Page 8 - Canadian Urological Association guideline on male lower urinary tract symptoms/benign prostatic hyperplasia (MLUTS/BPH): 2018 update

Nickel et al

BPH-related bleeding: A complete assessment, including References
history and physical examination, urinalysis (routine micros-
copy, culture and sensitivity, cytology), upper tract radiologi- 1. Nickel JC, Mendez-Probst CE, Whelan TF, et al. 2010 update: Guidelines for the management of benign
cal assessment and cystoscopy, is necessary to exclude other prostatic hyperplasia. Can Urol Assoc J 2010;4:308-14. https://doi.org/10.5489/cuaj.10124
sources of bleeding. Finasteride has been reported to reduce 2. McVary KT, Roehrborn CG, Avins AL, et al. American Urological Association guideline: Management of
benign prostatic hyperplasia (BPH). Published 2010; reviewed and validity confirmed 2014. Available at
the risk of recurrent BPH-related hematuria. 86 http://www.auanet.org/guidelines/benign-prostatic-hyperplasia-(2010-reviewed-and-validity-
We suggest that a trial with a 5ARI is appropriate in men confirmed-2014). Accessed Aug. 28, 2018.
with BPH-related hematuria (conditional recommendation 3. Gratzke C, Bachmann A, Descazeaud A, et al. EAU guidelines on the assessment of non-neurogenic male
based on low-quality evidence). lower urinary tract symptoms including benign prostatic obstruction. Eur Urol 2015;67:1099-1109.
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BPH patients with prostate cancer concern: The BPH 4. GRADE Guidelines 15. Available at http://www.gradeworkinggroup.org/. Accessed Aug. 28, 2018.
patient with an elevated serum PSA and negative prostate 5. Abrams P, Cardozo L, Wagg A, et al. Incontinence. 6th International Consultation on Incontinence, Tokyo,
biopsy may be counselled on the potential benefits of 5ARI September 2016, ICUD, 6th edition 2017
therapy (finasteride, dutasteride) for prostate cancer detec- 6. Nickel JC, Saad J. The American Urological Association 2003 guidelines on management of benign prostatic
tion risk reduction. 87,88 The patient must be aware of the hyperplasia: A Canadian opinion. Can J Urol 2004;11:2186-93.
possible low absolute increased risk (0.5–0.7%) in incidence 7. Ramsey EW, Elhilali M, Goldenberg GS, et al for the Canadian Prostate Health Council. Practice patterns
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of high-grade (Gleason 8–10) cancer with 5ARI use. Most https://doi.org/10.1016/S0022-5347(05)67911-6
experts believe this phenomenon was observed due to an 8. Cockett ATK, Aso Y, Denis L, et al. Recommendations of the International Consensus Committee concern-
artifact of prostate glandular cytoreduction, induced by the ing: 1. Prostate symptom score (I-PSS) and quality of life assessment, 2. Diagnostic workup of patients
5ARI, and it appears there is no demonstrable increase in presenting with symptoms suggestive of prostatism, 3. Patients evaluation for research studies, and 4. BPH
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experience a rising PSA 6–12 months after PSA nadir is 9. Barry MJ, Fowler FJ Jr, O’Leary MP, et al. The American Urological Association symptom index for
reached should be assessed for the possibility of high-grade benign prostatic hyperplasia. The Measurement Committee of the American Urological Association. J Urol
prostate cancer. 90 1992;148:1549-57. https://doi.org/10.1016/S0022-5347(17)36966-5
We recommend case-to-case patient-specific informed 10. Robertson C, Link CL, Onel E, et al. The impact of lower urinary tract symptoms and comorbidities on quality
discussion and close PSA followup, as indicated in men on of life: The BACH and UREPIK studies. BJU Int 2007;99:347-54. https://doi.org/10.1111/j.1464-
410X.2007.06609.x
5ARI therapy treatment for BPH (moderate recommenda- 11. O’Leary MP, Wei JT, Roehrborn CG, et al. BPH registry and patient survey steering committee. Correlation
tion based on high-quality evidence). of the international prostate symptom score bother question with the benign prostatic hyperplasia impact
index in a clinical practice setting. BJU Int 2008;101:1531-5. https://doi.org/10.1111/j.1464-
