Urology>>>>>Benign Prostatic Hyperplasia (BPH) and Lower Urinary Tract Symptoms (LUTS)
Question 9#

Which of the following are important predictors for clinical progression of BPH?

A. Age > 75
B. PSA > 1.3 ng/mL
C. Q_max < 12
D. Prostate volume > 40 g
E. Chronic inflammation of the prostate

Correct Answer is E

Comment:

Answer E

A number of risk factors have been identified which can help predict disease progression in individual patients. An increased chance of disease progression is associated with age >70, symptom severity (IPSS > 7), reduced urinary flow rate (Q_max <10 mL/sec) and prostate size (>30 cc). Data from placebo arms of large drug trials has shown that PSA is an independent marker of disease progression. A PSA level of 1.4 ng/dL or higher indicates an increased risk of disease progression (McConnell et al., 2003).

The Olmsted County study measured the prevalence of symptoms of BPH in men aged 40–80. An average AUA symptom score deterioration of 0.18/yr was observed across the study with the fastest rate of deterioration observed in the 60–69 age group. Age greater than 70 is associated with a significant increase in risk of progression (Jacobsen et al., 1997).

Inflammation also appears to be important in the pathogenesis and progression of BPH. The risk of urinary retention has been found to be significantly greater in men with acute and/or chronic intraprostatic inflammation (ACI) than in those without.