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Rapid symptom improvement remains elusive for individuals treated for benign prostatic hyperplasia

April 29, 2025

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An analysis of real-world outcomes recorded for nearly 20,000 individuals treated for benign prostatic hyperplasia (BPH) showed that patients tend to experience less than expected improvement in symptoms in the first few months following surgical treatment or the initiation of pharmacotherapy for BPH. Claus Roehrborn, MD, Chair of the Department of Urology at UT Southwestern Medical Center, in Dallas, Texas, presented the findings at the 2025 Annual Meeting of the American Urological Association in Las Vegas, Nevada.

Roehrborn and colleagues analyzed data from unstructured electronic health records included in the American Urological Association Quality (AQUA) Registry to assess early symptom improvement after various treatments for BPH. The AQUA Registry is a national database that includes real-world data collected directly from electronic health record systems, which are used to help urologists improve diagnosis of various conditions and treatment outcomes. The researchers identified more than 1.1 million patients diagnosed with BPH between July 1, 2015 and July 31, 2023. Nearly 44,000 individuals with a diagnosis of BPH who were aged 40 years or older and had no previous treatments for BPH or prostate cancer were selected for the study. Of those, 19,642 received treatment for BPH during the study period and were included in the final analysis. International Prostate Symptom Scores (IPSS), which were available before and after treatment for all participants, showed that a vast majority of all treated patients (>75%) had moderate-to-severe symptoms before treatment.

Patients were grouped according to the first treatment they received after diagnosis. Pharmacotherapy, which included alpha blockers, 5-alpha reductase inhibitors, and PDE5 inhibitors, was the most common initial treatment for BPH. Surgical interventions included transurethral resection of the prostate (TURP), photoselective vaporization of the prostate (PVP), Aquablation, prostatic urethral lift (PUL), and Rezum water vapor therapy. The researchers analyzed changes in IPSS at 3 months after intervention across treatment types. Symptom severity was defined as mild (IPSS 0-7), moderate (IPSS 8-19), and severe (IPSS 20-35). After 3 months, there was a slight increase in moderate-to-severe symptoms in the pharmacotherapy group and a modest improvement in the surgical treatment group. Most patients still reported moderate symptoms, regardless of treatment modality. The analysis showed that, of all surgical therapies, PUL was associated with the greatest decrease in symptom severity in the immediate period following treatment.

“In this first-ever analysis of the AQUA database, we found less improvement than expected in IPSS after surgical therapies, and no improvement with drug therapy,” the authors said. “PUL appears to provide the most rapid symptom improvement at an early 3-month timepoint.”

The authors noted that the real-world data extracted from the AQUA Registry may differ from the findings of published studies. By providing a more accurate reflection of patient outcomes, this analysis can help clinicians and patients make informed decisions and design individualized plans for the treatment of BPH. 

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