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Summary 12. Levitt JM, Slawin KM. PSA and PSA derivatives as predictors of BPH progression. Curr Urol Rep 2007;
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MLUTS secondary to BPH remains one of the most com- 13. Rendon RA, Mason RJ, Marzouk K, et al. Canadian Urological Association recommendations on pros-
mon age-related disorders afflicting men. As the aging of the tate screening and early diagnosis. Can Urol Assoc J 2017; 11:298-309. https://doi.org/10.5489/
Canadian population continues, more men will be seeking cuaj.4888
advice and looking for guidance from their healthcare pro- 14. Lukacs B, Grange JC, Comet D. One-year followup of 2829 patients with moderate to severe lower urinary
viders on the management of their symptoms. The informa- tract symptoms treated with alfuzosin in general practice according to IPSS and a health-related quality-of-
life questionnaire. BPM Group in General Practice. Urology 2000;55:540-6. https://doi.org/10.1016/
tion offered in this guideline document, based on consensus S0090-4295(99)00539-7
evaluation of the best available evidence, will aid Canadian 15. Tsukamoto T, Masumori N, Rahman M, et al. Change in international prostate symptom score, prostate-
urologists as they strive to provide state-of-the-art care to specific antigen and prostate volume in patients with benign prostatic hyperplasia followed longitudinally.
their patients. Int J Urol 2007;14:321-4. https://doi.org/10.1111/j.1442-2042.2007.01596.x
16. Chapple CR. Alpha-adrenoreceptor antagonist in the year 2000: Is there anything new? Curr Opin Urol
2001;11:9-16. https://doi.org/10.1097/00042307-200101000-00002
Competing interests: Dr. Nickel has been a consultant for Astellas, Auxillium, Eli Lilly, Farr Labs, 17. Marberger M, Harkawa R, de la Rosette J. Optimizing the medical management of benign prostatic
Ferring, GSK, Pfizer, Redleaf Pharma, Taris Biomedical, Tribute, and Trillium Therapeutics; a hyperplasia. Eur Urol 2004;45:411-9. https://doi.org/10.1016/j.eururo.2003.10.016
lecturer for Astellas and Eli Lilly; and has participated in clinical trials supported by Eli Lilly, GSK, 18. Bozlu M, Ulusoy E, Cayan S, et al. A comparison of four different alpha 1-blockers in benign pros-A comparison of four different alpha 1-blockers in benign pros-
J&J, Pfizer, and Taris Biomedical. Dr. Aaron has attended advisory boards for AbbVie and Janssen; tatic hyperplasia patients with and without diabetes. Scand J Urol Nephrol 2004;38:391-5.
has been a speaker for Ferring and Janssen; holds investments in Johnson & Johnson; and has https://doi.org/10.1080/00365590410015678
participated in clinical trials supported by Asetllas, Ferring, and Janssen. Dr. Elterman has attended 19. Kirby RS. A randomized, double-blind crossover study of tamsulosin and controlled-release doxazosin in
advisory boards for, is a speaker for, and has received grant funding from Allergan, Astellas, patients with benign prostatic hyperplasia. BJU Int 2003;91:41-4. https://doi.org/10.1046/j.1464-
Boston Scientific, Ferring, Medtronic, and Pfizer; and has participated in clinical trials supported by 410X.2003.03077.x
Astellas and Medtronic. Dr. Zorn has received honoraria from Boston Scientific and as a proctor/ 20. de Reijke TM, Klarskov P. Comparative efficacy of two alpha adrenoreceptor antagonists, doxazosin
lecturer for Greenlight; and participated in the WATER2 clinical trial with aquablation supported by and alfuzosin, in patients with lower urinary tract symptoms from benign prostatic enlargement. BJU Int
2004;93:757-62. https://doi.org/10.1111/j.1464-410X.2003.04720.x
Procept Biorobotics. The remaining authors report no competing personal or financial interests. 21. Takmaz T, Can I. Clinical features, complications, and incidence of intraoperative floppy iris syndrome in patients
taking tamsulosin. Eur J Ophthalmol 2007;17:909-13. https://doi.org/10.1177/112067210701700607
This paper has been peer-reviewed. 22. Hutchison A, Farmer R, Verhamme K, et al. The efficacy of drugs for the treatment of LUTS/BPH, a study
in 6 European countries. Eur Urol 2007;51:207-15. https://doi.org/10.1016/j.eururo.2006.06.012

310 CUAJ • October 2018 • Volume 12, Issue 10