ArticleBMC urology2025
Management of patients with lower urinary tract symptoms due to benign prostatic enlargement at risk of progression treated with 5-alpha-reductase inhibitors: examining real-world clinical practice in Spain and Brazil.
Article in BMC urology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundFor patients with lower urinary tract symptoms due to benign prostatic enlargement (LUTS/BPE), assessing patient risk of disease progression is important to determine if treatment with 5-alpha-reductase inhibitors (5ARIs) is warranted. Clinical trials and guidelines have identified risk factors for disease progression, which affects subsequent treatment decision making; however, real-world clinical practices may differ. This non-interventional, cross-sectional study examined the management of patients with LUTS/BPE at risk of disease progression receiving 5ARIs by urologists from Spain and Brazil.
methodsUrologists were randomly recruited and completed an online questionnaire comprising multiple-choice, open-ended ranking and rating questions on their clinical approach in patients with LUTS/BPE receiving 5ARIs. Urologists also provided patient record forms for two recent patients treated with 5ARIs.
resultsIn Spain and Brazil (n = 100 each), 66% and 75% of urologists, respectively, assessed patients for their risk of LUTS/BPE progression. The most frequent parameters used to assess risk of progression were: post-void residual volume (PVR: 79% Spain, 83% Brazil), prostate volume (PV: 78% Spain, 82% Brazil), and International Prostate Symptom Score (IPSS: 79% Spain, 79% Brazil). These were also the most frequent parameters considered before initiating 5ARIs: PVR (60% Spain, 78% Brazil); PV (87% Spain, 89% Brazil); and IPSS (66% Spain, 61% Brazil). Thresholds used to assess risk factors of disease progression were generally higher than recommended by clinical guidelines. Reasons for initiating 5ARIs included: to achieve sustained symptom relief (70% Spain, 71% Brazil) and reduce the risk of progression (63% Spain, 66% Brazil). Impact on sexual function was a barrier to 5ARI initiation (46% Spain, 67% Brazil).
conclusionsMost urologists in Spain and Brazil recognized the benefits of assessing the risk of disease progression in patients with LUTS/BPE. Many urologists reported assessing fewer risk factors and using higher thresholds than recommended by international guidelines, highlighting the need for ongoing medical education.
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