Benign Prostate Disease
Robert F. Donnell, MD, Associate Professor of Urology
The approach to benign prostate disease has evolved significantly since most of us completed training. This year, the latest update to the American Urologic Association (AUA) guidelines for benign prostate hyperplasia (BPH) was published, concluding almost three years of intense evaluation of the literature. The AUA guidelines panel, under the guidance of the AUA board of directors, employed new techniques that ranked publications for their quality of study methods, as well as data reported. I was asked to serve on the committee, where I worked with thought leaders from around the country interested in benign diseases of the prostate. We were dedicated to publishing guidelines based on robust information all practitioners could use in daily practice. As a result of this effort, I believe you will now find it easier to identify recommendations based on level 1, level 2 and level 3 data. Further, the committee spent many hours carefully crafting the document to retool the thought processes of those who see and evaluate BPH. It is clear that not all men with enlarged prostates have symptoms and not all men with symptoms have enlarged prostates. There is now a strong focus on lower urinary tract symptoms (LUTS) to increase awareness that not all symptoms in the aging male are necessarily from a prostatic origin.
The committee universally agreed that the term benign prostate hyperplasia is a histology term and efforts to correctly use terminology would help better classify patients and help better direct therapies. In our effort to move to LUTS, it is believed we will increase awareness of non- prostate etiologies and the complexities of treating men who have voiding complaints. Disease management options were updated to include new data-driven treatment options, while therapies that are no longer commercially available were omitted. Similar to previous guidelines, no one therapy was mandated and the treatment algorithm based on absolute/relative indicators still remains a valuable tool when counseling a patient about treatment options. I hope you will find the new AUA guidelines valuable.
This year will also see the publication of our work as a member of the National Institutes of Health (NIH) steering committee for minimally invasive therapies. When we first wrote the NIH research outline, we were intrigued by this historical observation: it is rare that spinal cord injury patients develop histologic BPH. The article, which will be published in the September issue of Journal of Urology, highlighted successful outcomes when the neurotoxin botulinum toxin serotype A was injected into the prostate. In a double blind, multicenter randomized trial, botulinum injection into the prostate using office-based ultrasound guidance was safe, typically required 10 minutes to complete under a local anesthetic and was durable for the typical man for eight to 18 months. Interestingly, men also reported improved sexual function, although the etiology for this is unclear. Following the success of the NIH trial, a commercially sponsored multinational trial is under way. This larger study will provide valuable insight into the use of this new agent. We are honored that The Medical College of Wisconsin Department of Urology is a continued leader in this intriguing research. If you are interested in learning more about this research for one of your patients, please feel free to contact us.