Understanding patient and physician perceptions of benign prostatic hyperplasia in Europe: The Prostate Research on Behaviour and Education (PROBE) Survey

Abstract

Aims: Benign prostatic hyperplasia (BPH) is a bothersome disease that can progress if left untreated. However, patient and urologist perspectives on BPH management are not fully understood. The aim of the Prostate Research on Behaviour and Education (PROBE) Survey was to assess healthcare-seeking behaviour and attitudes to BPH treatment in 502 BPH patients, and the beliefs and management practices of 100 urologists, from France, Germany, Italy, Spain and the UK.

Results: The principal concerns of patients seeking medical advice were fear of cancer, sleep disruption, discomfort or embarrassment. The majority of BPH patients recalled receiving a digital rectal examination (61%), routine prostate-specific antigen (PSA) tests (67%) and prescription medication (72%). Eighty per cent of 5alpha-reductase inhibitor (5ARI) users vs. 68% of alpha-blocker users were satisfied with their treatment. More than half of the patients were concerned about requiring surgery or developing acute urinary retention, and >75% would prefer a drug that provides reduction in the risk of surgery than one that provides rapid symptom relief. Most urologists performed digital rectal examinations (96%) and PSA tests (71%) on >90% of patients presenting with BPH symptoms. Eighty-seven per cent of urologists believe that BPH progresses, and 78% believe that 5ARIs prevent BPH progression. However, most urologists prescribe alpha-blockers while few prescribe 5ARIs.

Conclusions: This study highlights discrepancies between views and beliefs of patients and physicians regarding BPH and current practice in Europe.

Figure 1

Proportion of patients with concerns (severe, moderate or mild) about their initial BPH symptoms (n = 502)

Figure 2

Patient concern (very, fairly, not very, not at all) about the requirement for surgery (total patient answers, n = 273) and the development of acute urinary retention (n = 117)

Figure 3

Patient selection of important drug attributes on a scale of 1–8, where 1 is a drug providing a 50% reduction in the risk of surgery and onset of symptom relief within 6 months, and 8 is a drug providing relief from symptoms within 2 weeks but no reduction in the risk of surgery (n = 502)