Identification of baseline clinical factors which predict medical treatment failure of benign prostatic hyperplasia: An observational cohort study

Objective: The aim of this study was to identify the clinical baseline factors that affect the long-term treatment failure of benign prostatic hyperplasia (BPH). Methods: 437 men over 50 years of age with BPH were enrolled for this analysis. Patients were allocated to a medication and a surgical treatment (following medication) group. We initially examined the International Prostatic Symptom Score (IPSS), uroflow rate, prostate volume, postvoid residual volume, and the serum prostate specific antigen level as clinical baseline factors and analyzed differences between the two groups. Results: 337 patients (77.1%) were given maintenance medical treatment during follow-up, and 100 patients (22.9%) had surgical treatment following medication. Statistically significant differences were found in IPSS and prostate volume between the surgical and medication groups (IPSS: 22.6 ± 6.4 vs. 18.7 ± 5.8, prostate volume (cm³): 36.3 ± 14.4 vs. 30.1 ± 11.0, respectively). According to the ROC curve-based prediction of the failure for medical therapy, the best cutoff values of IPSS and prostate volume were 21 (area under ROC curve: 0.67) and 32 cm³ (area under ROC curve: 0.65), respectively. Conclusions: The results show that BPH patients with more severe IPSS and larger prostate volume have a higher risk of medical treatment failure, and suggest that the IPSS and prostate volume may be useful predictors of medical treatment maintenance.