[Screening of clinical benign prostatic hypertrophy in general practice: survey of 18,540 men]

Urinary symptoms, mainly attributed to benign prostatic hyperplasia (BPH), are frequent in men over the age of 50, but their prevalence appears to be largely underestimated, as patients fail to report this complaint. We therefore tried to identify the reasons for failure to seek medical attention by symptomatic but undiagnosed patients and to evaluate the management of these patients by general practitioners.

This cross-sectional, prospective, multicentre epidemiological survey studied patients over the age of 50 without a diagnosis of BPH and not spontaneously reporting any urological symptoms. A clinical interview was systematically performed in order to identify such symptoms and the reasons why the patient did not complain of these symptoms. The management by general practitioners was then analysed, including appropriate clinical and complementary examinations to attribute the symptoms to BPH.

18,540 outpatients were recruited by 2,200 general practitioners. The prevalence of "confirmed BPH" (diagnosis established at the visit and I-PSS > or = 8, Bother score (I-PSS-Q) > or = 3) was 49.4%. These patients (mean age: 66 years) had suffered from urinary symptoms for almost 3 years; 70.1% of them reported to be at least "mostly dissatisfied" if they were to spend the rest of their life with these urinary symptoms. The mean I-PSS was 14.1 and 86.7% of patients were considered to be moderately symptomatic. The I-PSS increased with age (p = 0.001) and the history of symptoms (p = 0.001). The I-PSS-Q increased in parallel with the I-PSS (p = 0.0001). The main reasons for not consulting were "a problem considered to be common at this age" (69.8%) and "fear of surgery" (47.7%). Following a clinical diagnosis of BPH, 93% of patients underwent complementary diagnostic investigations and 33.5% of them were referred to a urologist. A treatment decision (medical treatment in 83.5% of cases) was taken in 85.9% of cases, especially in older patients (p = 0.001) with higher I-PSS scores (p = 0.001).

This epidemiological survey confirmed the difficulties of detection of BPH in general practice, as patients did not report any specific symptoms despite increasing discomfort. Management of the disease by general practitioners, following the diagnosis. complied with generally accepted clinical guidelines.