Purpose
To examine diagnostic tests and treatment patterns in men with new onset benign prostatic hyperplasia (BPH) using consolidated national electronic health record (EHR) data
Materials and Methods
The Humedica® EHR database consists of de-identified patient records from approximately 25 million patients in the US. Using this database, men with a new BPH diagnosis (benign prostatic hyperplasia, bladder neck obstruction, urinary retention, incomplete bladder emptying) between 7/1/2009 and 6/30/2012 were included. Exclusion criteria included conditions such as genitourinary cancers, radiation cystitis, neurogenic bladder, and urologic pain diagnoses. Diagnostic tests and treatments were summarized and stratified by age (<65 vs 65+) and serum prostate-specific antigen (PSA) level.
Results
A total of 38,252 men met inclusion criteria. Mean follow-up was 1020 days. Serum creatinine (92%), serum PSA (76%) and urinalysis (52%) were the most common tests. Invasive testing was obtained in <20% of patients. Treatments included watchful waiting in 40%, pharmacologic therapy in 59.4%, and surgery in 2.2%. Alpha-blockers were prescribed in 50.7% of men. Men over the age of 65 and with higher PSA levels were less likely to be managed with watchful waiting. Therapy with a 5-alpha reductase inhibitor (5-ARI) was prescribed in 23-29% of men across all PSA categories.
Conclusions
The majority of clinical care for new-onset BPH was in concordance with guideline recommendations. Based on PSA values, 5-ARI therapy was under-utilized in men with large prostates, and was over-utilized in men with small prostates.
Key Words
List of Abbreviations
Supported by the American Urological Association Data Committee.
This research was conducted on behalf of AUA Data Committee and Pfizer Inc. Mutual collaboration without any transfer of funds was carried out to better understand patterns of male LUTS care.
