Prognostic role of prostate-specific antigen and prostate volume for the risk of invasive therapy in patients with benign prostatic hyperplasia initially managed with alpha1-blockers and watchful waiting

Abstract Objectives To investigate the prognostic role of prostate-specific antigen (PSA) level and prostate volume (PV) for the need for benign prostatic hyperplasia (BPH)-related invasive therapy among patients initially treated with an alpha 1 -blocker or watchful waiting (WW) in real-life clinical practice. Methods Data were collected from 2264 consecutive patients with clinical BPH. Patients initially treated with an alpha 1 -blocker or WW were included in this study. They were stratified by baseline PSA level (less than 1.5, 1.5 to less than 3.0, 3.0 to 10.0 ng/mL) and PV (less than 30 and 30 to 200 cm 3 ), and analyzed for the time to BPH-related invasive therapy. Results Of the 2264 patients, 389 treated with alpha 1 -blockers and 553 who chose WW were included. Across the PSA and PV strata, the alpha 1 -blocker group had worse symptoms, peak flow, postvoid residual urine volumes, and obstruction than did the WW group. Increasing PSA levels produced an increase in the 5-year cumulative risk of invasive treatment: 20%, 34%, and 44% in the alpha 1 -blocker and 8%, 9%, and 15% in the WW group for a PSA level of less than 1.5, 1.5 to less than 3.0, and 3.0 to 10.0 ng/mL, respectively. The hazard ratio for the highest compared with the lowest PSA strata was 2.8 for alpha 1 -blocker and 2.7 for WW patients. An increasing PV increased the 5-year cumulative risk from 21% to 35% in the alpha 1 -blocker group and 8% to 11% in the WW group. The hazard ratio for the large versus small prostates in the alpha 1 -blocker group was 1.8 and in the WW group was 1.0. Conclusions A higher PSA level and larger PV resulted in a greater risk of BPH-related invasive therapy that was more pronounced in the alpha 1 -blocker than in the WW patients. However, symptom severity, flow parameters, and obstruction grade may have contributed to the difference in risk between the two treatment groups.