An analysis of the two-year CONDUCT study found that people with moderate benign prostatic hyperplasia (BPH), at risk of progression, benefit equally from suggested lifestyle changes whether they are simply put on watchful waiting or on drug therapy. The findings support a conservative approach to disease management, and indicate that a patient’s perceptions of life quality may be as good a judge of the need for treatment as measures of disease symptoms.
The research paper, “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,” was published in the World Journal of Urology.
CONDUCT looked at improvements in BPH symptoms and life quality among patients at risk of progression who either received treatment with a fixed-dose combination (FDC) of dutasteride and tamsulosin, or were managed using watchful waiting, the monitoring of symptom deterioration. All patients were advised as to beneficial lifestyle changes for their disease, like reducing the amount of caffeinated drinks or alcohol they consume. Patients under watchful waiting were moved to tamsulosin monotherapy if their symptoms began to worsen.
The results, previously published in BJU International, indicated that over one-third of the men in the watchful waiting group showed improvement in BPH symptoms without the start of drug therapy. Improvements were measured through changes in International Prostate Symptom Score (IPSS), while quality of life was measured by BPH Impact Index (BII), a questionnaire developed by the American Urological Association that assesses the impact of BPH symptoms in everyday life, and by question 8 of the IPSS (a quality of life question).
Results indicated that improvements in symptoms (IPSS) and life quality over 24 months appeared greater in both treated patients and those on watchful waiting, than were found in patients who moved from waiting to tamsulosin. Moreover, IPSS improvements seemed similar in both these groups (treatment and watchful waiting), except for those patients who reported being considerably bothered by their symptoms at the study’s start (BII 7–13). Such observations may be useful in choosing patient care and in future research.
“The results of CONDUCT support guidelines that recommend conservative management for men with mild symptoms and those who are not bothered by moderate symptoms, and suggest that using BII to further refine the selection of patients with moderate symptoms may provide a pathway to preventing the suboptimal management of BPH,” the researchers concluded.