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Treatment of Benign Prostatic Hyperplasia


Kevin L. Carter

Cincinnati—Benign prostatic hyperplasia (BPH) is the most common urological disorder in elderly men. There were an estimated 28.4 million patients with symptomatic BPH in the United States in 2010. As age increases, so does the prevalence of BPH; in men 31 to 40 years of age, it is 8%; 40% to 50% in men 51 to 60 years of age, and >80% in men 80 years of age and older. BPH is not a life-threatening condition, but its economic and human cost is significant. In 2005, direct and indirect private sector costs for the treatment of BPH were estimated to be $3.9 billion in the United States.

Depending on the severity of the condition, the 3 treatments for BPH are (1) watchful waiting, (2) oral drug therapy, or (3) surgery. The goals of these treatments are to alleviate lower urinary tract symptoms (LUTS) and prevent progression of the disease. Available therapies are limited by their efficacy, tolerability, or invasiveness. However, there are some promising minimally invasive therapies that are in the later stages of development.

Researchers discussed their analysis of the present state of the BPH treatment pathway during a poster session at the AMCP meeting. The poster was titled Benign Prostatic Hyperplasia: Treatment Utilization and Pathway Analysis. The objective of their analysis was to evaluate the treatment pathway after BPH diagnosis and to determine the population that will be stepping up from oral drug therapy to urologist-driven procedures.

For this study, a patient cohort was analyzed retrospectively using Thomson Reuters MarketScan® Commercial and Medicare claims databases. To be included, newly diagnosed adult (≥18 years of age) BPH patients had to have been continually enrolled in medical and drug insurance coverage plans both 12 months before and 24 months after the index date. Patients had to have either at least 2 outpatient or 2 inpatient BPH International Classification of Diseases, Ninth Revision (ICD-9) diagnosis codes between September 2007 and August 2011. Patients with prostate cancer ICD-9 diagnoses were excluded from the cohort. During the 24-month follow-up, observations for the following 3 treatment classes were analyzed: (1) alpha-adrenergic antagonists (AA), (2) 5-alpha reductase inhibitors (5ARI), and (3) procedures such as laser, standard surgery or minimally invasive treatments.

A total of 98,037 BPH patients were included in the analysis. During the 2-year follow-up period, 56,863 patients (58%) were treated with a drug or a procedure; 41,174 patients (42%) of patients received no therapy (watchful waiting), and 9,552 patients (10%) underwent at least 1 procedure. A total of 56,863 patients (58%) received 1 therapy, while 21,376 (21.8%) received 2 therapies and 2580 patients (2.6%) received 3 lines of therapy.

The most frequently observed first, second, and third lines of therapy were, respectively, AA (71.3%), 5ARI (57.7%), and procedures (70.2%). One of 4 patients discontinued oral drug therapy within 3 months of initiation, while 1 of every 2 patients discontinued oral drug therapy within 12 months of initiation. Of those patients treated by a urologist after 5ARI therapy, 6% saw the urologist between 12 and 18 months after initial diagnosis, and 4% saw the urologist 18 to 24 months after initial diagnosis.

The investigators said that a new, safe, and efficacious minimally invasive procedure would be very helpful for the sizeable population that will be transitioning from 5ARI oral therapy to surgery or other procedures.

This study was supported by Allergan, Inc.

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