[Factors determining treatment strategies for patients with benign prostatic hyperplasia. The DUO study]

The DUO study sought to identify the factors determining diagnostic and treatment strategies for benign prostatic hyperplasia (BPH) in daily practice.

Observational study conducted in France (from June 2004 through March 2005) among a representative sample of French urologists.

Two hundred two urologists included 1027 BPH patients (mean age: 68 years +/-9), 856 of whom were seen again six months later. The mean International Prostatic Symptom Score (IPSS) was 14.9 (+/-6.7) at inclusion and 10.5 (+/-6.7) at the follow-up visit. At inclusion, pharmacologic treatment was prescribed to 84% of patients, surgery was recommended to 13% and no treatment to 3%. Factors favoring surgery (versus drugs) were BPH severity (OR=2.5 for IPSS>or=20), patient choice (OR=2.5), expected quality of life improvement (OR=2.2), post-void residual (OR=2.1) and dribbling (OR=1.6). This choice was not associated with patient age, prostatic volume or active sex life. Choice of a 5alpha reductase inhibitor (versus alpha-blocker) was associated with large prostatic volume (OR=7.6), PSA results (OR=5.8), and patient age (OR=5.5 for >or=74 years, OR=2.1 for >or=68 years). Prescription of a combination of alpha-blocker plus 5alpha-reductase inhibitor (versus alpha-blocker alone) was associated with severity of BPH (OR=7.9), prostatic volume (OR=7.8), prevention of complications (OR=3.1), patient age (OR=3.0 if >or=74 years) and post-void residual (OR=2.3).

Both medical and surgical treatment of BPH resulted in improved IPSS scores at 6 months. Patient age and prostatic volume are reasons urologists prescribe 5alpha reductase inhibitors, but they do not affect the decision about surgical treatment. Surgery is performed in severe BPH or when patients choose surgery in the expectation of improving their quality of life. The factors determining treatment strategies identified in this study are patient age, BPH severity, prostatic volume, patients' wishes, PSA results and post-void residual.