperplasia at risk of progression will benefit from treatment? A post hoc analysis of data from the 2-year CONDUCT study

To investigate (in a post hoc analysis of the 2-year CONDUCT study) the characteristics and clinical outcomes of men with moderately symptomatic benign prostatic hyperplasia (BPH) at risk of progression who benefitted from lifestyle changes alone.

Patients were given lifestyle advice and randomized to a fixed-dose combination (FDC) of dutasteride and tamsulosin or watchful waiting (WW) and followed for 24 months. Patients in the WW group were escalated to tamsulosin if any follow-up International Prostate Symptom Score (IPSS) was equal or greater than the baseline value. Improvements in symptoms (change in IPSS) and quality of life [measured by BPH Impact Index (BII) and question 8 of the IPSS (IPSS-Q8)] were analysed in the FDC group, men who initiated tamsulosin (WW-TAM) and men who received no medical intervention (WW-no treatment) and the impact of baseline variables on IPSS determined.

The adjusted mean decrease in IPSS, BII and IPSS-Q8 at each post-baseline visit over 24 months appeared greater in the FDC (n = 369) and WW-no treatment groups (n = 144) than in the WW-TAM group (n = 229). IPSS improvements appeared similar in the FDC group and WW-no treatment subgroup, except in patients with the greatest degree of bother at baseline (BII 7-13).

BII at baseline may be a more relevant indicator than symptom severity as to whether a patient with moderate symptoms should receive medical therapy or not.

World journal of urology. 2016 Jun 22 [Epub ahead of print]

Claus G Roehrborn, Igor Oyarzabal Perez, Erik P M Roos, Nicolae Calomfirescu, Betsy Brotherton, Juan Manuel Palacios, Averyan Vasylyev, Michael J Manyak

Department of Urology, UT Southwestern Medical Center, 5323 Harry Hines Blvd, J8 142, Dallas, TX, 75390-9110, USA. ., Department of Urology, Mendaro Hospital, Mendaro, Gipuzkoa, Spain., Department of Urology, Antonius Hospital Sneek, Sneek, The Netherlands., Urology Clinic, Uroandromed, Bucharest, Romania., GlaxoSmithKline, Research Triangle Park, NC, USA., GlaxoSmithKline, Urology, Classic and Established Products, GlaxoSmithKline, Madrid, Spain., GlaxoSmithKline Pharmaceuticals, GlaxoSmithKline, Kiev, Ukraine., GlaxoSmithKline, Research Triangle Park, NC, USA.

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