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Benign but Burdensome: Complications and Management of Benign Prostatic Hyperplasia during Active Surveillance in a Large Cohort
Ashley Monaco, DO1, Sara S. Koh, BS1, Andrew Guo, BS1, Rebekka Garcia, MPH2, Taryn Ellis, MD2, Stephen Palasi, MD1, Tarek Lawen, MD2, Rodrigo Donalisio da Silva, MD1, Justin Gregg, MD2.
1McGovern Medical School, Houston, TX, USA, 2MD Anderson Cancer Center, Houston, TX, USA.
BACKGROUND: Men on active surveillance (AS) for prostate cancer commonly develop age-related urologic conditions, including lower urinary tract symptoms (LUTS) from benign prostatic hyperplasia (BPH), yet management of BPH in this population is poorly defined. We evaluated the prevalence of BPH interventions, incidence of BPH-related complications, and subsequent management among men on AS.
METHODS: An AS cohort database was reviewed. Men with <6 months of follow-up or missing key data were excluded. Baseline demographics, LUTS medication use, and prior BPH surgery were included. Outcomes included LUTS interventions during AS (pharmacologic/surgical) and BPH-related complications (acute urinary retention, bladder stones, prostatic bleeding, or recurrent urinary tract infections). Multivariable logistic regression was used to identify factors associated with complications. Time to first LUTS intervention was analyzed using Kaplan-Meier methods with cumulative incidence curves by prostate volume quartile. Differences in cumulative incidence across quartiles were assessed using log-rank test for trend.
RESULTS: A total of 744 men (median age 64 [58-69] years) were included. Prior to AS, 179 men (24%) had received LUTS treatment. During AS, 278 men (38%) underwent LUTS intervention. Men in the highest prostate volume quartiles experienced earlier and more frequent LUTS interventions compared to those with smaller prostates (log rank test for trend p<0.001). Ninety-nine men (13%) experienced a BPH-related complication. Larger prostate volume was independently associated with increased odds of complications (OR 1.03 per cc, 95% CI 1.02–1.04, p<0.001). Among men with complications, 17 (17.7%) underwent BPH surgery. Four men discontinued AS and pursued radical prostatectomy primarily due to uncontrolled LUTS.
CONCLUSIONS: BPH-related complications are common among men on AS, yet definitive surgical management is infrequently pursued even after complications. Larger prostate volume identifies patients at increased risk. These findings highlight the need for systematic assessment and evidence-based management of LUTS/BPH in the AS population.
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