A Spanish multicenter study revealed that improvement in symptoms and quality of life of benign prostatic hyperplasia (BPH) patients in a real-life setting was equal across all investigated treatments, except for patients on watchful waiting.
The study, titled “Quality of life in patients with lower urinary tract symptoms associated with BPH: change over time in real‑life practice according to treatment—the QUALIPROST study,” published in the journal International Urology and Nephrology, analyzed a total of 1,713 patients across 11 clinics. Most of the patients, 70.3 percent, received monotherapy while 20.8 percent received combination therapy and 8.9 percent were in watchful waiting.
Treatments were grouped into alpha-blockers, 5-alpha-reductase inhibitors (5-ARI), phytotherapy or other. The most commonly prescribed alpha-blocker was Tamsulosin, which accounted for 88.7 percent of all alpha-blockers. Dutasteride was the most common 5-ARI (53.2 percent), and hexanic extract of S. repens the most common phytotherapy (95.2 percent). Patients generally reported good adherence to treatment.
The research team measured symptoms using the International Prostate Symptom Score (IPSS) and quality of life using the Benign Prostatic Hyperplasia Impact Index. All patients receiving treatment improved, with no difference in the level of improvement between monotherapies, but patients on watchful waiting did not experience lessened symptoms or improved quality of life to a large degree.
Patients receiving combination therapy had more symptoms at treatment initiation but also improved the most when receiving treatment. There was, however, no difference between the patients receiving different combinations. Moreover, the team noticed that changes in symptoms and quality of life scores were tightly linked for all patient groups.
Patients receiving alpha-blockers reported the most adverse effects – 16.3 percent – and patients receiving phytotherapy with hexanic extract of Serenoa repens experienced the least, with only 0.8 percent. The most frequent adverse effect reported was erectile dysfunction and reduced libido. Interestingly, S. repens extract was found to be as efficient in improving symptoms as all other monotherapies investigated – a finding that differs from earlier reports.
The authors hope that the study can add to the accumulated evidence considering treatment options, and help both clinicians and patients to make informed decisions about treatment options.