Prognostic role of prostate-specific antigen and prostate volume for the risk of invasive therapy in patients with benign prostatic hyperplasia initially managed with alpha(1)-blockers and watchful waiting

Objectives. To investigate the prognostic role of prostate-specific antigen (PSA) level and prostate volume (PV) for the need for benign prostatic hyperplasia (BPH)-related invasive therapy among patients initially treated with an alpha(1)-blocker or watchful waiting (WW) in real-life clinical practice. Methods. Data were collected from 2264 consecutive patients with clinical BPH. Patients initially treated with an alpha(1)-blocker or WW were included in this study. They were stratified by baseline PSA level (less than 1.5, 1.5 to less than 3.0, 3.0 to 10.0 ng/mL) and PV (less than 30 and 30 to 200 cm(3)), and analyzed for the time to BPH-related invasive therapy. Results. Of the 2264 patients, 389 treated with alpha(1)-blockers and 553 who chose WW were included. Across the PSA and PV strata, the alpha(1)-blocker group had worse symptoms, peak flow, postvoid residual urine volumes, and obstruction than did the WW group. Increasing PSA levels produced an increase in the 5-year cumulative risk of invasive treatment: 20%, 34%, and 44% in the alpha(1)-blocker and 8%, 9%, and 15% in the WW group for a PSA level of less than 1.5, 1.5 to less than 3.0, and 3.0 to 10.0 ng/mL, respectively. The hazard ratio for the highest compared with the lowest PSA strata was 2.8 for alpha,blocker and 2.7 for WW patients. An increasing PV increased the 5-year cumulative risk from 21% to 35% in the alpha(1)-blocker group and 8% to 11% in the WW group. The hazard ratio for the large versus small prostates in the alpha(1)-blocker group was 1.8 and in the WW group was 1.0. Conclusions. A higher PSA level and larger PV resulted in a greater risk of BPH-related invasive therapy that was more pronounced in the alpha(1)-blocker than in the WW patients. However, symptom severity, flow parameters, and obstruction grade may have contributed to the difference in risk between the two treatment groups. (C) 2005 Elsevier In