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Can men with prostates sized 80 mL or larger be managed conservatively?
Alvin Lee1, Han Jie Lee1, Keong Tatt Foo1
1Department of Urology, Singapore General Hospital, Singapore.
Investigative and Clinical Urology
|September 5, 2017
Summary
Conservative management with medication is viable for men with large prostates (≥80 mL), despite a high rate of clinical progression. Long-term outcomes show improvements in PSA, QoL, and reduced residual urine with this approach.
Area of Science:
- Urology
- Andrology
- Clinical Outcomes Research
Background:
- Large prostate size (≥80 mL) poses challenges in management.
- Conservative approaches are often considered for benign prostatic hyperplasia (BPH).
Purpose of the Study:
- To evaluate the long-term clinical outcomes of men with large prostates (≥80 mL) managed conservatively.
- To assess the efficacy of pharmacotherapy in this patient group.
Main Methods:
- Retrospective analysis of 50 men with prostate size ≥80 mL.
- Evaluation of clinical parameters including IPSS, QoL, PSA, uroflowmetry, and ultrasound.
- Comparison of parameters at baseline and latest follow-up (median 62 months).
Main Results:
- Median prostate volume was 94 mL; 43 men received conservative management (98% pharmacotherapy).
- Significant reductions observed in serum PSA, QoL scores, and postvoid residual urine.
- 33% experienced clinical progression (retention or symptomatic deterioration).
- Of those on conservative treatment, 69% maintained favorable outcomes (peak flow ≥10 mL/s, QoL ≤3, mild-moderate IPSS).
Conclusions:
- Conservative management, primarily pharmacotherapy, has a role in men with large prostates despite high progression rates.
- Careful monitoring is essential for patients with large prostates undergoing conservative treatment.
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