Research Finds Surgery Outperforms Drug Therapy in Treatment of Benign Prostatic Hyperplasia

SAN FRANCISCO–(BUSINESS WIRE)–A 17-year-long community study looking at symptoms of enlarged prostate

in over 2,000 men age 40 to 79 years suggests that surgery for benign

prostatic hyperplasia (http://www.mayoclinic.org/bph/)

(BPH) offers more relief from incontinence and obstruction symptoms than

treatment from drug-based therapy, according to a new study by

researchers at Mayo Clinic. The researchers presented their results

today at the annual meeting of the American

Urological Association (http://www.auanet.org/content/homepage/homepage.cfm).

Candidiasis

Overall, results show:

  • Urinary incontinence was a common condition, coexisting with BPH/lower

    urinary tract symptoms.

  • In the community setting, patients with the highest symptom scores

    were most likely to receive surgical intervention.

  • Symptoms stabilized and did not get worse after treatment of all kinds.

  • Patients who underwent transurethral resection of the prostate (TURP)

    had the greatest decrease in both symptoms and incontinence compared

    to other treatment groups. Pre-TURP the incontinence rate was 64.5

    percent and post-TURP it was 41.9 percent.

Significance
The findings provide large-sample, long-term data

comparing the effectiveness of medical versus surgical treatments in a

large, general population, as compared to small, select clinical

populations of men. “Our data fills a gap in the research record that

can be used by physicians and patients to evaluate management options,”

says Amy

Krambeck, M.D. (http://www.mayoclinic.org/bio/13877739.html),

Mayo Clinic urologist and lead study investigator. “Because it’s a large

community-based study of more than 2,100 men, it includes the entire

broad range of male health. This suggests the results are stronger in

terms of being generalized and applied to other men.”

Background
BPH and lower urinary tract symptoms, such as frequent

urge to urinate or leakage, are common. By age 60, an estimated 50

percent of all men suffer from enlarged prostate symptoms; by age 90,

about 80 percent do. Multiple treatments exist. But data comparing drug

therapy to surgery are lacking, making clinical decisions vulnerable to

subjective factors.

About the Study
From 1990 through 2007, the study enrolled 2,184

healthy men, age 40-79, living in Olmsted County, Minn., All

participants completed surveys every other year about their urinary

symptoms and the treatments they received. From this information, the

investigators examined urinary problems and incontinence before and

after different types of treatment.

Results showed that of the 2,184 men:

  • 1,574 (72%) received no treatment for BPH symptoms.

  • 307 (14%) took alpha adrenergic receptor blockers (α-ARs).

  • 195 (9%) took the medication 5-alpha-reductase inhibitors (ARIs).

  • 23 (1%) received surgical laser vaporization.

  • 85 (4%) received surgical transurethral resection of the prostate

    (TURP).

Comments Dr. Krambeck: “After intervention, the greatest improvement in

symptom score was seen in the TURP group, followed by laser

vaporization, then the drugs, 5 alpha reductase inhibitors and alpha

adrenergic receptor blockers. Only the surgical TURP group reported a

decrease in incontinence — pre-TURP the incontinence rate was 64.5

percent and post-TURP it was 41.9 percent.” This reduction in

incontinence rates is significant when compared to the increase in

reported incontinence in the patients receiving both forms of medical

therapy and no change in symptoms for patients receiving laser

vaporization.

Collaboration and Support
In addition to Dr. Krambeck, other

investigators are Debra Jacobson; Michaela McGree; Deborah

Lightner, M.D. (http://www.mayoclinic.org/bio/12412414.html);

Michael

Lieber, M.D. (http://www.mayoclinic.org/bio/10203567.html);

Steven Jacobsen, M.D.; Jennifer St. Sauver, Ph.D. Their work was funded

by the Mayo Foundation for Medical Education and Research and National

Institutes of Health.

To request an appointment at Mayo Clinic, please call 480-422-1490 for

the Arizona campus, 904-494-6484 for the Florida campus, or 507-216-4573

for the Minnesota campus.

About Mayo Clinic
For more than 100 years, millions of people from

all walks of life have found answers at Mayo Clinic. These patients tell

us they leave Mayo Clinic with peace of mind knowing they received care

from the world’s leading experts. Mayo Clinic is the first and largest

integrated, not-for-profit group practice in the world. At Mayo Clinic,

a team of specialists is assembled to take the time to listen,

understand and care for patients’ health issues and concerns. These

teams draw from more than 3,700 physicians and scientists and 50,100

allied staff that work at Mayo Clinic’s campuses in Minnesota, Florida,

and Arizona; and community-based providers in more than 70 locations in

southern Minnesota., western Wisconsin and northeast Iowa. These

locations treat more than half a million people each year. To best serve

patients, Mayo Clinic works with many insurance companies, does not

require a physician referral in most cases and is an in-network provider

for millions of people. To obtain the latest news releases from Mayo

Clinic, go to www.mayoclinic.org/news.

For information about research and education visit www.mayo.edu.

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